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CHICA: Child Health Improvement through Computer Automation

by Stephen Downs

All Team Company Patients Physicians Hospital Partners Mission Innovation Details Supporters Comments Updates

About our project

The problem we solve: In value-based healthcare, payers like CMS, state Medicaid, and private insurers, demand documentation of quality, sometimes with stiff penalties if benchmarks aren’t met. But just reporting of quality metrics has been estimated to cost $50,000 per physician per year (Health Affairs, 2016). Physicians are "drowning in a sea of advice," faced with literally thousands of clinical guidelines and recommendations that change constantly. As the guidelines change, so do the quality indicators. With each new quality indicator, healthcare systems struggle to capture, improve, and report them. They offer quality bonuses and salary withholds to incentivize providers to meet metrics, often undertaking a constant stream of expensive quality improvement efforts. The result is millions of dollars wasted and an epidemic of provider burnout. The decision support systems market is forecast to grow from $3.79 billion in 2018 to $6.4 billion in 2024, at a compound annual growth rate of 9.3%.

About our solution: CHICA automates quality reporting by providing highly efficient decision support. It assesses risk directly from patients and the EMR, sets a patient-tailored care agenda for the physician, allowing the physician to quickly document care provided, thus improving quality of care while producing quality reporting as a free side effect. When the patient arrives at the clinic, CHICA produces a health risk survey, tailored to the patient and based on data in the EMR. The patient completes the information on an electronic tablet in the waiting room. Based on the patient’s responses and data in the EMR, CHICA generates an agenda for the physician that appears in the EMR. The physician responds to the items in the agenda by clicking boxes that document care in the record and store data for future encounters and for quality reporting. Dozens of randomized controlled trials have shown that CHICA improves quality of care. Documenting quality measures is a happy side-effect of improving care.

Progress to date:

CHICA went into production in 2004. In the succeeding 15 years, CHICA has served 64,000 patients and 40 physicians and nurse practitioners in 7 outpatient pediatric clinics. Over 50 publications demonstrate CHICA’s effectiveness. CHICA increased the rates of risk assessment for anemia by seven-fold and tuberculosis by more than double, maternal depression screening was almost universal. Attention deficit hyperactivity disorder (ADHD) diagnosis was 30% more likely to meet formal diagnostic criteria. Developmental screening rates tripled. Autism screening rates increased from 0 to 100%. CHICA increased diabetes screening rates four-fold, and HPV vaccination rates by 20%. CHICA also screens for social determinants of health, adolescent suicidality, and CHICA aids in parental smoking cessation counseling. CHICA produces a rich dataset of patient and physician reported data. DHS is entering into a $2M contract with the Child Neurology Foundation to build a child neurology version of CHICA.

About Our Team

Creator: Stephen Downs

Education: Indiana University, Regenstrief Institute, In

Bio: Stephen M Downs, MD, MS Dr. Downs, Jean and Jerry Bepko Professor of Pediatrics, is Vice Chair for General Pediatrics and Director of Children’s Health Services Research at Indiana University School of Medicine. He received his medical degree and master’s in medical informatics from Stanford University. He completed his residency in pediatrics and a Robert Wood Johnson Clinical Scholars fellowship at the University of North Carolina at Chapel Hill, where he served on the faculties of pediatrics, biomedical engineering and public health. Dr. Downs’s work is at the interface of decision sciences and medical informatics, and he has published well over a hundred articles in these fields. He is an elected fellow of the American College of Medical Informatics. He chairs the Partnership for Policy Implementation (PPI) and the Child Health Informatics Center Project Advisory Committee (CHIC PAC) for the AAP. He received the AAP Oberst award for significant contributions to the field of clinical information technology for children. He is the founding CEO of Digital Health Solutions, LLC and company created to distribute the proven software Dr. Downs’s team developed and researched over the last 15 years.

Hospital Affiliation: Indiana University Health, Eskenazi Health

Title: Jean and Jerry Bepko Professor of Pediatrics

Advanced Degree(s): MD, MS

About Our Company

Digital Health Solutions, LLC

Location: 133 W Market St
Indianapolis, IN 46204

Founded: 2017


Product Stage: Ready

Employees: 1-2

How We Help Patients

How We Help Physicians

How We Help Hospitals

How We Help Partners

Innovation Details

Intellectual Property Summary

The Child Health Improvement through Computer Automation system (CHICA) is the intellectual property of Indiana University. Digital Health Solutions, LLC (DHS) has an exclusive contract to market CHICA world wide.

