Kathy can no longer feel her hands and feet. The good, good, good days have become challenging days. Kathy would normally push through it, but her oncologist advised us that being stoic increases the risk of permanent nerve damage.
Based on the advice of her care team, Kathy is taking a break from chemotherapy this week to enable her body to recover.
She's also taking Vitamin B6 (100mg daily) based on anecdotal evidence that B6 reduces numbness and tingling in patients receiving Taxol.
Together, we continue to pack up our house for the April 27th move to our farm. We make a great team with Kathy doing logistics/operations planning and with me doing heavy lifting. It's quite a "spa treatment" - I've lost 6 pounds in the past few weeks and gained significant upper body strength. However, I do not recommend moving as a long term fitness strategy since the mental cost of displacing your entire household is high.
Although our move is proceeding on schedule, the sale of our existing home is on hold. The bidders negotiated the final price and paid a $1000 deposit. Our final contract was to be signed on March 26. On March 23 they notified us that they were bidding on two houses and elected to forfeit their deposit. Our house goes on the market today and our first open house is Sunday. Hopefully we'll have a quick sale since the process of keeping a house in perfect showing condition is anxiety provoking.
Thus no chemotherapy, B6, a focus on moving to our farm and a wrap up of 16 years in our existing home is the plan for this week. We remain optimistic, energetic, and ready for whatever the future will bring.
Thursday, March 29, 2012
Wednesday, March 28, 2012
The Salesman End Run Around IT
In my 15 years as CIO, I've experienced a gamut of sales techniques - the "end of quarter deal never to be repeated", the "we're your partner and you always get our best price", and the selling of products that don't yet exist.
However, today I experienced one of the most reprehensible - The Salesman End Run Around IT.
Don't like the answer IT is giving you? Go to the CFO and try to convince financial leadership that IT leadership is squandering budgets.
Here's the redacted email that the salesman sent the CFO.
"From: Storage Sales Specialist at a large company
Sent: Wednesday, March 28, 2012 9:00 AM
To: BIDMC Chief Financial Officer
Subject: Lower Storage Costs
I am the Storage Sales rep for the Caregroup hospitals. We have been working with healthcare organizations that are typically XXX shops and saving them $500,000+ in storage cost and associated resources. We will guarantee that we migrate your current environment to 50% or less storage. The industry leading analyst group Gartner has named our storage as the leader.
Why am I reaching out to you? I met with IT a few weeks ago and they told me they didn’t have the time or the resources to evaluate new technology and they were happy with XXX. I know healthcare organization have to think smarter and get more value out of the IT dollar. Our storage is easier to manage (we have customers who reduce admin by 90%+ with our storage), our storage is faster, highly available (ability to have five 9’s reliability for critical applications) and has superior service/support.
Can I schedule some time with you next week to go into detail on how our storage can make your IT budget go further and give your stakeholders the best experience they deserve? Please let me know a time that fits your calendar.
Best Regards,
Storage Sales Specialist at a large company"
I completely respect the challenges of commissioned salespeople and the difficulty that large companies face in a lackluster economy. However, there is no better way to sour a long term relationship than to bypass the usual lines of hierarchy in an organization via an end run.
This salesperson works at a company I respect a great deal, so I believe this is an example of rogue behavior. However, I welcome your comments and feedback - have you experienced the end run and how have you responded to it?
However, today I experienced one of the most reprehensible - The Salesman End Run Around IT.
Don't like the answer IT is giving you? Go to the CFO and try to convince financial leadership that IT leadership is squandering budgets.
Here's the redacted email that the salesman sent the CFO.
"From: Storage Sales Specialist at a large company
Sent: Wednesday, March 28, 2012 9:00 AM
To: BIDMC Chief Financial Officer
Subject: Lower Storage Costs
I am the Storage Sales rep for the Caregroup hospitals. We have been working with healthcare organizations that are typically XXX shops and saving them $500,000+ in storage cost and associated resources. We will guarantee that we migrate your current environment to 50% or less storage. The industry leading analyst group Gartner has named our storage as the leader.
