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Wednesday, March 21, 2012

Clinical IT Governance Update

I've written many posts about the importance of IT governance to set priorities, align stakeholders, and allocate budgets.

Today, I will meet with the Clinical IT Governance Committee to discuss the 5 major IS projects in the BIDMC Annual Operating Plan, brief them about the Meaningful Use Stage 2 NPRM, and discuss 2012 State HIE initiatives.

Here's an overview of what I'll say

*Electronic Medication Administration Records - at BIDMC, we wanted to eliminate all handwritten orders in every care setting, so we aggressively implemented CPOE before automating Medication Administration Records.   Now that we have 100% electronic ordering, we're implementing projects that close the loop - checking patients, medications, staff ID, and active orders when medications are given to the patient.   We've developed a scope, a timeline, and a workflow that embraces both fixed bedside devices and mobile technology to document when, where, and how medications are administered, reconciling orders and doses given.   We buy technology when it is mature and robust.   In this case, we'll need highly innovative, integrated technology supporting a unique workflow, so we're building it.

*Clinical Documentation - at BIDMC, our ambulatory documentation is entirely electronic.   In our monitored units, all flowsheets are electronic.  On our wards, progress notes are still written on paper.   In 2012, we're designing inpatient clinical documentation to align with the needs of our ICD10 project.  We'll use templates, macros, and free text input to support computer assisted coding, reducing the burden on clinicians and coders who need to pick the right code from 68,000 diagnosis and 87,000 procedure choices.  

*ICD10 - Although Secretary Sebelius has announced an intent to delay ICD10 enforcement dates, the project is such an enormous undertaking requiring policy change, workflow change and technology change that we're continuing full steam ahead.   We're executing a multi-phase project that includes current state documentation, a gap analysis, and a remediation plan.

*Personal Health Records - Patientsite, our PHR, is used by over 60,000 people every month.   Since its inception in 2000, Patientsite has not had a major upgrade.   This year, we're enhancing the look and feel, adding Open Notes (patients viewing all notes written about that), and creating a mobile friendly version.

*Standardized project management including a single intake process - among the many departments of BIDMC, different techniques are used for project charters, Gantt charts, issue logs, status reports, and project intake.  This year, we plan to create a single set of uniform project management artifacts that can be used by all business owners on IS related and other projects.

In addition to ICD-10, future stages of Meaningful Use Stage 2 will require multiple years of technology and policy work.   I'll present a summary of the challenges ahead based on the Stage 2 NPRM requirements .

Finally, in October of 2012, the Massachusetts Statewide HIE will go live and we'll use the infrastructure to enhance data sharing with payers, providers and patients.   At the same time we'll want to share more, compliance requirements will suggest further restrictions on data flows.   It will be a delicate balance.

I look forward to the meeting tomorrow.  Being a CIO means there's always new challenges and life will never be boring!

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