"Well child care" What do we really mean? How can we do it better?

How would Amazon.com ensure that every infant, child, and adolescent in the United States gets the preventive, acute, and chronic care he/she needs to be as physically, developmentally, and emotionally healthy as possible? Gift buying on the Internet provides a glimpse of what pediatric care might be if everyone involved put their creative heads together. The Internet purchasing process goes something like this: You find a Web site that you think will provide the gift idea you need. You search for that gift, but as you search, additional possibilities present themselves. As you search, the Web site's program proposes items based on what appear to be your needs and preferences. Often, an array of possibilities, new, used, refurbished, are presented at various prices. Once you identify an item, it's often possible to read the comments and reviews of prior purchasers of that item. These comments can be quite specific, e.g., the knob doesn't turn easily, or the earphones aren't comfortable. If the item you settle on isn't immediately available, you are told when it will be, and you are given a variety of options for delivery. If you purchase enough items-or at the right time, or the product that is in greatest supply-you are likely to receive a discount of some kind.

Of course it would be inappropriate for child health care to be as fragmented as Internet gift purchasing, and there aren't enough conveniently located providers to allow for the kind of competition that is possible when purchasing electronic gadgets. Yet it requires only a little time on the Internet to realize that our business-health care for children-is not taking advantage of what is now routine for most other services in the country.

What would comprehensive child health care look like if it entered the 21st century? A report from the Commonwealth Fund, "A High-Performing System for Well-Child Care: A Vision for the Future," (http:// http://www.cmwf.org/publications/publications_show.htm?doc_id=417069) describes a child health care system that would allow at-home screening of developmental and behavioral status, access to a care coordinator and a team-based approach for children with special needs, Web-based virtual visits and videoconferencing, customized health care visits, and availability of same-day appointments. Parents would have access to regional health information organizations and evidence-based standards of care. Medical records would not only be electronic but they would be available on a secure basis to families and consultants.