. "Appendix B: Meeting and Site Visit Agendas and Site Visit Methodology." Computational Technology for Effective Health Care: Immediate Steps and Strategic Directions. Washington, DC: The National Academies Press, 2009.
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Computational Technology for Effective Health Care: Immediate Steps and Strategic Directions
Appendix B
Meeting and Site Visit Agendas and Site Visit Methodology
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Appendix B
Meeting and Site Visit Agendas and Site Visit Methodology
B.1
MEETING AND SITE VISIT AGENDAS
B.1.1
Meeting 1—April 23, 2007 (Washington, D.C.)
Entirely closed session for NRC housekeeping
B.1.2
Meeting 2—June 13-14, 2007 (Washington, D.C.)
June 13, 2007—Open Session
9:30 a.m.
Welcome
William W. Stead, Chair
Jon Eisenberg, CSTB
9:40 a.m.
Charge to the committee
Donald A.B. Lindberg, Director, National Library of Medicine
11:00 a.m.
Panel 1: Health Care IT Industry
Industry overview—Greg Walton, Senior VP of HIMSS and HIMSS Analytics
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Penetration/adoption gaps, cost, and time to implement—B. Alton Brantley, Consultant
Untoward consequences—Randy Miller, Vanderbilt University Medical Center
12:30 p.m.
Group discussion and working lunch
1:00 p.m.
Panel 2: Federal Health Care IT Landscape
Federal landscape—Alicia A. Bradford, Office of the National Coordinator for Health Information Technology
Commission on Systemic Interoperability recommendations and status—Scott Wallace, National Coalition for Health Care IT
Standards initiatives—Betsy Humphreys, National Library of Medicine
2:45 p.m.
Panel 3: Visions for Health Care
Vision for evidence based personalized medicine—IOM EBM Roundtable—Denis Cortese, Mayo Clinic [via videoconference]
VA's quality transformation: Quality, IT and outcomes—Jon Perlin, HCA
Vision of a health care system for the 21st century (IOM “Quality Chasm” series, and the challenges in translating visions into practice)—Janet Corrigan, National Quality Forum
June 14, 2007—Entirely closed session for NRC housekeeping
B.1.3
Meeting 3—October 12, 2007 (Washington, D.C.)
11:45 a.m.
Opportunities for improving health care through computer science: Work life of primary care physicians, acute care nurses, and emergency medical technicians
Eric Dishman, Gina Grumke, and Monique Lambert
B.1.4
Meeting 4—January 28-29, 2008 (San Francisco)
Entirely closed session for report development
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B.1.5
Online Briefings
November 27, 2007
Peter J. Fabri
Professor of Surgery and Associate Dean, University of South Florida
Adjunct Professor of Surgery, Northwestern University
November 28, 2007
Peter Neupert,
Corporate Vice President, Health Solutions Group
Microsoft Corporation
December 4, 2007
Kenneth D. Mandl
Assistant Professor of Pediatrics,
Harvard Medical School
Affiliated Faculty, Harvard-MIT Division of Health Sciences and Technology
B.1.6
Site Visit on September 12-13, 2007 (University of Pittsburgh Medical Center, Pittsburgh)
September 12, 2007
6:20 a.m.
Physician rounds at Children’s Hospital of Pittsburgh of UPMC
James Levin
8:00 a.m.
Welcome: UPMC and ISD Overview
(General information on the number and different types of IT systems in use at UPMC, e.g., clinical support systems, inventory management, medication management, etc.)
William Fera
Sean O’Rourke
Jody Cervenak
Ed McCallister
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9:15 a.m.
Magee-Womens Hospital of Pittsburgh of UPMC
overview and demonstration: PPID (Positive Patient Identification)
(Nursing shadowing session)
Kim Gracey
Michele Steimer
11:30 a.m.
Children’s Hospital of Pittsburgh of UPMC
overview and demonstration: CPOE (Computerized Physician Order Entry)
(Shadowing session)
Jacque Dailey
Steven Docimo
James Levin
Jocelyn Benes
2:30 p.m.
Tour of Wiser Institute
Tom Dongilli
4:00 p.m.