Why am I reaching out to you? I met with IT a few weeks ago and they told me they didn’t have the time or the resources to evaluate new technology and they were happy with XXX. I know healthcare organization have to think smarter and get more value out of the IT dollar. Our storage is easier to manage (we have customers who reduce admin by 90%+ with our storage), our storage is faster, highly available (ability to have five 9’s reliability for critical applications) and has superior service/support.
Can I schedule some time with you next week to go into detail on how our storage can make your IT budget go further and give your stakeholders the best experience they deserve? Please let me know a time that fits your calendar.
Best Regards,
Storage Sales Specialist at a large company"
I completely respect the challenges of commissioned salespeople and the difficulty that large companies face in a lackluster economy. However, there is no better way to sour a long term relationship than to bypass the usual lines of hierarchy in an organization via an end run.
This salesperson works at a company I respect a great deal, so I believe this is an example of rogue behavior. However, I welcome your comments and feedback - have you experienced the end run and how have you responded to it?
Tuesday, March 27, 2012
The March HIT Standards Committee Meeting
The March HIT Standards Committee meeting focused on a review of the Standards and Certification NPRM, as well as planning for our upcoming second quarter work on the NwHIN portfolio, QueryHealth, Radiology image exchange standards, and governance.
Doug Fridsma began with an ONC update. He described S&I Framework activities in 2011 that resulted in a single lab results implementation guide, merging the work of HITSP and CHCF/ELINCS. This same approach will be used to create a single lab ordering implementing guide, including a standardized compendium of the most commonly ordered tests. He described the plans for S&I Framework efforts on Clinical Decision Support standards. He noted that ONC is looking at RESTful transport standards and the use of TLS for consumer mediated exchange. He described further refinements to the NPRM that are needed to constrain Consolidated CDA (CCDA) in sufficient detail to ensure interoperability, such as the requirement to have specific templates for transitions of care. Finally he described the future work needed on Health Insurance Exchanges and NIEM.
A robust discussion followed including the role of CCDA for longitudinal summaries verses episode of care summaries, the use of CCDA for submission to registries/quality measurement entities, and the possible use of CCDA for submission of data about multiple individuals in batch.
Next, Liz Johnson and Cris Ross described the Implementation Workgroup evaluation of certification criteria and testing procedures. Here's a summary and here's the detail.
Highlights include a focus on workflows and testing procedures that are relevant to clinical environments in the domains of CPOE, e-Prescribing, Clinical Decision Support. – The workgroup offered to develop clinical scenarios for use in testing such as ensuring EMAR implementations support the five rights - Right Medication, Right Dose, Right Patient, Right Time, Right Administration Method.
Jamie Ferguson provided an update on the Clinical Operations Workgroup and Vocabulary task force. Issues include:
*The use of SNOMED-CT instead of ICD-10 for diagnosis. If the intent is to gather clinical data, SNOMED-CT is best. If billing classification is needed ICD-10 can be used. There needs to be some criteria of usability for data entry of diagnosis.
*When e-Prescribing discharge medications, HL7 is often used inside an organization. The NPRM does not include an HL7 option. This may or may not be an issue because the NPRM does not describe workflows within an organization.
*The NPRM should include structured allergy vocabularies such as RxNorm for medications, UNII for individual ingredients, NDF-RT for categories, and SNOMED-CT for non-medications. Since RxNorm includes UNII and NDF-IT, RxNorm CUI codes may work for all.
*Transmission - the Workgroup recommended both SMIME/SMTP and SOAP be required
*For patient access to view/download/transport, the Workgroup recommended TLS for transport and CCDA for download.
*For Family history, the Workgroup highlighted the adoption of the Surgeon General's Family History XML Format and tools, even though it is incomplete
Jim Walker provided update on the work of the Clinical Quality Workgroup, highlighting the work ahead on the journey to making quality measures easier to compute from existing EHR data.
Leslie Kelly Hall described the charter and work ahead for the Consumer Engagement Power Team.
Dixie Baker provided an update from the Privacy & Security Workgroup. Highlights include the need to clarify the role of SOAP as an optional transport standards in the transitions of care as described in my recent post about transport. She also discussed suggested improvements to patient audit log access, record download, and correction to records.
