The Affordable Care Act is influencing the use of technology in areas of quality healthcare, health services delivery, and patient engagement. Health information technology references come in an array of acronyms. It is useful to untangle these terms and definitions as technology provide a significant benefit to families and children in accessing information and services as well as in improving quality (Table 9.1). Health information technology (you will see referred to as HIT) has the foundational element of combining information about an individual (child) from various sources so the health care professional delivering care has an integrated and actionable view of health history and health status. Within a hospital setting or even within connected clinics this is not too difficult if a child frequents the same set of providers. However, across different hospitals and delivering physicians, therapy companies, or supply vendors, the creation of a health record electronically depends on a health information exchange (HIE). Acceptance of use of HIE technology is occurring but definitely not on a universal basis. Integration of health care information at a comprehensive level is facilitated in part by what is known as “Stage 2 of Meaningful Use.” Effective January 2014 health care professionals must use HIT to optimize care coordination (Teich 2013). The Federal government first gave hospitals and physicians support funding to pay for equipment and training to implement electronic records and to receive continued financial subsidy they must now use the technology for the purpose of care coordination. These financial incentives are propelling adoption of electronic records and HIE adoption across the United States. This is a great thing for both families and health care providers as establishing health information exchanges and developing technology infrastructure improves quality, reduce costs; and improves care coordination across hospitals, labs, pharmacies, physicians and other all types of delivery entities while ensuring security of information (Fig. 9.1).

Tips for Parents: Be prepared to answer the question of your preference to consent to your child’s health information shared across providers. Understand that access to a complete picture of your child’s health may reduce duplication, errors, and your need to repeat a lengthy medical history yet again.

Tip for Health Care Professional: Signing onto an HIE is one step in providing consistent care for your patients.

Although helpful in communication, primary care offices have adopted use of many different kinds of electronic health systems (EHR) which sets up barriers for easy information transfer. The Office of the National Coordinator for Health Information Technology (ONC), is a position legislated in the HITECH Act, that is charged with improving connection of health information technology infrastructure and development on a national level. One area of development is that of a personal health record (PHR). A PHR aggregates information such as allergies, immunizations, family history, medications, hospital records, and records of office visits into one file that contains a full picture of an individual (child’s) health. However, consent to allow your child’s health information to be shared across providers must be gained by the child’s legally authorized representative.

So how does this help coordinate a child’s care most effectively? One example can be seen in the instance a child has both physical health and behavioral health needs to address. In this situation, it is important that each discipline be aware of the medications and testing result of the child to make sure no untoward interaction occurs and each practitioner understand necessary laboratory monitoring involved in care. Another example of HIE advantage would be if a child was visiting outside a reasonable transportation range of their medical home and needed to seek services at an emergency center. Having access to past medical records, including an accurate listing of current medications and treatment, would avoid duplication of testing and allow the provider to understand what normal thresholds of function exist for this specific child, something that could easily prevent duplication of testing and a more efficient focus on the acute reason the child presented for treatment. If a part of the treatment required radiography, the wait for a physician to read the films would be decreased as the ‘picture’ could be transmitted to any location for a radiologist review, speeding the diagnosis and move to appropriate treatment.

Treatment of children with multiple and/or chronic conditions demonstrates optimal use of this technology sharing as each specialty has a part to play in supporting maximum function and outcomes (Antonelli, 2013). Providing a view where every person can understand what the other has ordered or planned, assists in setting goals and measuring progress along the course of treatment. Tracking of laboratory values, such as the blood sugar levels in children with diabetes, helps in family management of the child’s day to day care, delivering consistent information to both caregivers and care providers. Engagement and shared decision making is enhanced with use of the clinical information. The data created in the PHR can also be evaluated, using sophisticated analytics to predict next steps and response to evidenced based guidelines.

Technology initiatives in place that support child/family engagement with practitioners and with their own health status have been enhanced through internet improvements increasing access to health information. Familiar technology includes alarm notices from pulse oximetry or assistive respiratory equipment and person-activated devices such as an alarm indicating a child has fallen and assistance is needed. Newer technology enhances engagement which is a major focus for optimal health (Chase 2012).

An example of technology assistance comes at the time of a child’s discharge from an inpatient stay. Hospitalizations are so stressful for the entire family that retention or understanding of verbal information is limited and written information may also seem incomplete once the family is home and caring for their child. Use of smart phones to record audio or video segments of discharge instructions or procedure techniques can be of tremendous help to families in reducing stress and improving accuracy when administering care. Prior to discharge, as a component of care coordination, information is being shared more freely during patient stays to improve understanding of medications and treatments. An example, Main Line Health in Pennsylvania has developed a Patient Daily Care Plan from electronic patient record information (Glaser 2013). This printout familiarizes families with medications, specialists names, pending studies as well as current treatments. The National Transitions of Care Coalition has published a white paper defining necessary technology elements of care transition which include strong care coordination and use of goals to engage accountability (Stricker 2013).

Reminder technology, expanding from automated reminder phone calls, has spread to text reminders for appointments as well as the need to complete testing prior to a health care appointment. Scheduling, as well, can be completed online for many primary care and specialty practices including calendar reminders automatically being sent to families to improve successful attendance. Once in the office setting, a tablet device or health kiosk is an increasingly accepted way to update demographic information as well as complete survey instruments on a child’s development. These entries are automatically scored so the primary care provider can incorporate the results in the visit within minutes, reducing the need for a second visit (http://​www.​pedstest.​com/​OnlineScreening.​aspx).

If chronic health conditions or developmental delays are identified, technology can be employed in ongoing monitoring, development of an online care plan, and interaction in health coaching, and case management delivery. Ongoing monitoring opportunities vary according to health need including such items as biometric monitoring of blood glucose, pulmonary function, weight which transmit information to treating practitioners and include an alert feature for instances when values are outside of set parameters. These devices require child/family engagement as well as integration with a healthcare provider.