An Update for the Medical Executive Committee

Of all the governance and oversight bodies I serve at BIDMC, the Medical Executive Committee (MEC) is one of the most important.   Here is a communication I wrote today for the MEC Newsletter which summarizes our major FY13 efforts.

"Every year, Information Systems at BIDMC completes dozens of projects prioritized by steering committees and advisory groups of clinicians, staff, and administrators.    Although those involved in these activities track our progress day to day, it's important to widely share our goals and activities so that everyone knows what to expect over the coming year.

BIDMC has a build and buy strategy.   We buy those clinical products that are mature, are regulated by the FDA, or are required by departments with very specialized functionality.   We build those products that need seamless integration, more functionality than commercial products, or are uniquely innovative.    For example, there is no commercial web-based, iPad compatible provider order entry or inpatient medication reconciliation application available on the market today.   BIDMC created them.

Many of our clinical applications are world class, enabling BIDMC to be the first hospital in the country to achieve Meaningful Use as part of the federal stimulus program for healthcare information technology.  However, there are gaps.      We do not perform bedside medication verification with bar codes at the point of medication administration.   We currently do not chart progress notes or nursing flowsheets from inpatient ward areas electronically.  We do not have an entirely electronic hospital record or billing workflow, instead using a hybrid of paper and electronic approaches.

In the next two years we'll develop and pilot systems to fill many of these gaps.

1.  We have a multidisciplinary committee, led by clinicians, pharmacy, and IS, to optimize the entire medication management process, ensuring that we support the '5 rights' of medication administration:

the right patient
the right drug
the right dose
the right route
the right time

As first steps, we're designing screens for electronic medication administration records, and selecting the right bar coding hardware (a combination of mobile and fixed devices) to support bedside medication verification.

2.  We have another multidisciplinary committee, which includes clinicians, administrators, and expert staff to design inpatient clinical documentation.  We're considering the best approaches including the use of templates (such as disease specific structured data), macros (easy to use standard text), computer assisted coding which can prompt clinicians for the precise details needed to improve documentation, social networking approaches that enable team authorship of notes, and single click incorporation of med lists/labs/other parts of the record.

We've already deployed electronic documentation in the Emergency Department and we hope to pilot inpatient ward documentation/nursing notes in FY13.

3.  ICD10, which expands coding from 14,000 to 170,000 codes, will have a profound impact on the way we document and bill.   This critical project will require the intense participation of stakeholders throughout the medical center.    A side benefit of the project will be automating many of our remaining paper billing processes.

In addition to filling these gaps, the years ahead will include many challenges to support compliance requirements and security mandates.   We have 50 projects that IS and compliance have prioritized together that will reduce our risks over the next two years.   Many of these projects are driven by Federal and State regulations which mandate they be done.  However, some of the projects will introduce restrictions, limitations, and responsibilities that some will find inconvenient.   We'll work closely with all stakeholders to balance confidentiality and ease of use.

Finally, FY13 will be a time of preparation for the next phase of meaningful use.  There will be 16 core objectives for hospitals and 17 core objectives for professionals.   BIDMC was the first hospital in the country to attest to meaningful use and we'll work hard to be an early adopter of the next stage.

These are a few of the many projects we'll work on together in FY13.   As we evolve into a mature accountable care organization coordinating wellness across the community, I'm sure more projects and the need for innovation will keep us all busy."