Clinical Information

CHICA has been extensively evaluated for its effectiveness in improving and documented care quality, frequently with randomized controlled trials. Specifically, CHICA improved adolescent depression screening, detection of patient risk factors, autism screening, asthma detection, ADHD diagnosis, developmental screening, maternal depression screening, anemia and TB screening, smoking cessation counseling, and diabetes screening. CHICA's acceptability to users has also been extensively evaluated. These studies are cited below.

1.            Aalsma MC, Zerr AM, Etter DJ, et al. Physician Intervention to Positive Depression Screens Among Adolescents in Primary Care. J Adolesc Health. 2018;62(2):212-218.

2.            Anand V, Carroll AE, Downs SM. Automated primary care screening in pediatric waiting rooms. Pediatrics. 2012;129(5):e1275-1281.

3.            Anand V CA, Biondich PG, Dugan TM, Downs SM. Pediatric decision support using adapted Arden Syntax. Artificial intelligence in medicine. 2015;92:15-23.

4.            Bauer NS, Carroll AE, Saha C, Downs SM. Computer Decision Support Changes Physician Practice But Not Knowledge Regarding Autism Spectrum Disorders. Applied clinical informatics. 2015;6(3):454-465.

5.            Biondich PG, Anand V, Downs SM, McDonald CJ. Using adaptive turnaround documents to electronically acquire structured data in clinical settings. AMIA  Annual Symposium proceedings / AMIA Symposium AMIA Symposium. 2003:86-90.

6.            Biondich PG, Downs SM, Anand V, Carroll AE. Automating the recognition and prioritization of needed preventive services: early results from the CHICA system. AMIA  Annual Symposium proceedings / AMIA Symposium AMIA Symposium. 2005:51-55.

7.            Carroll A, Anand V, Dugan T, Sheley M, Xu S, Downs S. Increased Physician Diagnosis of Asthma with the Child Health Improvement through Computer Automation Decision Support System. Pediatric allergy, immunology, and pulmonology. 2012;25(3):168-171.

8.            Carroll AE, Bauer NS, Dugan TM, Anand V, Saha C, Downs SM. Use of a computerized decision aid for ADHD diagnosis: a randomized controlled trial. Pediatrics. 2013;132(3):e623-629.

9.            Carroll AE, Bauer NS, Dugan TM, Anand V, Saha C, Downs SM. Use of a computerized decision aid for developmental surveillance and screening: a randomized clinical trial. JAMA pediatrics. 2014;168(9):815-821.

10.          Carroll AE, Biondich P, Anand V, Dugan TM, Downs SM. A randomized controlled trial of screening for maternal depression with a clinical decision support system. Journal of the American Medical Informatics Association : JAMIA. 2013;20(2):311-316.

11.          Carroll AE, Biondich PG, Anand V, et al. Targeted screening for pediatric conditions with the CHICA system. Journal of the American Medical Informatics Association : JAMIA. 2011;18(4):485-490.

12.          Downs SM, Biondich PG, Anand V, Zore M, Carroll AE. Using Arden Syntax and adaptive turnaround documents to evaluate clinical guidelines. AMIA  Annual Symposium proceedings / AMIA Symposium AMIA Symposium. 2006:214-218.

13.          Downs SM, Zhu V, Anand V, Biondich PG, Carroll AE. The CHICA smoking cessation system. AMIA  Annual Symposium proceedings / AMIA Symposium AMIA Symposium. 2008:166-170.

14.          Grout R, Cheng E, Carroll A, Bauer N, Downs S. A six-year repeated evaluation of computerized clinical decision support system user acceptability. Manuscript Under Review. 2017.

15.          Hannon TS, Dugan TM, Saha CK, McKee SJ, Downs SM, Carroll AE. Effectiveness of Computer Automation for the Diagnosis and Management of Childhood Type 2 Diabetes: A Randomized Clinical Trial. JAMA pediatrics.171(4):327-334.

Regulatory Status

Under current FDA rules, CHICA is not regulated.  CHICA provides decision support to a physician intermediary. So it is not considered a medical device.

How we will use the funds raised

The funds will be used to establish marketing and sales talent to moce CHICA into the commercial space.

Thank You

CHICA is a well-developed and evaluated production system that we know works. DHS is a tiny company just getting off the ground. We believe CHICA solves a critical problem, but it needs to get out there. Basically, we have a product in need of a company. If DHS can get CHICA out there, children will be healthier.


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Stephen Downs
Jean and Jerry Bepko Professor of Pediatrics
Indiana University, Regenstrief Institute, In

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