Wednesday, May 29, 2013

Clinical IT Governance Update

Yesterday I led the Clinical IT Governance meeting at BIDMC and I thought it would be interesting for my readers to get an inside look of the kind of topics we're discussing and how we're implementing our most challenging projects.

1.  Joint Commission debrief
Last week the Joint Commission visited BIDMC and the experience was very positive.  When there are process variations and potential shortcomings identified by the Joint Commission, IT solutions are often suggested.   In this particular visit, there were a few small software changes made during the visit to better support National Patient Safety goals such  as ensuring all care team members know the preferred oral and written language preferences of each patient.   We made modifications to ensure all our sites of care - ED, inpatient, outpatient, OR, and ICU gather this information consistently and display it routinely.   That was the only issue involving IT in this Joint Commission visit.

One of the great challenges of IT governance is maintaining focus on the annual operating plan and avoiding the distraction of the day.   Audits, visiting committees, and even Joint Commission visits have the potential of creating attention deficits which derail IT staff from long term must do's.    I'm grateful that Joint Commission preparation has become such an integrated part of our standard work that no projects were derailed.

2.  Enterprise and Community interoperability
I'm often asked when interoperability will become a standard practice in communities.   In many Massachusetts institutions, data exchange is already happening and the state HIE is processing over a million transactions a month.   However, there are still gaps in offering hospital-based clinicians access to the EHRs of private practice referring physicians.   I outlined the work we're doing this Summer to ensure that opt-in consent to disclose is captured at referring clinician practices as this will enable us to complete the electronic linkage which provides 24x7x365 on demand data sharing.

3.  Annual Operating Plan update
IT has 5 goals in 2013 and I reviewed our progress on all of them
Meaningful Use Stage 2 - we have achieved all MU2 hospital requirements except Electronic Medication Administration Records/Bedside Medication Verification.   Our new EMAR/BMV application goes live in July and we are on track to have 10% of all medication orders processed through it for the October-December Meaningful Use reporting period.

ICD10 - our greatest challenges are clinical documentation improvement such that enough information is available to justify highly detailed ICD10 codes and outpatient coding strategies so that we do not need paper-based superbills hundreds of pages long for every clinic.   We're working with 2 established companies and one start up to create novel computer assisted coding workflows and real time documentation improvement, linking the act of documenting to the requirements for accurate billing in a single workflow.

Laboratory Information System - we go live with the pathology module in our new Laboratory Information System on August 2.  Integrated testing is going well.

ACO support - we've worked hard to generate all the data necessary for our ACO to produce the quality and financial performance reports required by CMS.   We finished our first year as an ACO with a positive margin.  

Compliance/Security - I presented the project plans for 14 work streams of security enhancements suggested by our recent security audit.   Improvements include network access control, security information and event management applications, and a comprehensive NIST 800 ongoing risk management program.

4.  Conversation Ready Project - As part of  the Joint Commission visit, we showed the reviewers screenshots for a new end of life preference documentation application we're building.   Our feeling is that structured data and metadata around end of life planning is not sufficient.   We need documents which reflect a deep conversation about preferences, so that it what we are creating.   Documents may be handwritten, faxed, typed, or natively electronic, so we need to support multiple document capture workflows.

5.  Patient and Family Engagement in ICUs Grant - We collaborating with a major private foundation to think about patient and family engagement in ICUs.   The Clinical IT Governance committee needed to understand the level of work and its alignment with our strategic plan, meaningful use, and compliance requirements.    I always discuss grant opportunities  with governance committees, because sometimes grants are not well aligned with existing work and become a costly distraction.    The committee asked many good questions about this grant opportunity and we're now poised to refine the workplan with the foundation leaders.

A very productive meeting.

1 comment:

Anand Shroff said...


Fascinating update, and I look forward to hearing more about your ICD-10 efforts as you make progress with your technology partners.

One question: How do the statewide HIE efforts influence the operation of your ACO? Are there interdependencies or a way for the ACO goals to benefit from the availability of a statewide data source?

Anand Shroff
Health Fidelity