Tuesday, December 30, 2008

Looking back on 2008

It's the eve of New Year's Eve. Since I'll be posting my 2009 New Year's resolutions tomorrow, today's blog is a look back at my 2008 resolutions. How did I do and most importantly what did I learn along the way? This is a very long blog entry, so my apologies to readers on iPhones and Blackberrys.

1. One of my major 2008 goals for BIDMC was to build a cloud computing center hosting EHRs for community clinicians in Massachusetts via software as a service of approach.

Status - the center is live and 4 practices are fully implemented. We're implementing 6 practices per month throughout 2009 and 2010. We're in progress creating a connection the the Mass eHealth Collaborative quality data warehouse, integrating with the MA-Share health information exchange, and piloting Google Health PHR integration.

Lessons learned - Free is not cheap enough for primary care physicians in the US. Stark safe harbors enable hospitals to subsidize 85% of the costs of EHR implementation. Many PCPs do not have enough spare cash to fund the 15% plus office hardware. In 2009, I'll work with our physicians' organization (not bound by Stark funding restrictions) to develop a strategy to reduce the cost even further.

2. BIDMC has centralized just about all IT application and infrastructure services. My 2008 goal involved creating a plan for centralizing image lifecycle management of radiology, cardiology, pulmonary, GI, and Ob/Gyn.

Status - We've made progress but still have work to do. We've created the governance to do this - an Enterprise Image Management Steering Committee including all departmental stakeholders. We've assigned project management responsibility. Enterprise Image management software selection is led by a consultant, Joe Marion, one of the most knowledgable PACS experts in the country. Infrastructure design and PACS disaster recovery efforts are led by my internal management and staff.

Lessons learned - In the image management industry, products are still rapidly evolving. We're approaching this project using hardware (EMC Atmos) and software that did not exist when I wrote my 2008 goal. We plan to pilot of our design in 2009 by unifying all cardiology image sources (cath, echo, vascular).

3. 2008 was a tumultuous time for my infrastructure teams since we moved over 2000 people for the opening of our new Center for Life Sciences research building. Completing this project plus those of our physician practices, community sites, and our internal moves led to many deferred vacations, long nights and weekend work. One of my goals for 2008 was to ensure the moves/adds/changes plans were better communicated from business owners to IS.

Status - We've increased the size of our project management and community support teams, built a standardized process for project intake, and assigned an IT liaison to our facilities and community practice departments.

Lessons learned - There is no substitute for formal project management. Every project requires communication, coordination, and resource allocation. Whenever I'm asked to bypass my usual processes to accelerate projects, the answer is that workarounds will actually slow down the project.

Harvard Medical School
1. The Clinical Translational Science Awards (CTSA) brought over $200 million in NIH funding and in kind contributions to Harvard Medical School. One of my goals for 2008 was to build the social networking infrastructure to support collaboration throughout the Harvard Empire.

Status - Catalyst is live and includes a very powerful function called Profiles to identify collaborators based on the their publications and funding. In 2009, Profiles will include even more advanced tools for active and passive networking

Lessons Learned - Every aspect of catalyst is via Google Analytics so we know what is used and how. Our plans for features and new applications were markedly changed to match the demands of our users.

2. In an era of budget reductions (Harvard's endowment losses have led the medical school to implement a 10% cut in all departments), strong financial management is a necessity. Once of my goals was to implement financial analytics/business intelligence and not just a budgeting function in IS.

Status - we hired a business manager who brings thoughtful analysis to IS financial operations.

Lessons Learned - As organizations mature, their needs change. The budgeting function of the past needed to evolve into strong financial analysis for us to manage the budget as tightly as the economy demands.

3. When budgets are tight, economies of scale must be exercised whenever possible. In 2008, one of my goals was enhance our centralized high performance computing capabilities.

Status - During our 2008 Harvard High Performance Computing Symposium, we announced the New England Biocomputing Center, a collaborative of many academics, researchers, and industrial affiliates that will serve as a resource for all of New England. Thus far, we've had substantial commitments to donate and participate in building our economies of scale beyond just one school.

Lessons Learned - Cloud computing for research offers such great capabilities and low cost that political barriers are not an issue.

1. In 2008, we continued the expansion of our statewide e-prescribing gateway and our health information exchange of clinical summaries. My goal was to increase the number of organizations exchanging data.

Status - e-prescribing is live for all the physicians of BIDMC and Partners healthcare. Clinical data exchange is live for BIDMC and its network of private clinicians. Children's and Northeast Health System are live. Others will soon follow.

