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NIH Clinical Center: An IT Perspective

NIH Clinical Center: An IT Perspective. Jon Walter McKeeby, D.Sc. NIH Clinical Center CIO. NIH Clinical Center.

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NIH Clinical Center: An IT Perspective

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  1. NIH Clinical Center: An IT Perspective Jon Walter McKeeby, D.Sc. NIH Clinical Center CIO

  2. NIH Clinical Center • The National Institutes of Health (NIH) is the medical research agency of the U.S Government. It is an agency of the U.S. Department of Health and Human Services similar to the FDA, CDC, CMS and AHRQ. • The Clinical Center at the NIH in Bethesda, Maryland, is the nation's largest hospital devoted entirely to clinical research. • Approximately 1,500 studies are in progress at the NIH Clinical Center. Most are Phase I and Phase II clinical trials.

  3. NIH Clinical Center • 240 inpatient beds, 3 day hospitals and 14 outpatient clinics. • 10,000 new patients a year • 6,000 inpatient admissions a year • 90,000 outpatient visits a year • 2200 CC Employees • 4500 CRIS Users • 1,200 credentialed physicians, dentists, and PhD • 620 nurses • 450 allied health-care professionals, such as pharmacists, dietitians, medical technologists, imaging technologists, therapists, medical records and medical supply staff • More than 1,600 laboratories conduct basic and clinical research

  4. Department of Clinical Research Informatics • 100 government and contractor staff • Clinical system administration • Clinical system support • Custom application development • Database administration • Interface administration • Network administration • Project management • System administration • Technical desktop support

  5. What Makes Me Proud • Dedicated and skilled staff: Team Philosophy • Configuration Management Process 2004 • All Applications • Data Center • Project Management Office 2004 • Security & Privacy Section 2010 • Outcome Measurement Section 2010

  6. Clinical Research Information System (CRIS) • MIS TDS 7000 from - 1980 - 2004 • Allscripts Sunrise Clinical Manager- August 2004 • Patient Registration • Ordering: Computerized provider order entry (CPOE) • 90% Medication, 70% All other Orders • Results: Laboratory Medicine, EKG, Radiology, Anatomic Pathology, etc • Electronic Medication Administration Record (eMAR) • Clinical Documentation, Vital Signs

  7. CRIS Vision 2003

  8. HIMSS Analytics Stages

  9. Initiatives from Last 12 Months • Barcode: Patient identification, Specimen Collection, Blood Transfusion Medicine • Electronic ICU: Clinical Documentation, Sign-Out Tab, Device Interfaces • Surgical and Anesthesia: Clinical Documentation, Device Interfaces, CRIS/SCM Interfaces • Respiratory Information System: Clinical Documentation, CRIS/SCM Interfaces • Investigation Drug Management System Replacement • CRIS/SCM Upgrades • PDFs to CRIS/SCM: Protocol Consents, Advance Directives, EKG Tracings, GI Results • Nursing Documentation • Read Only Copy for Downtimes • User Management • Desktop Security, MS Office 2007 Deployment, Workstation on Wheels Deployment • Data Center Infrastructure • Build, Migration of 514 Devices, Network Switch • SAN Consolidation, Virtual Consolidation • Active Directory Migration • CITRIX Upgrade

  10. Initiatives For Next 12 Months • Outpatient Pharmacy System • CRIS/SCM 5.5 Upgrade • Enterprise Scheduling System • Barcode: Medication Administration • Surgical and Anesthesia Upgrade • CRIS/SCM Upgrades • Physician Documentation • User Management • MS Office 2010 Deployment, Radiology Image Workstation Deployment • Tablet/Smart Phone Device Management • PIV/SmartCard Deployment • Data Center Infrastructure • Disaster Recovery Improvements • PIV/SmartCard Deployment • Security/Privacy Office • C&A Program

  11. When implementing systems good/great organizations plan.

  12. System Implementations • Components • Strategy • Requirements • Business • System • Functional • Plans • Project • Communication • Training • Test • Support • Contingency/Disaster Recovery • Project Lifecycle (Cradle to Grave) • People • Project Sponsors • Executive Leadership • Business Owners • Stakeholders • Super Users • Users • Service Desk Staff • Builders • IT Staff

  13. Idea, Procurement, Implementation 3-5 Years • NIH CC Hospital Information System • Idea 1997; Procurement 2001 – 2003; Project 2003 – 2004 • NIH CC Pharmacy System • Idea 2004; Procurement 2004 – 2006; Project 2006 – 2008 • NIH Surgical Information System • Idea 2003; Procurement 2004 – 2005; Project 2006 – 2011 • NIH CC Outpatient Pharmacy System • Idea 2004; Procurement 2009-2010;Project 2010-2011

  14. What Keeps Me Up At Night • Movement into Dependency on Wireless • Connectivity and VPN Issues • Quantity of Projects • Cornerstone Concept • New Devices • Management of Devices • Toy versus Tool

  15. Smart Phones, Tablets, Anything Shiny • When will I get an oWidget? • How will you use the oWidget? • The oWidget will resolve all my issues. • What issues are you having? • It will help me do my job more effectively. • Do you have requirements for the oWidget? • I want an oWidget. • Do you have a justification for the oWidget? • There are security and procurement issues with the oWidget. • When will I get my oWidget?

  16. Saving Grace • Clinical Research is the focus. • Toys are not the focus. • Tools have the appropriate focus. • Decisions and procurement are based on data. • Policies and Processes govern device procurement and use. • All Shiny Devices require justification to the Director. • Include research process and metrics to measure. • Require follow-up to Director. • All Mobile Devices require justification to the CIO. • All IT Equipment Request go through Budget and CIO Approval.

  17. When implementing devices good/great organizations plan.

  18. Focus on the Function and not the Device • What are the requirements of the device? • What outcome(s) are you looking for? • What problem(s) are you trying to solve? • If you are looking for a replacement for a laptop the a tablet may not be the device. • If you are looking for a great screen to display radiology images to patients while visiting their bed a device with a great screen may be an option.

  19. Device Deployment and Support • Components • Strategy • Requirements • Business • System • Functional • Plans • Project • Communication • Training • Test • Support • Contingency/Disaster Recovery • Project Lifecycle for Initial Roll-out • People • Executive Leadership • Business Owners • Stakeholders • Super Users • Users • Service Desk Staff • Builders • IT Staff • Administrative Support

  20. Infrastructure Must Be In Place • Technologies • Wireless Infrastructure • Support Desk • Management of Device • Procurement • Replacement • Loss • Security • Application Purchases

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