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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 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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Computational Technology for Effective Health Care: Immediate Steps and Strategic Directions 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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Computational Technology for Effective Health Care: Immediate Steps and Strategic Directions 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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Computational Technology for Effective Health Care: Immediate Steps and Strategic Directions 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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Computational Technology for Effective Health Care: Immediate Steps and Strategic Directions 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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Computational Technology for Effective Health Care: Immediate Steps and Strategic Directions 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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Computational Technology for Effective Health Care: Immediate Steps and Strategic Directions 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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Computational Technology for Effective Health Care: Immediate Steps and Strategic Directions 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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Computational Technology for Effective Health Care: Immediate Steps and Strategic Directions 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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Computational Technology for Effective Health Care: Immediate Steps and Strategic Directions 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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Computational Technology for Effective Health Care: Immediate Steps and Strategic Directions 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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Computational Technology for Effective Health Care: Immediate Steps and Strategic Directions 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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Computational Technology for Effective Health Care: Immediate Steps and Strategic Directions 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