3/26/2011
Dean Smith MD, MBI
Senior Advisor for Medical Informatics
S i Ad i f M di l I f
i
US Department of State, Washington, DC
[email protected]
MED’s IT Projects
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Electronic Health Record (EHR)
(
)
Telemedicine (& TeleSOAP)
The MCI (the “new” PCD)
Customer Dashboard
MED SharePoint Site
Scanned Documents (aka LaserFiche)
Others Projects & Initiatives: electronic prescribing &
immunizations, SMART, Internet site, Privacy Training
“The computer has replaced the stethoscope as the most important tool for our clinicians” – Roger Baker, CIO, Veteran’s Administration
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3/26/2011
EHR vs. EMR
 What
What’s
s the difference?
 An EMR is simply an electronic version of the paper
medical record.
 An EHR is an EMR that extends beyond the provider’s
office through exchange of information.
 EHRs must be interoperable and have integrated or
t th d applications
tethered
li ti
such
h as personall health
h lth records
d
and registry interfaces.
“A $40K EHR is like a $40K grand piano. Whether you play Chopin or Chopsticks depends on your training” ‐Ron Moody, MD, CMIO Military Health System
MED’s EHR Project
Our EHR vision: “buy not build”… “COTS not GOTS”…
g
not isolated”
“Integrated
“Don’t let perfect be the enemy of good” ‐ Voltaire In December we completed Phase 1 of our EHR project :
 We enlisted the support of IRM’s Project Service Office.
 We interviewed our “lines of business” and mapped our
workflow.
 We defined the clinical capabilities our future EHR must have.
 For example: robust immunization and electronic prescribing
modules, scheduling, scanned documents, and pharmacy
inventory management tools, a patient portal.
 We now have the core functional requirements - clinical,
technical and security- for our future EHR.
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The EHR Project  We recently
y issued a Request
q
for Information ((RFI))
to the EHR COTS vendor community.
 27 responses were received and included most of
the key players in the EHR market (Epic, Cerner,
eClinicalWorks, Allscripts etc).
 These responses will be very helpful as we move
forward with p
phase II – Acquisition
q
– and issue a
Request For Proposal (RFP).
“An RFI is a Request for Inertia … an RFP is a Request for Prevarication”
‐John Kenagy, CIO, Providence Health Systems
The EHR Project
 We are also exploring the possibility of sharing the
Coast Guard’s
Guard s recently acquired EHR (Epic)
(Epic).
 This would shorten our time frame, reduce costs,
and show interagency collaboration and
interoperability.
 We’re conducting an Cost Benefit Analysis to assess
y intriguing
g g option.
the feasibilityy of this very
 Stay tuned – more to follow very soon.
“Let us never negotiate out of fear, but let us never fear to negotiate” ‐ JFK
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3/26/2011
Telemedicine
Telemedicine
If you can
If
you can’tt bring the mountain to Mohammed, bring Mohammed to bring the mountain to Mohammed, bring Mohammed to
the mountain ‐Proverb
 MED is piloting telemedicine at HUs Paramaribo (sending) and
Caracas (receiving).
 Lessons learned so far – it works, but network settings and user
training are crucial.
 Our network traffic varies, and telemed transmission may not work so
g network “rush hour.”
well during
 We have a telemedicine system set in MED for training and for
telemed conferences with the field.
 More details regarding our telemed program on our SharePoint site:
http://med.m.state.sbu/ex/mi/systems/Pages/Telemedicine.aspx
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TeleSOAP ‐ A simplified version of oMED
The MCI – our “new” PCD
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The MCI Work on the MCI (Medical Capabilities Information Database) is nearing
completion.
The MCI will have several distinct advantages over the existing PCD:
 Highly customizable by MED, making future enhancements easy.
 Has a patient portal where they can get post- and condition-specific
information, making their bidding process much more transparent.
 Incorporates a MED personnel database, and will interface with the HR
database, so tracking our demographics and credentials will be much easier.
 Has a bidding tool so that our assignments can be readily administrated.
 Much easier to update and maintain.
maintain
Note: the MCI will only be as useful as the information in it is accurate.
“We are only as good in treating patients as the information we have.” ‐David Blumenthal MD, ONC
Corollary ‐ We are only as good in clearing patients as the information we have.
MED Customer Dashboard
 We’re creating a customer dashboard tool – a site where
MED ““customers”
t
” go to
t gett real-time
l ti
information
i f
ti
regarding the status of their business process with MED.
 We’re starting with 2 sections that generate the majority
of our customer inquiries – Clearances & Finance.
 It will be hosted on our MED SharePoint site.
 The tool will initially
y be limited to those with Intranet
access, but the same functionality can be incorporated
into a Personal Health Record portal in our future EHR.
“Ask your customers to be part of the solution, not part of the problem”
‐Alan Weiss
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MED SharePoint site
When you need info about MED please check our SharePoint Website first.
And give us your feedback to make it better – and more useful – for you.
Scanned Documents (LaserFiche)
Access to our LaserFiche System merits clarification:
It is limited to MED direct hire personnel - here
here’s
s why:
 The system cannot be configured to access control, i.e. once
in you have access to all the content in it.
 Some of the patient-specific information in the system is
sensitive (e.g. mental health related).
 Making it accessible to all violates Privacy regulations
 And yes, we do routinely audit system access.
Note: a document management system will be an integrated
component of our EHR, and that system will have role-based
access control.
“You know you have a successful IT application when users do not tolerate any downtime.” ‐Bill Hersh, MD
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Change Management
“An EHR implementation is like upgrading the engines on an airplane while it is flying” ‐
Robert Murry, MD, PhD
Questions?
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