Tour of data center
Jeff Szymanski
4:30 p.m.
Discussions of UPMC IT systems’ technical underpinnings
Paul Sikora
September 13, 2007
6:30 a.m.
Informal chat session with physicians
Robert Kormos
Vivek Reddy
7:30 a.m.
Overview of quality initiatives and Theradoc
Tami Merryman
9:00 a.m.
eRecord overview
Daniel Martich
10:00 a.m.
dbMotion and intraoperability
William Fera
Sean O’Rourke
12:00 p.m.
Break
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2:00 p.m.
UPMC Presbyterian, Physician Rounds
Robert Kormos
3:00 p.m.
Adjourn information-gathering portion of meeting
B.1.7
Site Visit on October 10-11, 2007 (Veterans Affairs Medical Center, Washington, D.C.)
October 10, 2007
1:00 p.m.
VistA and patient care services
Stanlie Daniels, Deputy Chief Officer, Patient Care Services
Mike Mayo-Smith, Chief Consultant, Primary Care
2:30 p.m.
VistA and patient safety
Neil Eldridge, Executive Assistant, National Center for Patient Safety
3:30 p.m.
VistA’s information technology architecture
Joaquin Martinez, Director, Software Engineering and Integration
Tracie Loving, Acting Portfolio Management Officer, Management, Enrollment, and Financial Systems
5:00 p.m.
Break and debriefing
October 11, 2007
8:00 a.m.
Chief residents’ rounds
Medical Service Conference Room
9:00 a.m.
Round with nurse or round with teams
Fourth Floor
10:00 a.m.
Greetings and facility overview
Fernando O. Rivera, Medical Center Director
Director’s Conference Room
10:30 a.m.
Electronic health records (EHR), My HealtheVet
Ross Fletcher, Chief of Staff
Director’s Conference Room
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12:00 p.m.
Lunch
1:00 p.m.
Surgical admissions nurse
Admissions Office, First Floor
1:30 p.m.
Emergency room
Kenneth Steadman
2:00 p.m.
Pharmacy
Linwood Moore, Assistant Chief
2:30 p.m.
Primary care (Yellow)
Neil Evans, Co-Chief, Ambulatory Care
3:00 p.m.
Comprehensive nursing and rehabilitation center/polytrauma rooms
Raya Kheirbek, Medical Director
3:45 p.m.
Adjourn information-gathering portion of visit
B.1.8
Site Visit on November 15-16, 2007 (HCA TriStar, Nashville, Tenn.)
November 15, 2007
8:30 a.m.
Welcome and overview of HCA
Kimberly Lewis, CIO, TriStar Division
9:00 a.m.
HCA information technology systems
General information on the number and different types of IT systems in use (e.g., clinical support systems, inventory management, medication management, etc.)
Annette Matlock, HDIS, Centennial Medical Center
David Archer, Director, Application Services-Technical
Darryl Campbell, Director, Application Services-Clinical
10:00 a.m.
Session with content development team
Melody Rose, Senior Clinical Analyst
11:00 a.m.
Visit medical surgery, ICU
Kelly Wood, Medical Director
ICU Nurses
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1:00 p.m.
Shadowing session: Doctor(s) on rounds
1:45 p.m.
Shadowing session: Nursing
2:30 p.m.
Observe workflow at a central nursing station
3:30 p.m.
Discussion with chief quality/safety officer
Ruth Westcott, Vice President of Quality, TriStar Division
4:15 p.m.
Observe workflow at pharmacy/central medication management location
5:00 p.m.
Adjourn information-gathering activities for the day
November 16, 2007—Observation Session
8:30 a.m.
Shadowing session: Doctor(s) on morning rounds
John Wilters, Obstetrics and Gynecology
9:15 a.m.
Shadowing session: Nursing
10:15 a.m.
Observe admissions and/or discharge process (perhaps including transition from outpatient to inpatient)
10:45 a.m.
Observe workflow in or take tour of emergency department
11:30 a.m.
Informal chat session with a small selection of doctors and nurses
1:00 p.m.
Adjourn information-gathering activities for the day
B.1.9
Site Visit on November 16-17, 2007 (Vanderbilt University, Nashville, Tenn.)
