In times of great change, governance is absolutely key to align priorities and resources.
Here are the projects that have been discussed in my leadership and governance committees.
Overall clinical IT goal:
Move from the current hybrid electronic/paper medical record to a fully electronic integrated record by 2015 by redefining workflows and then implementing automation in support of meaningful use, healthcare reform, and patient engagement.
To do that requires that we fill our functional gaps. Highlights include
Electronic Medication Administration Records - we will redefine the entire medication management process from doctor's brain to patient's vein then automate it using iPads, smartphones, and novel applications. We will select build/bought solutions in FY12, pilot it in FY13 and then widely roll it out.
Patientsite - we will ensure every BIDMC provider is enrolled and every patient is offered access to our PHR.
IT Resource Prioritization - we will implement a highly functional overall clinical IT governance process that ensures resources are aligned with priorities and interoperability is maximized. Here's a brief proposal for this work
"Currently we have a series of department and domain specific IT committees which plan their individual priorities- lab, radiology, critical care, inpatient, outpatient etc.
These do not report in a formal way to the Clinical IT Governance Committee.
We propose that the Clinical IT Governance Committee should meet 10 times per year (no meeting in August and December due to vacations). At each of these meetings, the Committee should hear from subcommittees to better understand their goals, their project progress, barriers, enablers, staffing, and competing priorities.
The Clinical IT Governance committee can
*Resolve resource conflicts between subcommittees
*Assist with decision making about software build/buy selection in the context of the entire BIDMC application portfolio, ensuring integration and interoperability, along with prudent and equitable use of resources
*Ensure the work to be done is aligned with the Annual operating plan, BIDMC strategy, compliance timelines and staffing levels
*Review the performance/efficacy of each subcommittee based on objective criteria and recommend membership/structural change if needed
*Sponsor those projects which are enterprise-wide and have no specific departmental or domain sponsor - such as electronic medication administration records and inpatient documentation
To kick off this process, we'll begin with an objective review of our existing subcommittees using the characteristics we discussed at our last meeting. We'll schedule our first subcommittees to present their plan in September"
Inpatient clinical documentation - a multi-stakeholder group will study inpatient clinical documentation and specify an ideal workflow for integrated documentation that meets regulatory requirements. We will eliminate paper while also eliminating redundancy in clinical documentation.
ICD-10 - we will continue our work on ICD-10. On Thursday, our statewide CIO Forum will examine ways that the community can do ICD-10 together, reducing the burden for all.
Business intelligence tools - we will implement novel business intelligence tools that are needed to support new payment methodologies such as alternative quality contracts.
We'll do all this on top of the usual infrastructure and application activities that keep the trains running on time. If FY11 was the year of living anxiously, I'm hoping FY12 is a year of great achievement.