Preparing for a New CEO

On October 17, 2011, Dr. Kevin Tabb MD joins Beth Israel Deaconess as the new CEO.

As part of his briefing packet, I needed to summarize all the key IS issues for the next 3 months, 6 months and 1 year.     Here's what I said:

Introduction

Information Systems at BIDMC has a 30 year tradition of industry firsts:
First web-based Healthcare Information Exchange, CareWeb - 1997
First web-based Enterprise-wide Personal Health Record, Patientsite - 1999
First web-based Enterprise-wide Provider Order Entry system - 2001
First web-based Enterprise-wide electronic medication reconciliation system - 2007
First "Magic button" for health information exchange invented at BIDMC - 2008
Pilot hospital to exchange data with Google Health, Healthvault, and CDC - 2008
Pilot hospital to exchange data with the Social Security Administration (Megahit) - 2009
First hospital to implement clinical iPads - 2010
First hospital to achieve federal certification of its EHR systems - 2011
First hospital to achieve meaningful use and receive Federal IT stimulus funding - 2011

The Information Week 500 Awards ranked BIDMC the #1 healthcare IT organization in the country for 2011.   By the end of 2011, we'll have eliminated handwritten orders and the emergency department will be paperless.

We've done this with an operating budget that is less than 2% of BIDMC's operating expenses and a capital budget that has been increasingly constrained.

Scope of responsibilities

Information Systems at BIDMC is responsible for all clinical, financial, research, education, and administrative applications.  Telecom, Media Services, Knowledge Services, and Health Information Management (medical records) are part of IS.  Our scope includes comprehensive IT support for 83 locations including the Main Campus in the Longwood Medical Area, Needham Hospital, APG (owned practices), HMFP (academic affiliates), BIDPO (physician organization that includes many private clinicians), and Community Health Centers.  Our infrastructure includes a primary and disaster recovery data center.   We support 18,626 user accounts  (of which 17,410 have email boxes), 10,600 desktops, 2000 laptops/tablets, 3000 network printers. 600 iPads, 1600 iPhones, 403 servers  (152 physical, 2501 virtual) and 1.5 petabytes of storage.

Key challenges

90 Days
Laboratory Information System - On January 21, 2012, BIDMC will replace all laboratory automation in a single day, retiring 30 years of home-built lab systems with a commercial system from Soft Computer.   Additional functionality will be added after the go live via planned additional phases.    The Laboratory Information Systems Steering Committee will prioritize ongoing future work.

 5010 go live - On January 1, 2012, all private and public payers in the US will implement a new revenue cycle transmission and content format called 5010.   All BIDMC systems and interfaces are complete.   The challenge is testing with all our payers, many of which are not yet ready.    We will be able to transmit old (4010) and new (5010) formats, so we are prepared for any payer contingency plans.  

Malware control - Harvard networks are attacked every 7 seconds, 24x7x365.  The sophistication of the attacks has increased dramatically since identity theft has become a profitable business for organized crime.  We have an expert team of security professionals and a multi-layered defense of firewalls, intrusion detection, and anti-virus tools.

Compliance - over the past three years, the number of government and plaintiff attorney requests for information has skyrocketed.    The impact on IS is that an increasing percentage of our staff time is spent on e-discovery, file sequestration, and applications that support compliance efforts.  

Hospital integration - Milton hospital will join the BIDMC family in the next few months.   The clinical system integration includes bi-directional viewing of BIDMC webOMR and Milton Meditech via the web, as well as bidirectional viewing of Atrius Epic and Milton Meditech via the web.   This is the same integration we offer all affiliated hospitals and clinician offices.  Here's an overview of the Massachusetts state-wide health information exchange effort

180 days
 Analytics-  Although the precise future of Accountable Care Organizations is unknown, their formation requires a combination of health information exchange and analytics.  Here's an overview of BIDMC's strategy.    

Community IT - As BIDMC expands its footprint to Anna Jaques, Milton, Lawrence General, more primary care offices, and potentially new affiliations, we must have a scalable community IT function that can respond to changing needs with agility.

365 days
ICD10- Despite our efforts to convince CMS and HHS to delay ICD10, reducing the burden on organizations which are trying to implement Meaningful Use, 5010, and healthcare reform simultaneously, it is clear that ICD10 will go forward with an October 1, 2013 deadline.    Here's an overview of the challenges it creates.     Although the project is burdensome, has no ROI, and will distract resources from other strategic imperatives, ICD10 will be a top hospital priority in FY12.  We have a steering committee compromised of all the right stakeholders.  ICD10 is not an IS project, but requires the unified collaboration of all operational areas.

eMAR - Medication safety has been a strength of BIDMC, with its innovative provider order entry, medication reconciliation and e-prescribing systems.  In FY12, BIDMC will leverage the work done in FY11 on idealized medication workflow redesign to implement bedside medication verification and electronic medication administration record pilots.   Hospitals which have adopted these technologies early have been limited by available technology (computers on wheels) and have low user satisfaction.  Our aim is to use mobile devices such as the iPhone/iPod/iPad to create a better workflow and user experience.

Clinical documentation - although BIDMC’s ambulatory documentation is fully automated, inpatient progress notes are still handwritten, then scanned.   A multi-disciplinary stakeholder group will devise a unified care team documentation workflow which will then automate and pilot.  Our hope is to create “wiki-like” team charting.

Learning Management System - As noted above, compliance requirements are increasing in the short term and long term.   To address the staff education aspects of compliance, BIDMC will be implementing a learning management system over the next year.  

Healthcare Reform
As discussed above, healthcare reform will require additional health information exchange and analytics.  The blog postings noted above outline the details.  Additionally, BIDMC has been been an IT pilot site for numerous state and federal efforts.  We expect to be the IT learning laboratory for healthcare reform.

Key opportunities
We’re experts in mobile, wireless, disaster recovery, security, and data standards. We lead national and statewide efforts to share data for population health, quality measurement, public health, electronic disability adjudication and payer/provider collaboration.  We're experts at interoperability and analytics.    We  host EHRs for every affiliated clinician and provide quality/outcome/process analytics.  We’ve achieved meaningful use for our hospitals and 90% of our physicians will attest by 12/31/11.    

We look forward to the opportunities ahead.