Finally, we emphasized the need for ongoing communication among ONC, workgroup chairs, and members to consolidate and coordinate all the NPRM input over the next month. Liz Johnson was nominated as a person to serve as the HITSC representative to the HITPC Certification/Adoption Work Group, ensuring cross FACA coordination.
A great discussion and I'm very pleased with the progress we're making on the 2012 HITSC work plan.
Doug Fridsma began with an ONC update. He described S&I Framework activities in 2011 that resulted in a single lab results implementation guide, merging the work of HITSP and CHCF/ELINCS. This same approach will be used to create a single lab ordering implementing guide, including a standardized compendium of the most commonly ordered tests. He described the plans for S&I Framework efforts on Clinical Decision Support standards. He noted that ONC is looking at RESTful transport standards and the use of TLS for consumer mediated exchange. He described further refinements to the NPRM that are needed to constrain Consolidated CDA (CCDA) in sufficient detail to ensure interoperability, such as the requirement to have specific templates for transitions of care. Finally he described the future work needed on Health Insurance Exchanges and NIEM.
A robust discussion followed including the role of CCDA for longitudinal summaries verses episode of care summaries, the use of CCDA for submission to registries/quality measurement entities, and the possible use of CCDA for submission of data about multiple individuals in batch.
Next, Liz Johnson and Cris Ross described the Implementation Workgroup evaluation of certification criteria and testing procedures. Here's a summary and here's the detail.
Highlights include a focus on workflows and testing procedures that are relevant to clinical environments in the domains of CPOE, e-Prescribing, Clinical Decision Support. – The workgroup offered to develop clinical scenarios for use in testing such as ensuring EMAR implementations support the five rights - Right Medication, Right Dose, Right Patient, Right Time, Right Administration Method.
Jamie Ferguson provided an update on the Clinical Operations Workgroup and Vocabulary task force. Issues include:
*The use of SNOMED-CT instead of ICD-10 for diagnosis. If the intent is to gather clinical data, SNOMED-CT is best. If billing classification is needed ICD-10 can be used. There needs to be some criteria of usability for data entry of diagnosis.
*When e-Prescribing discharge medications, HL7 is often used inside an organization. The NPRM does not include an HL7 option. This may or may not be an issue because the NPRM does not describe workflows within an organization.
*The NPRM should include structured allergy vocabularies such as RxNorm for medications, UNII for individual ingredients, NDF-RT for categories, and SNOMED-CT for non-medications. Since RxNorm includes UNII and NDF-IT, RxNorm CUI codes may work for all.
*Transmission - the Workgroup recommended both SMIME/SMTP and SOAP be required
*For patient access to view/download/transport, the Workgroup recommended TLS for transport and CCDA for download.
*For Family history, the Workgroup highlighted the adoption of the Surgeon General's Family History XML Format and tools, even though it is incomplete
Jim Walker provided update on the work of the Clinical Quality Workgroup, highlighting the work ahead on the journey to making quality measures easier to compute from existing EHR data.
Leslie Kelly Hall described the charter and work ahead for the Consumer Engagement Power Team.
Dixie Baker provided an update from the Privacy & Security Workgroup. Highlights include the need to clarify the role of SOAP as an optional transport standards in the transitions of care as described in my recent post about transport. She also discussed suggested improvements to patient audit log access, record download, and correction to records.
Finally, we emphasized the need for ongoing communication among ONC, workgroup chairs, and members to consolidate and coordinate all the NPRM input over the next month. Liz Johnson was nominated as a person to serve as the HITSC representative to the HITPC Certification/Adoption Work Group, ensuring cross FACA coordination.
A great discussion and I'm very pleased with the progress we're making on the 2012 HITSC work plan.
Monday, March 26, 2012
The State HIE Privacy and Security Program Information Notice
On March 22, ONC issued important privacy and security guidance to State Designated Entities. It addresses concerns from State leaders and other stakeholders that health information exchange efforts have been hampered and slowed by the lack of consistent approaches to core privacy and security issues. The Program Information Notice (PIN) provides clear national guidance.
