Tuesday, November 20, 2007

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.


Aditya said...

How about leveraging internet 3.0 - social media. I know its not something that should keep you awake at night. but wouldn't it be interesting to leverage social networking and social knowledge to help quality of healthcare in parts of the world which do not come under your 400,000 miles of travel? :)

Unknown said...

Yay! You mentioned Decision Support. It's nice to see such services in the forefront of a CIO's mind. In our organization, Decision Support falls under the COO though.

I'm a decision analyst, and I can't tell you how many people give me that "what the heck is that?" look when I say it.

I knew that offering this as a service to managers and administration would start catching on in the industry. I'm only 2 years in at this department and already I see how ingrained it is in our CQI culture. Considering the size of our facility (medium/large community hosp.) I'm surprised we have a 7 person crew in our Decision Support Department.

Unknown said...

Ok, so I read through the Decision support section of your BIDMC plan.

I have a feeling our Decision Support, and your's might differ in some ways. This may again be due to size and softwares. BIDMC seems to have a lot of home grown Decision Support software. This of course is based on your goals for the year regarding decision support, and several of it's bullet points.

Where you provide software to aid in Decision support, my department is the Decision Support.

I often describe us as the business/statistic minded IT people. Our IT department is full of good IT analysts who know computers and data, but don't understand hospitals. Our department bridges that gap.

We are often described as Internal Consulting, and as a Quality Management and Performance Improvement department.

John Halamka said...

I'll blog about our decision support systems next week, so you'll learn about our approach in detail.

Social media is very important to me. Our new intranet and extranet will be designed with social media features baked in. I'm in the process of testing many collaboration features right now - from IM to Second Life to LinkedIn to Facebook.

Unknown said...

Interesting to see Facebook being embraced. My hospital IT guys has that site blocked.

We have a discussion board, that doesn't seem to be used. It was mainly put in place for communication use during a Hurricane. We do have a classifieds section on our Intranet site, which seems slightly used.

I'll hand it to your use of blogs. Even though both your's and Paul's aren't directly linked to the hospital I think they are an interesting tool to convey ideas and discuss information. For a student like me who wants insight into a C_O's mind, your sites are treasure troves.

The blogs can offer a more human side to the executives who run your facility. I know our CEO could probably have a wonderful blog, but I doubt she has the time for it. I'm surprised any CEO would.

chalohyd said...

For your storage needs have you looked at Amazon S3 service? I am not sure whether the SLA would hold up for your needs, but it warrants a look as a secondary offsite backup solution.

John Halamka said...

The reason we have insourced storage to date is that we use 10 Gig network connections over dark fiber to 200 Terabytes of EMC storage, replicated across two data centers. We're able to restore function very quickly by switching to shadow storage systems rather than restoring from backup. However, there may be some customers for which a more lengthy restore would work, so I'll check out Amazon

Unknown said...

Hate to nitpick John...
"we use 10 Gig network connections over dark fiber"

if you use it...doesn't that mean it isn't dark fibre?