Substantial work lies ahead to convert the American Academy of Pediatrics Bright Futures guidelines into computerized prompts for physicians, find researchers from the Indiana University School of Medicine and Regenstrief Institute.

Currently, Bright Futures--a multitude of health supervision recommendations for children from birth through 21 years of age--is not organized to easily translate into computerized prompts, according to a new study published in Applied Clinical Informatics. Recommendations are listed according to what should happen at each visit, which assumes the child will be seen for health supervision at each age and that previous visits have been completed. However, children may miss or have delayed visits to their physician.

A child scheduled for an annual well visit may present with an illness or concern that takes up most of the visit time, leaving some or all health supervision topics unaddressed. For example, the doctor may focus on a child's ear ache rather than discussing with the parent whether the child is exposed to second-hand smoke in the home. If a clinician is not able to address a recommendation at the age scheduled, he or she has to consider whether to do so at a later visit or to skip it entirely.

By consolidating recommendations and vague constructions that were repeated across visits or consisted of many smaller actions, researchers in the study reduced the total number of recommendations from a daunting 2,161 to a more manageable 245. However only 1 in 5 of these 245 was actionable and thus could be converted to prompts in an electronic health record system.

"Decidability--when I am supposed to take action--and executability--what action should be taken--are key to computer decision support," said Stephen M. Downs, M.D., senior author of the study. "So, extensive work will be needed to prepare the Bright Future guidelines for electronic health record systems.”

The study is available here.

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