Vision for hospital's future HIT

By John Halamka

The role of the chief information officer is very operational -- keeping the trains running on time, ensuring budgets are sufficient and aligning IT resources with the needs of stakeholders.

One other important task of the CIO, however, is to market the work of the IT Department to internal and external audiences. Although IT staff and those involved in IT governance committees are interested in the granular details of projects and their time lines, many audiences want the vision - the big, audacious goals that are really transformational.

To ensure I target the right message to the right audience, I create two documents each year -- an operating plan and an "elevator speech." I'm working with all our governance committees over the next few months to complete the details of the operating plan, but here's my strawman elevator speech for 2009:

• We will lead the country in interoperable electronic health records

• Every doctor in New England affiliated with BIDMC or its associated organizations will have a hospital provided or hospital subsidized electronic health record with e-Prescribing and connections to our community data sharing systems by the end of 2011.
• Every patient will be given the opportunity to have a Patientsite, Google Health, Microsoft Health Vault or Dossia personal health record by the end of 2011.
• All inpatient documentation will be electronic and multidisciplinary by the end of 2011

• We will lead the country in "social networking tools" for health care.

• We will launch a new intranet which includes IM, blogging, wikis, and forums by the end of 2009 ensuring every doctor and staff member can be an author and publisher.
• We will pioneer the concept of the "patient specific healthcare wiki" for team management of patient medications, documentation of problem lists, and creation of clinical documentation by 2010. The idea behind this concept is that an entire community of caregivers should work together to create and maintain the lifetime medical record of each patient. This means that any caregiver should be able to add/amend/correct the patient's lifetime record, with a complete audit trail to identify every source of data and edits.

• We will use a combination of personal health records, electronic health records, and social networking tools to ensure continuity of care among all stakeholders in our community by 2011.

• We will lead the country in 'event driven' medicine.
• We will adopt electronic clinician notification systems for our hospital applications based on physician communication preferences (EHR, email, fax, page, cell phone) by the end of 2009. These systems will close the loop for laboratory, radiology, discharge, referral and other important communications needed to ensure safety.
• We will deploy business intelligence tools connected to our clinical data marts by the end of 2009.
• We will embrace next generation decision support tools from Safe-Med and others by the end of 2010. They will provide the business rules to trigger notification of clinicians. This will ensure that clinicians receive just in time information to deliver the best possible care.

These three concepts will be challenging to implement because the path to success is not entirely clear. There are few vendors or hospitals which have implemented this functionality. Along the way, I'll share all our lessons learned - good and bad.

John D. Halamka, MD, MS, is Chief Information Officer of the CareGroup Health System, Chief Information Officer and Dean for Technology at Harvard Medical School, Chairman of the New England Health Electronic Data Interchange Network (NEHEN), CEO of MA-SHARE (the Regional Health Information Organization), Chair of the US Healthcare Information Technology Standards Panel (HITSP), and a practicing emergency physician.