Medical University of South Carolina
Information Management Council
December 13, 2006
P. Cawley, F. Clark, B. Ellis, S. Mixon, M. Schaffner, M. Schmidt, J. Waller, P. Wamsley,V. West
|| T. Basler, D. Clancy, T. Higerd, L. Montgomery, B. Quinlan, M. Snook, D. Soper
Rosemary Ellis, Kurt Nendorf, Mark Daniels
Dr. Clark opened the meeting at 7:05. Minutes from the previous meeting were approved as written.
Proposal for Evidence-Based Care
Rosemary Ellis, the Director of Quality and Patient Safety, Center for Clinical Effectiveness and Patient Safety distributed a business plan and handout summarizing her presentation. She described how data elements are extracted from over four hundred medical records a month in order to meet external reporting mandates. While some of the mandates are considered "voluntary", it is critical that certain measures be reported and benchmarks obtained. CMS will reduce payments to hospitals, based on failure to report, and there is a potential to lose $1.6 M for every 1% reduction. Reporting challenges are not only from external sources such as CMS and JCAHO, but there are also patient expectations of quality and quality data reporting, as well as physician and leadership expectations. The Center is looking for technology that will facilitate data extraction and minimize the need for FTEs in the future. The software should also be able integrate operational and aggregate patient data, monitor episodes of care and provide solutions for data submission that are common to the various external agencies. In the absence of acquiring a software tool to support these requirements, it is estimated that six additional FTEs would need to be hired through 2010.
The projected costs for FY07 are $267,500, plus ongoing maintenance. The potential return on investment is $17.5 if we meet and exceed the reporting parameters giving us a "full market basket" from CMS's stand point, and cost avoid for hiring of additional FTEs.
Dr. Schmidt asked if this software would accommodate the recent DHEC law regarding the reporting of infection control data. Ms. Ellis replied that very few vendors actually mine data for infection control data according to CDC definitions and that this is a weak area for all of the available solutions. Vendors specializing in clinical and operational management systems have included IC modules more as an afterthought. Infection Control reporting has been carved out and will be purchased separately as it is critical that these vendors meet CDC definitional guidelines.
Dr. Clark asked that the current process for data extraction and reporting be described. Ms. Ellis replied that a download is obtained from Keane to identify Medicare patients. Patients are then located in Access Anywhere (LanVision document imaging) and records are sorted, however discrete data elements are not searchable. This process requires an individual to manually and methodically go through each record. Specific data elements are then loaded into an access database and formatted in the required manner to be uploadable to the various agencies such as CMS, UHC for JCAHO. Those same data elements are then developed into approximately 30 or more different aggregate reports that go to different internal committees. Nearly all hospitals in the U.S with greater than 250 beds are using some type of software tool to do this reporting. Ms. Ellis also stated that McKesson does not have a product yet that will fully address this required functionality, and this shortfall was substantiated during discussions with Duke.
Dr. Clark emphasized the importance for the proposed software tool to not be a medical record or create a second clinical data repository. The focus needs to be on the output and required reporting components.
After Ms. Ellis departed, council members discussed the proposal. Dr. Schaffner commented that while we do need to address the problem, we want to make sure that we don't buy something we already have, and that we should put additional pressure on our vendor. Council members were all in agreement that the purchase should proceed, but in a prudent and appropriate manner. Dr. Clark suggested that in moving forward with the project, that Ms. Ellis meet with John Dell and Mark Daniels to ensure that we're extracting data out of the most appropriate place(s) and that we don't repurchase functionality that we already have or don't duplicate efforts. Council members were in agreement and the proposal was approved.
NetID project – Kurt Nendorf
Mr. Nendorf provided an update to council members on the Identity and Access Management System (IDAM). Members of the IS infrastructure team have been working with Sun on an Identity Management as a basis into eventual single-sign-on functionality. Another goal is also to further secure and simplify access to our network.
Network access revolves around three primary components: Identification, Authentication, and Authorization. Currently, our “MNA”, or MUSC Network Account is the key to accessing network resources. Several issues are problematic with the existing MNA foundation, including multiple sponsorship and registration processes, lack of sound account management with regard to terminations, required separate logins to applications, and passwords do not follow standard security guidelines.
As of November 2006, Human Resources and Enrollment Services have been identified as the authorized sponsors for all account registrations. We are using Sun's Identity and Access Management System. By February 2007, everyone will be converted over to the NetID framework to access network resources.
Dr Schimdt inquired regarding the scalability of the system, and asked that its ability to support our requirements be carefully assessed before rolling it out to the masses. NetID will support the identification and authentication components, however the authorization process will still be manual for the time being.