It covers eight Core Domains
1. Individual access
2. Correction
3. Openness and transparency
4. Individual choice
5. Collection, use and disclosure limitation
6. Data quality and integrity
7. Safeguards
8. Accountability
Here's a summary of the highlights:
Access and Correction
Where HIE entities store, assemble or aggregate individually identifiable health information (IIHI), such as longitudinal patient records with data from multiple providers, HIE entities should make concrete plans to give patients electronic access to their compiled IIHI and develop clearly defined processes (1) for individuals to request corrections to their IIHI and (2) to resolve disputes about information accuracy and document when requests are denied.
Openness and transparency
Where HIE entities store, assemble or aggregate IIHI, individuals should have the ability to request and review documentation to determine who has accessed their information or to whom it has been disclosed.
Individual Choice
Push Model
Where HIE entities serve solely as information conduits for directed exchange of IIHI and do not access IIHI or use IIHI beyond what is required to encrypt and route it, patient choice is not required beyond existing law. Such sharing of IIHI from one health care provider directly to another is currently within patient expectations.
Pull Model
Where HIE entities store, assemble or aggregate IIHI beyond what is required for an initial directed transaction, HIE entities should ensure individuals have meaningful choice regarding whether their IIHI may be exchanged through the HIE entity. Both opt-in and opt-out models can be acceptable means of obtaining patient choice provided that choice is meaningful
Use and Disclosure Limitation
In principle, a health care provider should only access the minimum amount of information needed for treatment of the patient.
Data quality and integrity
Where HIE entities store, assemble or aggregate IIHI, they should implement strategies and approaches to ensure the data exchanged are complete and accurate and that patients are correctly matched with their data.
Safeguards
HIE entities should conduct a thorough assessment of risks and vulnerabilities.
Accountability
HIE entities should ensure appropriate monitoring mechanisms are in place to report and mitigate non-adherence to policies and breaches.
In my view, these are very reasonable principles. The use of "shall" and "should" in these guidelines is important to note. Shall means your must and should means it's a good idea to try. Should is used for more aspirational goals that need additional technology, standards, and policies.
Massachusetts goes live with its statewide HIE this Fall, so it was very helpful that no new regulations are required by the PIN for Push transport models. The new guidance is completely aligned with the Strategic and Operating Plan we already have in process to replace existing paper-based workflows with electronic workflows leveraging current consent models.
It covers eight Core Domains
1. Individual access
2. Correction
3. Openness and transparency
4. Individual choice
5. Collection, use and disclosure limitation
6. Data quality and integrity
7. Safeguards
8. Accountability
Here's a summary of the highlights:
Access and Correction
Where HIE entities store, assemble or aggregate individually identifiable health information (IIHI), such as longitudinal patient records with data from multiple providers, HIE entities should make concrete plans to give patients electronic access to their compiled IIHI and develop clearly defined processes (1) for individuals to request corrections to their IIHI and (2) to resolve disputes about information accuracy and document when requests are denied.
Openness and transparency
Where HIE entities store, assemble or aggregate IIHI, individuals should have the ability to request and review documentation to determine who has accessed their information or to whom it has been disclosed.
Individual Choice
Push Model
Where HIE entities serve solely as information conduits for directed exchange of IIHI and do not access IIHI or use IIHI beyond what is required to encrypt and route it, patient choice is not required beyond existing law. Such sharing of IIHI from one health care provider directly to another is currently within patient expectations.
Pull Model
Where HIE entities store, assemble or aggregate IIHI beyond what is required for an initial directed transaction, HIE entities should ensure individuals have meaningful choice regarding whether their IIHI may be exchanged through the HIE entity. Both opt-in and opt-out models can be acceptable means of obtaining patient choice provided that choice is meaningful
Use and Disclosure Limitation
In principle, a health care provider should only access the minimum amount of information needed for treatment of the patient.
Data quality and integrity
Where HIE entities store, assemble or aggregate IIHI, they should implement strategies and approaches to ensure the data exchanged are complete and accurate and that patients are correctly matched with their data.
Safeguards
HIE entities should conduct a thorough assessment of risks and vulnerabilities.
Accountability
HIE entities should ensure appropriate monitoring mechanisms are in place to report and mitigate non-adherence to policies and breaches.
In my view, these are very reasonable principles. The use of "shall" and "should" in these guidelines is important to note. Shall means your must and should means it's a good idea to try. Should is used for more aspirational goals that need additional technology, standards, and policies.
