The leader of an Indianapolis-based software startup says pediatricians are expected to do the impossible: comply with thousands of recommended guidelines for care during a typical patient visit. Digital Health Solutions believes, having proved its value at the bustling urban pediatric clinic at Eskenazi Health, its technology is primed to be deployed nationwide—helping pediatricians cut through the clutter and deliver better care.

“There’s simply not enough time in a typical visit to the pediatrician for a checkup to deal with all of the things that are recommended,” says Digital Health Solutions LLC President Dr. Stephen Downs.  “We wanted to build a computer system that would help pediatricians screen and prioritize the things that had to be taken care of first.”

Noting that “improving care for children is near and dear to my heart,” Downs led the development of the software, called CHICA (Child Health Improvement through Computer Automation), which is designed for outpatient pediatric clinics. Families are given a tablet when they arrive in the waiting room, and based on information in the patient’s existing EHR, the software generates 20 questions specific to that patient.

“The 20 questions are unique to each patient who comes in, based on what the computer system knows about them,” says Downs. “[The questions] can cover a wide range of things, including risky behaviors, social determinants of health, exposure to lead and safe sleep. That information goes into CHICA, which prioritizes and selects up to six alerts to tell the doctor what items are the highest priority to discuss.”

Training tomorrow’s pediatricians as a professor of pediatrics at the Indiana University School of Medicine (IUSM), Downs realized the need for a tool to help doctors with the daily grind of meeting guidelines. The software is designed to work within the most common electronic health records (EHRs) systems, so the startup says CHICA can be installed within clinics’ existing programs.

Led by Downs, a team at IUSM began developing the software about 12 years ago to be used in Eskenazi’s pediatric clinics in Indianapolis; the highly active urban setting not only tested CHICA’s capabilities, but provided a resource-rich environment to develop the technology.

“[Eskenazi, formerly Wishard] provided a unique opportunity to build the system, because that organization has had a long-standing record of working with informatics, or computer-based solutions, to improve health care through partnership with the Regenstrief Institute here on the IUPUI campus,” says Downs. “It became a great place to develop a novel, new computer-based system.”

Using Eskenazi as a springboard, CHICA expanded to five more clinics and, most recently, was installed at the primary care clinic at Riley Hospital for Children at Indiana University Health. To gauge the impact of the software, the startup tested four clinics’ ability to follow guidelines for the screening of developmental disorders in children under three years old; half the clinics used CHICA and half did not.

“We found the clinics using CHICA not only had many times higher rates of doing the developmental screening in accordance with the recommended guidelines, but also identified developmental problems substantially earlier in the child’s life,” says Downs, “which has a huge impact on the child’s development.”

Encouraged by scientific studies that indicated the software was making a real difference for patients, Downs formed Digital Health Solutions to bring the benefit to children throughout the country. While the market is crowded with add-on software for EHRs, Downs believes CHICA stands out because it can be used with “every patient who walks in the door” and collects data directly from families that, otherwise, might be lost in the shuffle.

“When you have the problem that pediatricians are given a list of guidelines they’re supposed to follow that vastly overwhelms what they can possibly do, having a system that can pre-screen the families and prioritize what are the most important things to deal with is incredibly valuable,” says Downs. “There are no other systems out there that do that.”   

Downs says the startup will work to expand the software beyond the pediatric market.

Downs says CHICA can improve reimbursement as the health care industry shifts its focus to quality of care instead of fee for service.

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