Quality and Information Systems Update to PCAC

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

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

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

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

14. Clinical Systems Plan