November 16, 2007
2:00 p.m.
VUMC overview
William W. Stead, Associate Vice Chancellor for Strategy and Transformation
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2:30 p.m.
Bed management
Marsha Kedigh, Manager, VUH Admitting/ED Registration
3:15 p.m.
Operating room schedule coordination and technology-enabled supervision
Ken Holroyd, Assistant Vice Chancellor for Research
4:00 p.m.
Pharmacy
David Gregory, Assistant Director for Education and Research, Department of Pharmaceutical Sciences
4:45 p.m.
Demo-process control dashboards and decision support
Neal Patel, Associate Professor of Pediatrics and Anesthesia
5:30 p.m.
Physician work rounds
Sara Hutchison, Manager, Trauma Unit
6:15 p.m.
Evidence-based content
Jack Starmer, Assistant Professor of Biomedical Informatics
6:45 p.m.
Nursing shift change
Sara Hutchison, Manager, Trauma Unit
November 17, 2007
8:30 a.m.
CVICU
Rashid M. Ahmad, Chief Informatics Officer
Vanderbilt Heart Institute
9:15 a.m.
Emergency Department
Corey Slovis, Chair, Emergency Medicine
10:00 a.m.
Architecture
John Doulis, Assistant Vice Chancellor
Chief Operations Officer
10:45 a.m.
RHIO
Mark Frisse, Director, Regional Informatics Program
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11:30 a.m.
Biomedical Informatics
William W. Stead, Associate Vice Chancellor for Strategy and Transformation
12:00 p.m.
Adjourn information-gathering portion of visit
B.1.10
Site Visits on December 3, 2007 (Partners, Boston, Mass.)
8:30 a.m.
Brigam and Women’s Hospital (BWH)
John Glaser and David Bates
9:40 a.m.
Overview of BWH inpatient clinical activities: Current and future state
10:00 a.m.
General discussion, questions and answers
10:30 a.m.
Tour of the BWH
Jeff Schnipper and Anuj Dalal
(Asked to emphasize contact/observation/interaction with doctors/nurses)
11:45 a.m.
Tour of central pharmacy and overview of medication safety from pharmacist’s perspective
1:00 p.m.
Massachusetts General Hospital
Henry Chueh, Director, Laboratory of Computer Science
Challenges and opportunities for information technology—what has worked at MGH
1:30 p.m.
Ambulatory care practice—Internal Medical Associates
Blair Fosburgh, Internist, IMA
What are important issues and opportunities for information technology in the practice of medicine?
2:00 p.m.
Carol Mannone, Nurse Leader
What are important issues and opportunities for information technology in nursing ambulatory care?
2:30 p.m.
Virginia Manzella, Administrator, IMA
What are important issues and opportunities for information technology in nursing ambulatory care?
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3:30 p.m.
John Goodson, Senior Internist, IMA
See and discuss the issues and problems of ambulatory care practice and the issues and opportunities for information technology
4:00 p.m.
Adjourn information-gathering portion of meeting
B.1.11
Site Visit on January 7-8, 2008 (Intermountain Healthcare, Salt Lake City, Utah)
January 7, 2008
8:30 a.m.
Welcome and overview of Intermountain Healthcare, Marc Probst, VP and Chief Information Office
9:00 a.m.
Intermountain Healthcare information technology systems
General information on the number and different types of IT systems in use (e.g., clinical support systems, inventory management, medication management)
Stan Huff, Chief Medical Informatics Officer
11:00 a.m.
Introduction to clinical programs at Intermountain Healthcare
Overview of integration of clinical practices with goals, direction, and information systems initiatives
Brent Wallace, Chief Medical Officer
11:45 a.m.
Discussion with chief quality/safety officer
How are quality, safety, and risk management issues addressed at Intermountain? What role does information technology play in ensuring quality and safety?
Lynn Elstein
Observation Session 1 Latter Day Saints Hospital
2:00 p.m.
Latter Day Saints Hospital: Shadowing session: Doctor(s) on rounds
2:45 p.m.
Latter Day Saints Hospital: Shadowing session: Nursing
3:30 p.m.
