1. 1 Quality and Information Systems Update to PCAC John D. Halamka MD Justine M. Carr MD June 25, 2008

2. 2 Agenda National Perspective BIDMC Governance Information Systems Approach Challenges PCAC Request Status 2008 Accomplishments 2009 Priorities

3. National Perspective By 2014 most Americans will have electronic health records in order to prevent errors, improve quality and manage costs. President George Bush 2004 Current state –Outpatient EHRs: 4-18% adoption –Inpatient EHRs: 25% adoption

4. AHIC Quality-HIT Roadmap 4

5. Governance Clinical Information Systems Steering Committee Goal –Overview of clinical information systems Identification and prioritization of emerging needs Membership –Chairs of 11 IS clinical committees –Selected senior leadership

6. Information Systems Approach I.Build a fully electronic record Guided by need for stepwise approach, e.g. electronic orders + drug bar coding + patient bar coding  electronic medication administration II.Accelerate priority projects A.Ordering: e.g. Oncology, NICU, ED B.Documenting: e.g. integrate MD and RN notes C.Tracking e.g. referrals, test results notification III.Respond to evolving needs with enhancements to existing programs A.Safety/Quality: e.g. PCAC requests, decision support B.Efficiency: e.g. SPIRIT requests C.Pay for Performance: e.g. CMS vaccine administration

7. Challenges Timing –Stepwise building –Urgent priorities may bump other projects Prioritization –Competing demands –Evolving landscape Move from siloed documentation to multidisciplinary –Build vs. buy Benefits of specialty application may be offset by limited integration. –Work flow redesign

8. PCAC Request Status StatusCategory Completed or in progress Tracking referrals: under development (now funded by CRICO) Tracking Incidental abnormal radiology results: done Tracking abnormal path and cardiology results: in pilot areas. POE High Risk Safety Alert across admissions: done Discharge Trigger Criteria: done Dilaudid drop down doses in POE: done POE Epidural ordering decision support: done Heparin orders for IV lines to protect allergic patients: done Obstructive Sleep Apnea management in PACU: done Deferred for further evaluation POE roll – out to procedural areas. Fix the discharge med screen for insulin ordering: to P&T Microbiology results display: to CCSC

9. 9 Major 2008 Projects Ordering –Oncology Management –e-Prescribing Documentation –ICU Documentation System –Inpatient History and Physical –Medication Reconciliation –Emergency Department Documentation –Document scanning –Ambulatory documentation Tracking –Peri-anesthesia modules

10. Major 2009 Initiatives Ordering –Decision support Documentation –Inpatient notes and discharge applications Tracking/transitions –Referral management –Results notification –Coordination of handoffs –Who’s the doctor? Infrastructure –Laboratory information system

11. APPENDICES

12. CISSC Membership

13. Glossary AHIC Am Health Information Community Public/private advisory panel to Secretary of HHS and the National Coordinator for HIT. CDSClinical Decision Support Electronic reminders that prompt clinicians to consider a specific course of action. EHRElectronic health record Generic term used to describe electronic medical records that are interoperable. H&PHistory and PhysicalInitial patient evaluation by physician HITHealth Information Technology Generic term used to describe use of technology to enhance health care. Med RecMedication Reconciliation Process of insuring that all medications are addressed at each care transition. POEProvider Order EntryClinical care orders for inpatients communicated electronically. webOMRWeb On-line Medical Record BIDMC electronic record, originally outpatient, now expanding to be both in and outpatient.

14. 14 Clinical Systems Plan