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The CHICA System | Child Health Informatics Research and Development Lab | Children’s Health Services Research Center | IU School of Medicine

Child Health Improvement through Computer Automation (CHICA) System

Known as the CHICA System, the Child Health Improvement through Computer Automation is both a computerized decision-support system and an electronic medical record (EMR) for pediatric preventative care and disease management. CHICA integrates into the high-volume workflow of IU School of Medicine’s pediatric practices by implementing age-appropriate screening of patients in the waiting room via a tablet and then combining this information with electronic medical record data to generate patient-specific recommendations and reminders for the physician.

How CHICA Works

When a patient is registered in the clinic, CHICA accesses the patient’s medical record and selects 20 questions to ask the patient. These questions are displayed on an electronic tablet that is given to the patient or proxy to complete in the waiting room. This innovative decision-support system can interface with any electronic health record to capture patient-reported concerns, risks and outcomes, and pass these as alerts and reminders to physicians.  Since 2004 the system has served over 47,000 patients and has been the subject of multiple National Institutes of Health, Agency for Healthcare Research and Quality, Centers for Disease Control, and foundation grants, resulting in over 30 peer-reviewed publications.

Randomized controlled trials have shown that CHICA improves screening for tuberculosis, anemia, depression, tobacco exposure, asthma and developmental disorders. CHICA also covers a wide range of other issues, including domestic violence, food insecurity, housing insecurity, substance use, sexual behaviors, sleep problems, obesity management, diabetes, hypertension management, television watching, literacy, dental care, vision screening and vaccinations. Decision support for these topics is covered by more than 400 rules that screen the patient, alert the clinician, produce printed materials for patients and track appropriate protocols of care over time. 

CHICA Initiatives

Utilizing computer-based clinical decision support in clinical care can help neurologists stay abreast of the latest advancements. Implementing SMART on FHIR to integrate into the Cerner and EPIC EMRs permits CHICA Child Neurology to address the 21 potential measures proposed by the American Academy of Neurology Institute and assist providers in adhering to these recommendations.

Starting at age 14, adolescents should begin becoming familiar with managing their health care process. The Transition Readiness Assessment Questionnaire (TRAQ) implemented through CHICA focuses on meeting the youth-to-adult transition needs of adolescents by identifying areas that need further intervention. These areas are flagged for the physician to discuss with the family and evaluated over the year to determine if patient experience has changed.

Sudden Unexplained Death in Epilepsy (SUDEP) is the most common epilepsy-related cause of death. It often refers to death of a mostly healthy person with epilepsy who dies unexpectedly and with no clear reason. CHICA evaluates if a patient has had a seizure previously and helps the physician monitor medical adherence and if the patient has been seen by a neurologist.