Transcript IS/Clinician Partnership Clinical Information Systems

Quality and Information
Systems
Update to PCAC
John D. Halamka MD
Justine M. Carr MD
June 25, 2008
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Agenda
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National Perspective
BIDMC Governance
Information Systems Approach
Challenges
PCAC Request Status
2008 Accomplishments
2009 Priorities
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National Perspective
• By 2014 most Americans will have
electronic health records in order to
prevent errors, improve quality and
manage costs. President George Bush 2004
• Current state
– Outpatient EHRs:
– Inpatient EHRs:
4-18% adoption
25% adoption
AHIC Quality-HIT Roadmap
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Governance
Clinical Information Systems Steering Committee
• Goal
– Overview of clinical information systems
Identification and prioritization of emerging
needs
• Membership
– Chairs of 11 IS clinical committees
– Selected senior leadership
Information Systems Approach
I.
Build a fully electronic record
Guided by need for stepwise approach,
e.g. electronic orders + drug bar coding + patient bar coding
electronic medication administration
II.
Accelerate priority projects
A.
B.
C.
III.
Ordering:
Documenting:
Tracking
e.g. Oncology, NICU, ED
e.g. integrate MD and RN notes
e.g. referrals, test results notification
Respond to evolving needs with enhancements to
existing programs
A.
B.
C.
Safety/Quality:
e.g. PCAC requests, decision support
Efficiency:
e.g. SPIRIT requests
Pay for Performance: e.g. CMS vaccine administration
Challenges
• Timing
– Stepwise building
– Urgent priorities may bump other projects
• Prioritization
– Competing demands
– Evolving landscape
• Move from siloed documentation to multidisciplinary
– Build vs. buy
• Benefits of specialty application may be offset by limited
integration.
– Work flow redesign
PCAC Request Status
Status
Category
Tracking referrals: under development (now funded by CRICO)
Tracking Incidental abnormal radiology results: done
Tracking abnormal path and cardiology results: in pilot areas.
Completed or in
progress
POE High Risk Safety Alert across admissions: done
Discharge Trigger Criteria: done
Dilaudid drop down doses in POE: done
POE Epidural ordering decision support: done
Heparin orders for IV lines to protect allergic patients: done
Obstructive Sleep Apnea management in PACU: done
POE roll – out to procedural areas.
Deferred for further
Fix the discharge med screen for insulin ordering: to P&T
evaluation
Microbiology results display: to CCSC
Major 2008 Projects
• Ordering
– Oncology Management
– e-Prescribing
• Documentation
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ICU Documentation System
Inpatient History and Physical
Medication Reconciliation
Emergency Department Documentation
Document scanning
Ambulatory documentation
• Tracking
– Peri-anesthesia modules
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Major 2009 Initiatives
• Ordering
– Decision support
• Documentation
– Inpatient notes and discharge applications
• Tracking/transitions
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Referral management
Results notification
Coordination of handoffs
Who’s the doctor?
• Infrastructure
– Laboratory information system
APPENDICES
CISSC Membership
Marqusee
Marqusee
Talmor
Carr
Sheehan
TBD
Lewis
Wood
Fischer
Lisbon
Moorman/Canacari
C hair of the L aboratory Information S ys tems C ommittee
C hair of R adiology Information S ys tems C ommittee
C hair of C ritical C are Information S ys tems C ommittee
C hair of Inpatient Information S ys tems C ommittee
C hair of Ambulatory Information S ys tems C ommittee
C hair of Health Information Management C ommittee
C hair of C ommunity Information S ys tems C ommittee
C hair of D ecis ion S upport Information S ys tems C ommittee
C hair of R evenue C ycle Information S ys tems C ommittee
Medical E xecutive C ommittee R epres entative
O perating R oom E xecutive C ommittee R epres entatives
Buehrens
Anderson
Sands
Folcarelli
Abrahamian
Markson
COO
SVP Clinical Operations
SVP Health Care Quality
Safety Officer, Health Care Quality
HIM
VP Information Systems
Glossary
AHIC
Am Health Information
Community
Public/private advisory panel to Secretary of
HHS and the National Coordinator for HIT.
CDS
Clinical Decision
Support
Electronic reminders that prompt clinicians to
consider a specific course of action.
EHR
Electronic health
record
Generic term used to describe electronic
medical records that are interoperable.
H&P
History and Physical
Initial patient evaluation by physician
HIT
Health Information
Technology
Generic term used to describe use of
technology to enhance health care.
Med Rec
Medication
Reconciliation
Process of insuring that all medications are
addressed at each care transition.
POE
Provider Order Entry
Clinical care orders for inpatients
communicated electronically.
webOMR Web On-line Medical BIDMC electronic record, originally outpatient,
Record
now expanding to be both in and outpatient.
Clinical Systems Plan
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