Clinical Systems Midyear Update

Every year, I work with my governance committees to create the Information Systems Operating Plan. Each January, I given an update on our progress. I thought my blog readers would enjoy the insight into the details of our clinical systems work.

Inpatient

• We will go live with statewide clinical summary exchange through the Massachusetts Regional Heath Information Organization called MA-Share in early February 2008. Inpatient discharge documents and the ED discharge documents will be electronically sent to providers using the HITSP Continuity of Care Document format.
  
• New influenza vaccine prompting and tracking features went live in Provider Order Entry
• Chemotherapy ordering for inpatient setting will integrate with inpatient Provider Order Entry and our outpatient Oncology Management system. It will go live in late March 2008, completing our effort to eliminate handwriting in chemotherapy treatment at every site of care.
  
• Provider Order Entry for the NICU – Planning meetings held with NICU to discuss resources needed for work. Formal project kick off planned for early March 2008, after the iMDSoft Metavision ICU documentation pilot is completed. Once completed we will eliminate the last handwritten orders in any site of care in the institution.
  
• Inpatient History and Physical with medication reconciliation – Initial meeting of Clinician Advisory Group held in December, with much interest expressed for this project. Formal kick off planned for late January/early February 2008. This project will eliminate paper history and physicals while also supporting medication reconciliation at the point of patient arrival.
  
• Scanning of inpatient paper records with a web viewer on track for go live in early 2008. This will enable our medical record coders to work anywhere in the world, expanding the pool of talented people we can hire. It also gives clinicians easy access to any historical paper records.
  
• Completed all requested order sets for clinical pathways in Provider Order Entry.
  
• Completed dashboard to support inpatient physician rounding.

Outpatient

• Completed numerous medication list enhancements to make outpatient medication reconciliation more efficient, and to foster better communication/workflow among the multiple providers who often care for patients.
• Completed a onetime “autoretire” of old medications to help remove inactive drugs from medications lists.
• Numerous ePrescribing enhancements have gone live: eligibility, formulary, alternate drug recommendations, mail order, and community medication history. Further piloting and roll out in coming months.
• Automated Results notifications and sign off – Additional specialty divisions have begun using the system (Pulmonary, Orthopedics, GI, Dermatology, Rheumatology). New physician coverage features have been developed and are being piloted. The pathology orders interface was enhanced to improve the accuracy of results routing.
• Ordering for BID Needham (our community hospital) studies is now live in webOMR. Areas that are included are lab, radiology, cardiology, EEG, pulmonary and sleep.
• Work on outpatient scanning with viewing in webOMR will begin after inpatient scanning goes live in early 2008. Projects will be prioritized by the webOMR Users Group with a goal of facilitating standardization of webOMR documentation at BIDMC. First project will be Dermatology outpatient progress notes.

Radiology Information System

• RIS enhancements – An initial set of requirements for a web-based portal that focuses on integration with other clinical systems is currently being defined.
• Preliminary reports and wet reads – Medical Executive Committee mandated changes to remove preliminary ( unsigned) reports from clinical viewers and provide a workflow to request wet reads. Work in progress and will be completed in Feb 2008.

Operating Room/Perioperative Information System
Work in progress to create Pre-Anesthesia Testing documentation (medication reconciliation, nursing assessment form) and web-based versions of the CCC PACU log that are integrated with OR Scheduling. On track for late winter/early spring go live.

Decision Support
A subgroup of the Decision Support Steering Committee has been formed to oversee development of ambulatory quality reporting, with the SVP of Healthcare Quality as chair. First priority is to develop diabetes management reports based on the diabetes registry.

Electronic Health Records for non-owned physicians
Work continues on implementation of a hosted ASP model for BIDPO eClinical Works. Final design completed. Beginning work on Model Office setup.

Positive Patient ID
Rollout of bar-coded wristbands to the remaining (23) inpatient is scheduled for completion by February 2008. Once done, all inpatient units will have the ability to print new or replacement bands on demand at the time the patient presents.

Critical Care Documentation System
Testing complete; planning in progress for a late January / early February Pilot in one adult ICU and the NICU; expected roll-out to all ICUs to follow.

OB-TV Fetal Monitoring Surveillance System
Emergency Department – Rev E. All testing completed in December 07; go-live planned in February 08 (the ED pushed go-live out due to other commitments).
OB - Upgrade to Rev E. Funding approved in November 07; contract discussions beginning.

Anesthesia Information System (AIMS)
Major upgrade to Rev E is in early planning stages; timeline TBD. This will allow the AIMS to begin receiving lab data.

NTRACS Trauma Database
Successful December go-live of NTRACS Performance Manager Upload. ’08 work will include, version upgrade, implementation of a report module and modified National Trauma Data Standard (NTDS) dictionary.

New Laboratory Information System Implementation

• Soft Computer module build nearing completion
• Work with the lab managers in progress to develop approach for managing security, patient & management reporting, specimen tracking, etc.
• Solution for handling organizational and workflow issues around creation of fiscal number in the ambulatory, outreach and community sites is in discussion
• Key lab vacancy (LIS Manager) filled; two additional lab FTEs for the project just approved
  
• A software upgrade (Lab/Path) which includes contracted customizations is scheduled for installation in early January
  
• Work is progressing on the clinical viewer with the expectation that all requested changes will be completed by spring 08
• Integration work with POE and ADT is moving forward
• Validation test scripts in development;
• Validation testing is targeted to begin in late spring/early summer 08
  

Global Image Management
Participating in discussions to explore the potential to leverage Radiology PACS to meet growing imaging and storage needs in other departments (e.g. Cardiology, GI).

Rad Onc Infrastructure Improvements
Upgrades to Oracle databases completed; move of RadOnc and Cyberknife databases to a more secure environment recently completed. Rollout of Portal Vision workstations nearing completion.

Cardiology
Participating in planning for upcoming consulting engagements to assess and develop a strategy for Cardiovascular Institution (CVI) related needs at both BIDMC and CVI’s growing number of remote locations. Clinical Systems staff participating in assessment of EMR and imaging requirements at CVI remote locations.

Continue to support various Apollo efforts including:

• Implementation of new Vascular Surgery module
• Development and testing of new Cardiac Cath Registry export
• Planning and implementation of a Physical Inventory module
• Assisting with development of STS reports

GE MACLab/CardioLab
Participating in planning discussions for MacLab 6.5.3 upgrade

Other

• Adverse Events Tracking – Numerous enhancements based on user feedback were included in a major version release.
• Transfer Log – New features to allow MD comments and to allow log data to be viewed even after patients have been admitted.
• New ADT feed to support rollout of new lab and coding systems went live
• Billing system interface for ED visits enhanced to improve accuracy and reduce the need for manual billing interventions.