Massachusetts goes live with its statewide HIE this Fall, so it was very helpful that no new regulations are required by the PIN for Push transport models. The new guidance is completely aligned with the Strategic and Operating Plan we already have in process to replace existing paper-based workflows with electronic workflows leveraging current consent models.
Friday, March 23, 2012
Cool Technology of the Week
I've often posted about transport standards and the need to accelerate interoperability by mandating a method for EHRs to send/receive data from each other.
The Meaningful Use Stage 2 NPRM includes such a requirement for transport standards, making healthcare information exchange real. Here's a capsule summary of what it says:
The NPRM proposes that EHR technology be required to implement the Direct specifications - §170.202(a)(1) Applicability Statement for Secure Health Transport - SMTP/SMIME and §170.202(a)(2) XDR/XDM for Direct Messaging. Products cannot be certified unless they support these transport standards.
Transport is also referenced in the Transitions of Care Meaningful Use objective. To support this objective, ONC’s 2014 Edition standards and certification criteria proposed rule includes a certification criterion at § 170.314(b)(2) which would require EHR technology to be certified to the Direct specifications (mentioned above). However, for this certification criterion, EHR technology is also able to be certified to the standard proposed for adoption at §170.202(a)(3) “SOAP-based Secure Transport Requirements Traceability Matrix 1.0” in order to accomplish the cross organizational transport among different vendor applications proposed by CMS as part of Stage 2.
As new transport implementation guides, such as REST, become available, ONC will consider adding them as transport options. The Direct specification certification will be required but others will be listed as viable optional alternatives.
Just as CCR and CCD were offered in Stage 1, then reduced to a single standard in Stage 2, Consolidated CDA, I believe that by Stage 3 a single transport standard will be chosen by the community as the harmonized approach for healthcare information exchange.
With Stage 2, we finally have a parsimonious set of required transport options that will break down data silos in healthcare. That's cool!
The Meaningful Use Stage 2 NPRM includes such a requirement for transport standards, making healthcare information exchange real. Here's a capsule summary of what it says:
The NPRM proposes that EHR technology be required to implement the Direct specifications - §170.202(a)(1) Applicability Statement for Secure Health Transport - SMTP/SMIME and §170.202(a)(2) XDR/XDM for Direct Messaging. Products cannot be certified unless they support these transport standards.
Transport is also referenced in the Transitions of Care Meaningful Use objective. To support this objective, ONC’s 2014 Edition standards and certification criteria proposed rule includes a certification criterion at § 170.314(b)(2) which would require EHR technology to be certified to the Direct specifications (mentioned above). However, for this certification criterion, EHR technology is also able to be certified to the standard proposed for adoption at §170.202(a)(3) “SOAP-based Secure Transport Requirements Traceability Matrix 1.0” in order to accomplish the cross organizational transport among different vendor applications proposed by CMS as part of Stage 2.
As new transport implementation guides, such as REST, become available, ONC will consider adding them as transport options. The Direct specification certification will be required but others will be listed as viable optional alternatives.
Just as CCR and CCD were offered in Stage 1, then reduced to a single standard in Stage 2, Consolidated CDA, I believe that by Stage 3 a single transport standard will be chosen by the community as the harmonized approach for healthcare information exchange.
With Stage 2, we finally have a parsimonious set of required transport options that will break down data silos in healthcare. That's cool!
Thursday, March 22, 2012
Our Cancer Journey Week 14
Taxol's major side effect is peripheral neuropathy. Kathy will receive the 4th cycle of Taxol this week. At this point, she can no longer feel her fingers and toes.
As an artist, she depends on a fine sense of touch. The peripheral neuropathy was the side effect we dreaded most. She'll meet with her doctors on Friday to discuss next steps - possible change in medications and addition of other medications to reduce the intensity of numbness/pain.
She's tolerated the Taxol well, keeping up with her daily activities with the usual verve. One other complication is that her nails are black and brittle. The slightest impact causes extreme pain - imagine that brushing your nails against a counter feels like slamming your hand in car door.