Latter Day Saints Hospital: Observe workflow at a central nursing station
4:30 p.m.
Observe workflow in or take tour of ED
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January 8, 2008
Observation Session 2—Intermountain Medical Center
8:00 a.m.
Welcome and facility/setting overview
8:30 a.m.
Shadowing session: Doctor(s) on rounds
9:15 a.m.
Shadowing session: Nursing
10:00 a.m.
Observe workflow at pharmacy/drug dispensary/central medication management location
10:45 a.m.
Session with content development team (e.g., order sets)
11:30 a.m.
Informal chat session with a small selection of doctors and nurses
Topics include quality, safety, technology, technology implementation, technology’s effects on workflow and patient care, and so on
12:30 p.m.
Adjourn information-gathering activities for the day
B.1.12
Site Visit on January 14, 2008 (UCSF, San Francisco)
8:00 a.m.
UCSF, Mount Zion Campus, Women’s Health Center
Introduction, overview, and quick tour
Jon Showstack, Michael Kamerick
8:30 a.m.
Regulatory overhead in clinical research
Jon Showstack
Extent and complexity of regulatory overhead of clinical research
Clinical health research considerations (Sharon Friend, Deborah Yano-Fong)
9:30 a.m.
Lack of integration of EMR and clinical research
Gail Harden
10:45 a.m.
San Francisco General Hospital
Brief introduction and tour of SFGH neurosurgical ICU
Geoff Manley
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11:00 a.m.
Complexity of data and metadata for querying across heterogeneous databases, especially for translational research
Geoff Manley
B.1.13
Site Visit on January 14, 2008 (PAMF, Palo Alto, California)
12:35 p.m.
Palo Alto Medical Foundation
Welcome and introductions (including working lunch)
Paul Tang
1:00 p.m.
Walk-through of ambulatory care setting
Steve Hansen
1:30 p.m.
Discussion of physician workflow challenges in EHR implementation
Paul Tang, Albert Chan, Charlotte Mitchell
2:30 p.m.
Pitfalls of deriving quality measures from EHRs
Paul Tang, Tomas Moran
3:45 p.m.
Billing and administrative costs from care
Gil Radtke, Neil Knutsen
4:15 p.m.
General discussion
4:45 p.m.
Adjourn information-gathering portion of meeting
B.2
SITE VISIT METHODOLOGY
For each site visit, the committee sought to:
Observe the best of what the site had been able to achieve.
Ask about what the site needed but did not have.
Obtain site input on the gap between needs and the state of the art of the health care information technology industry.
Identify, clarify, and categorize “pain points” for the site.
Identify where improvement is possible through application of existing knowledge and where further research is needed.
To preserve face time for interactive questions and answers, each site host was asked to provide as much background as possible as pre-visit reading material. Hosts were requested to limit formal presentations to a
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10-minute overview of their key messages, leaving the majority of each time block for interactive exploration. Where possible, hosts arranged for committee visitors to shadow care providers engaged in workday activities (e.g., on rounds, at the central nursing station). Shadowing teams were generally composed of one health care provider and one computer scientist (and one staff person), so that teams could operate in parallel.
Information requested in pre-visit reading material included:
Organization “facts” (FTEs, admissions, visits, research dollars, and so on)
Health care organization's organizational chart
Health care organization's strategic plan
IT organization chart
Information management or IT strategic plan
Information system inventory
Information technology architecture or standards specifications
Most recent wired survey responses
Last joint commission visit report
During each visit, the committee visitors sought to see or to hear about as many of the following facility components as possible:
Enterprise overview
IT/systems overview
Question and answer sessions
Chief quality/safety officer
Risk management
Observation points
Transition points
Bed control, transfer center, life flight
Emergency room to inpatient, outpatient to operating room to intensive care unit to intermediate care
Medication reconciliation, outpatient to inpatient to outpatientMedication reconciliation, outpatient to inpatient to outpatient
Nursing shift change, house officer signout
Settings
Shadow a nurse during medication administration
Shadow a doctor on morning rounds
Pharmacy
Inventory management
Eligibility/billing
Content management
Charge master, reimbursement contracts
Formulary, drug-drug interactions
Order sets, pathways