Dr. Schaffner asked about keeping accounts “clean” down the road. Mr. Nendorf replied that the product provisions and deprovisions based on messages from Human Resources, so this process should be much cleaner in the future.
Council members reminded Mr. Nendorf that we need to make sure that we address emeriti faculty, board members etc. in some proactive manner prior to making the cutover.
APOC Update – Mark Daniels
Mark Daniels distributed a gantt chart showing timelines for implementation of the APOC components. Implementation status is as follows:
- Materials Management went live in August, 2006.
- The ED Tracking board went live in September, and the Chest Pain Center is scheduled for the spring.
- The inpatient Pharmacy system went live on October 22, and is integrated with their robots and dispensing machines. There are some outstanding issues with lock-ups, but generally the system implementation went well.
- The Clinical Portal is in the initial build phase and the project is scheduled for go-live in the April time frame.
- The Clinical Data Repository (CDR) actually went live on November 15, 2006 and has been collecting real-time data every day. The team is starting the backload of Oacis into the McKesson CDR on Jan 1, 2007 .
- Clinical Documentation – Phase I for adult inpatient will be implemented in three phases, with the first roll-out in early April, followed by the remainder of Med-Surg and then Critical Care.
- Bedside Meds Administration – this is a combination Nursing and Pharmacy project
- CPOE – scheduled to go live initially in pilot during July 07 before new hospital opens. The goal is for all of units moving to Courtney Campus to be up on this product when they move. Building the orderable catalog is a huge task which encompasses essentially anything that a physician wants to order. There are real-time interfaces into Pharmacy, Lab, and Radiology. Remaining departments will have orders entered in the system, but paper requisitions will be printed in the department.
- Perioperative – there are two major pieces. The scheduling and preference card modules will go live in February. Clinical management, consisting of Pre-Op, PACU, Anesthesia, and documentation will go live between February and May.
The primary focus for order sets is on GI and Cardiology in order to be ready for the Courtney Campus opening.
CIIC: Dr. Schaffner distributed a status report to council members. The GetWell network still has some wiring challenges with Comcast. She expressed pleasure regarding progress and staff nurse involvement in the Clinical Documentation project. Velos will go live with Cardiology transplant in January. There were some lessons learned regarding report writing expectations during the ED project and it is hoped these can be applied toward future implementations. There is some effort to rename the project to make it more friendly and meaningful. Dr. Waller added that the Marketing folks had suggested a change in nomenclature and branding to capture what we're really trying to do. It is critical to reinforce that this is a clinical project and not a technology project. “APOC” probably doesn't communicate the right message.
FAIC: Mr. Wamsley distributed a status report on FAIC activities. The last meeting was in October, when the Evidence Based Care Proposal was on the agenda. Another large effort is the Enterprise Resource Planning (ERP) System feasibility study. Thirteen members are on the study group, which has submitted an RFI and held a vendor conference. Vendor demos scheduled this week with six vendors: Oracle / PeopleSoft, Siemens / SAP, InFor, SunGard, Colleague, and UDS. The group's goal is to submit a recommendation to Frank and Lisa early in 2007. The Imaging subcommittee is working on select implementations and is looking for a copier based scanning product. The UMS subcommittee is focusing on the business process management enhancements through BPMS / Extensity and will be targeting the labor distribution issue as their first initiative. Mr. Mixon added that the planned conversion of social security numbers as employee ID numbers is scheduled for Memorial Day, 2007. Unique IDs will be created that identify employees rather than using their social security numbers. The Internet Budgeting System is ready for roll-out and updates are being provided to the campus regarding use of the system for 2008 budget planning.
EDUCATIONAL & RESARCH SUBCOMMITTEE: Dr. West suggested that Dr. Lanier, as the new Associate Provost for Research, be added to the IMC. She also reported that the implementation of the E-Value system is in process, and progress is being made on iTunes, although there is still some data needed from Colleague. Several copyright issues have arisen with the iTunes project. Spring semester is the targeted roll-out.
UPDATES FROM OCIO : Dr. Clark passed out a bi-fold compendium and summary of the more detailed “IT Enabled Strategic Plan”. Using technology to advance the mission of MUSC, he stressed that most projects are content-based, with the exception of the Infrastructure Team, which focuses on more technical and global issues and projects on a daily basis.
Dr. Schmidt led the council members in congratulating Dr. Schaffner on completion of her Doctorate in Nursing from MUSC's College of Nursing . Dr. Schaffner defended her dissertation on Monday December 11.
Next Meeting Date / Time:
here was no further business and the meeting adjourned at 08:29 am . The next meeting will be held on Wednesday, January 10 at 7:00 am in CSB Room 6