As we continue with treatment, we're planning ahead for the end of chemotherapy in May, the imaging studies to evaluate the results of chemotherapy and the surgery to come. I've cancelled all my international travel for the rest of the year and have minimized domestic travel to a single day trip to Washington or Chicago each month. Whatever the future brings, we'll be ready for it.
My colleagues at BIDMC have been incredibly supportive, giving me the flexibility to join Kathy at chemotherapy appointments, to be available for heavy lifting when she needs help at home with activities that are too painful or awkward for her to complete on her own, and to relax my meeting schedule enough to bring better balance between my work and personal lives at a time when my family needs extra attention.
I know that it may seem ill advised to plan changes in our lives like purchasing a farm (closes April 27), selling our old home (closes May 2), and moving during cancer treatment. In general, the consents for chemotherapy emphasize that major life decisions should be avoided. However, as I've written about in other blog postings, part of winning the battle against cancer is taking control. We've long wanted to live more rurally, and now that we're empty nesters and I've focused my job responsibilities on BIDMC and the State HIE, we're ready for a new beginning. Sometimes a change in home with corresponding reduction of the stuff you own and refinement of the lifestyle you lead can be transformative. What better way to plan for the completion of chemotherapy and surgery, than emerging from the cocoon of your old life as the butterfly in a new life.
As an artist, she depends on a fine sense of touch. The peripheral neuropathy was the side effect we dreaded most. She'll meet with her doctors on Friday to discuss next steps - possible change in medications and addition of other medications to reduce the intensity of numbness/pain.
She's tolerated the Taxol well, keeping up with her daily activities with the usual verve. One other complication is that her nails are black and brittle. The slightest impact causes extreme pain - imagine that brushing your nails against a counter feels like slamming your hand in car door.
As we continue with treatment, we're planning ahead for the end of chemotherapy in May, the imaging studies to evaluate the results of chemotherapy and the surgery to come. I've cancelled all my international travel for the rest of the year and have minimized domestic travel to a single day trip to Washington or Chicago each month. Whatever the future brings, we'll be ready for it.
My colleagues at BIDMC have been incredibly supportive, giving me the flexibility to join Kathy at chemotherapy appointments, to be available for heavy lifting when she needs help at home with activities that are too painful or awkward for her to complete on her own, and to relax my meeting schedule enough to bring better balance between my work and personal lives at a time when my family needs extra attention.
I know that it may seem ill advised to plan changes in our lives like purchasing a farm (closes April 27), selling our old home (closes May 2), and moving during cancer treatment. In general, the consents for chemotherapy emphasize that major life decisions should be avoided. However, as I've written about in other blog postings, part of winning the battle against cancer is taking control. We've long wanted to live more rurally, and now that we're empty nesters and I've focused my job responsibilities on BIDMC and the State HIE, we're ready for a new beginning. Sometimes a change in home with corresponding reduction of the stuff you own and refinement of the lifestyle you lead can be transformative. What better way to plan for the completion of chemotherapy and surgery, than emerging from the cocoon of your old life as the butterfly in a new life.
Wednesday, March 21, 2012
Clinical IT Governance Update
I've written many posts about the importance of IT governance to set priorities, align stakeholders, and allocate budgets.
Today, I will meet with the Clinical IT Governance Committee to discuss the 5 major IS projects in the BIDMC Annual Operating Plan, brief them about the Meaningful Use Stage 2 NPRM, and discuss 2012 State HIE initiatives.
Here's an overview of what I'll say
*Electronic Medication Administration Records - at BIDMC, we wanted to eliminate all handwritten orders in every care setting, so we aggressively implemented CPOE before automating Medication Administration Records. Now that we have 100% electronic ordering, we're implementing projects that close the loop - checking patients, medications, staff ID, and active orders when medications are given to the patient. We've developed a scope, a timeline, and a workflow that embraces both fixed bedside devices and mobile technology to document when, where, and how medications are administered, reconciling orders and doses given. We buy technology when it is mature and robust. In this case, we'll need highly innovative, integrated technology supporting a unique workflow, so we're building it.
*Clinical Documentation - at BIDMC, our ambulatory documentation is entirely electronic. In our monitored units, all flowsheets are electronic. On our wards, progress notes are still written on paper. In 2012, we're designing inpatient clinical documentation to align with the needs of our ICD10 project. We'll use templates, macros, and free text input to support computer assisted coding, reducing the burden on clinicians and coders who need to pick the right code from 68,000 diagnosis and 87,000 procedure choices.
