What will keep me up at night in 2008

Every year, I have new infrastructure and application challenges. In 2002, I had an outage that required a major focus on replacing the entire data network. In 2007, a number of safety/quality related projects including medication reconciliation and automated chemotherapy ordering were my focus. What about 2008?

1. Stark safe harbors now enable hospitals to fund 85% of the implementation costs of electronic health records for non-owned physicians. I will be implementing a large hosting facility offering web-based electronic health records for 300 private physicians in New England.

2. Storage is increasingly an utility. This means that heat, power, light, networking and terabytes need to be provisioned on demand. Achieving a balance of highly reliable storage, archival storage, and backup at low cost will be a major body of work over the next year. This means I'll have to figure out the right combination of continuous data protection, hierarchical storage management, data de-duplication, virtual/actual tape libraries, and information lifecycle management. Of course we'll need to implement this new infrastructure in a "green" manner that keeps the entire power consumption of our data center under 220kw, our 2008 energy goal.

3. e-Prescribing means much more than just prescription routing. It means eligibility checking, formulary enforcement, community medication history sharing and decision support. We will complete the rollout of all of these features to all of our clinicians this year. We'll also have other medication safety initiatives are part of our pay for performance contracts including electronic medication administration records and protocol driven inpatient chemotherapy systems.

4. Data sharing for clinical care among a community of caregivers poses significant privacy policy and technology challenges. We are going live with clinical summary sharing using the Continuity of Care Document among the providers of BIDMC, Lahey, Children's and Northeast Health Systems in 2008.

5. Security is a journey that will require enhanced virus/malware protection, web content filtering, host-based intrusion protection, and intelligent audit trail reviews. Substantial staff resources will be required to safeguard patient confidentiality.

6. RFID and Bar coding will increasingly be used to identify patients, staff, medications and assets. Workflow will be driven by the proximity of patients, doctors, and supplies. Deploying the right technology for the right purpose will require several pilots.

7. Providing decision support to every level of the organization will require additional tools and staff. Quality improvement, outcomes measurement, pay for performance goals, and clinical research necessitate more analysts, data marts, and self service applications to supply information on a need to know basis.

8. Compliance requirements for new revenue cycle workflows including enhanced electronic data interchange for claims, national provider identifier support, and evolving coding methodologies will require substantial improvements to existing systems.

9. Internal and external websites need to be enhanced to support self-service publishing models, collaboration and new media. This means new content management systems, enhanced wikis/blogs/forums/whiteboards, and search engines.

10. Disaster recovery needs to be built into the design of every application. Recovery time must be on the order of hours and the recovery point objective is 100% data integrity. The only way to achieve this level of reliability is to have entirely redundant data centers.

For a list of the 200 different projects that will enable us to meet these goals, you'll find my 2008 BIDMC IS Operating plan here and my 2008 Harvard Medical School IS Operating plan here.