Lessons learned - Health information exchange for technology's sake is not sustainable. There must be a business value case. In Massachusetts, the exchange of medication transactions and sharing of clinical summaries brings cost avoidance that payers and providers are willing to fund.

1. NEHEN has been the administrative healthcare information exchange for Massachusetts since 1997. Our implementations started with institutions and large provider organizations than expanded to community hospitals. My 2008 goal was to expand NEHEN capabilities to small providers.

Status - We have made significant progress in 2008, approaching our goal of adding an additional 80 organizations to the data exchange.

Lessons Learned - As with our EHR implementation, we learned that physicians in small practices are struggling. We reduced the price for solo practitioners to accelerate adoption.

1. AHIC gave HITSP 3 use cases in 2006, 4 in 2007 and 6 in 2008. The 2008 Use Cases were particularly difficult because of rapid change in some of the domains, such as the genome and consumer healthcare devices. My goal was to facilitate standards harmonization for the genome/family history, secure provider/patient messaging, connectivity to healthcare devices, public health reporting, immunization history, and consultation/transfers of care.

Status - all HITSP deliverables were completed and presented to AHIC.

Lessons Learned - Implementation is a very important measure of standards harmonization success. HITSP work products are implemented by several organizations now with more to follow in 2009. The Value Case approach suggested by the AHIC Successor prioritizes work for HITSP and CCHIT based on factors such as customer demand and likelihood of implementation will accelerate interoperability in the US in 2009.

Personal Goals
1. My 2008 personal goals included a major effort to further refine my vegan lifestyle to eating locally and regionally. From May until November we grew our own vegetables and picked up weekly vegetable shares from our CSA, Redfire Farm. We canned throughout October and now continue to enjoy vegetables from canning stores and root cellar.

2. I tried very hard to fly less in 2008, using Webex, teleconferences, and trains as much as possible. I still traveled too much. Cisco has agreed to partner with me on a home telepresence pilot. I'll blog about that effort next month. If works well, I may be able to reduce many flights in 2009.

3. In 2008, I've kept up my physical activity with kayaking from April through October, cycling May through November, climbing June through October, skiing December through March and hiking year round. I did climb the Eichorn pinnacle (photo above) and played my Japanese flutes on many summits. My daughter joined cross country and track so our walks have turned into runs together.

Status - the balance of family, personal and work time seems to be working

Lessons learned - a vegan lifestyle, consistent exercise, and reserved time for family have resulted in a happy and healthy 2008.

Tomorrow - a glimpse of what I hope 2009 will bring.


molave said...

I had to smile when I read your statement that "Free is not cheap enough for primary care physicians in the US."

From the Philippines, all I can say to that is: "in the East, as it is in the West..."

James said...

John –

From my seat reading your blog is the equivalent of watching Tiger Woods play golf or Michael Jordan play basketball. It is a pleasure to follow those who push the envelope on transparency and self-development and I applaud both yourself and Mr. Levy with driving theory into practice.

I have 2 questions for you within the realm of EHR and Healthcare IT systems:

1. With regards to integrated Healthcare IT systems what organization(s) across the country would you say are pushing the envelope with integrating IT health informatics platforms, the VA notwithstanding, and

2. Given the multiple barriers to EHR/EMR/ePrescribing adoption, and the challenges with current systems lacking the level of intuitiveness to motivate adoption, where along the product development stage do you see EHRs and have any industry-types discussed the idea of skipping development (economically driven) stages and pushing EHR/PHR vendors to make these platforms much more intuitive and less complex?

Thanks very much for all your contributions.

Medical Quack said...

If you keep this up, you're going to perhaps find yourself on the listing for Obama's CTO candidates!

As always good posts and information and compared to what I have seen in the press, there's nobody else out there that I can see who would be as qualified as well.

What makes the difference in my tiny opinion here is the fact that you have "on hand" knowledge and are not afraid to roll up your sleeves and jump in there, something that is rarely found today, but oh so valuable when you have the knowledge upstairs, and the true desire to promote transparency everywhere. Technology and paperless records are coming whether folks are ready or not.

I post quite a bit about EHRs and PHRs and having spent time with a physician years ago writing one, it changed how I looked upon the process and really strengthened my belief in partners and proper implementation of software and getting the "buy in" from all concerned too, which is not an easy task as you know.

Be the jet and keep the good stuff coming!