*ICD10 - Although Secretary Sebelius has announced an intent to delay ICD10 enforcement dates, the project is such an enormous undertaking requiring policy change, workflow change and technology change that we're continuing full steam ahead. We're executing a multi-phase project that includes current state documentation, a gap analysis, and a remediation plan.
*Personal Health Records - Patientsite, our PHR, is used by over 60,000 people every month. Since its inception in 2000, Patientsite has not had a major upgrade. This year, we're enhancing the look and feel, adding Open Notes (patients viewing all notes written about that), and creating a mobile friendly version.
*Standardized project management including a single intake process - among the many departments of BIDMC, different techniques are used for project charters, Gantt charts, issue logs, status reports, and project intake. This year, we plan to create a single set of uniform project management artifacts that can be used by all business owners on IS related and other projects.
In addition to ICD-10, future stages of Meaningful Use Stage 2 will require multiple years of technology and policy work. I'll present a summary of the challenges ahead based on the Stage 2 NPRM requirements .
Finally, in October of 2012, the Massachusetts Statewide HIE will go live and we'll use the infrastructure to enhance data sharing with payers, providers and patients. At the same time we'll want to share more, compliance requirements will suggest further restrictions on data flows. It will be a delicate balance.
I look forward to the meeting tomorrow. Being a CIO means there's always new challenges and life will never be boring!
Today, I will meet with the Clinical IT Governance Committee to discuss the 5 major IS projects in the BIDMC Annual Operating Plan, brief them about the Meaningful Use Stage 2 NPRM, and discuss 2012 State HIE initiatives.
Here's an overview of what I'll say
*Electronic Medication Administration Records - at BIDMC, we wanted to eliminate all handwritten orders in every care setting, so we aggressively implemented CPOE before automating Medication Administration Records. Now that we have 100% electronic ordering, we're implementing projects that close the loop - checking patients, medications, staff ID, and active orders when medications are given to the patient. We've developed a scope, a timeline, and a workflow that embraces both fixed bedside devices and mobile technology to document when, where, and how medications are administered, reconciling orders and doses given. We buy technology when it is mature and robust. In this case, we'll need highly innovative, integrated technology supporting a unique workflow, so we're building it.
*Clinical Documentation - at BIDMC, our ambulatory documentation is entirely electronic. In our monitored units, all flowsheets are electronic. On our wards, progress notes are still written on paper. In 2012, we're designing inpatient clinical documentation to align with the needs of our ICD10 project. We'll use templates, macros, and free text input to support computer assisted coding, reducing the burden on clinicians and coders who need to pick the right code from 68,000 diagnosis and 87,000 procedure choices.
*ICD10 - Although Secretary Sebelius has announced an intent to delay ICD10 enforcement dates, the project is such an enormous undertaking requiring policy change, workflow change and technology change that we're continuing full steam ahead. We're executing a multi-phase project that includes current state documentation, a gap analysis, and a remediation plan.
*Personal Health Records - Patientsite, our PHR, is used by over 60,000 people every month. Since its inception in 2000, Patientsite has not had a major upgrade. This year, we're enhancing the look and feel, adding Open Notes (patients viewing all notes written about that), and creating a mobile friendly version.
*Standardized project management including a single intake process - among the many departments of BIDMC, different techniques are used for project charters, Gantt charts, issue logs, status reports, and project intake. This year, we plan to create a single set of uniform project management artifacts that can be used by all business owners on IS related and other projects.
In addition to ICD-10, future stages of Meaningful Use Stage 2 will require multiple years of technology and policy work. I'll present a summary of the challenges ahead based on the Stage 2 NPRM requirements .
Finally, in October of 2012, the Massachusetts Statewide HIE will go live and we'll use the infrastructure to enhance data sharing with payers, providers and patients. At the same time we'll want to share more, compliance requirements will suggest further restrictions on data flows. It will be a delicate balance.
I look forward to the meeting tomorrow. Being a CIO means there's always new challenges and life will never be boring!
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