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National Research Council (US) Committee on Engaging the Computer Science Research Community in Health Care Informatics; Stead WW, Lin HS, editors. Computational Technology for Effective Health Care: Immediate Steps and Strategic Directions. Washington (DC): National Academies Press (US); 2009.

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

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Appendix BMeeting 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. WelcomeWilliam W. Stead, ChairJon Eisenberg, CSTB
9:40 a.m. Charge to the committeeDonald 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
  • 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 techniciansEric Dishman, Gina Grumke, and Monique Lambert

B.1.4. Meeting 4—January 28-29, 2008 (San Francisco)

Entirely closed session for report development

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 UPMCJames 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 FeraSean O’RourkeJody CervenakEd McCallister
9:15 a.m. Magee-Womens Hospital of Pittsburgh of UPMCoverview and demonstration: PPID (Positive Patient Identification)(Nursing shadowing session)Kim GraceyMichele Steimer
11:30 a.m. Children’s Hospital of Pittsburgh of UPMCoverview and demonstration: CPOE (Computerized Physician Order Entry)(Shadowing session)Jacque DaileySteven DocimoJames LevinJocelyn Benes
2:30 p.m. Tour of Wiser InstituteTom Dongilli
4:00 p.m. Tour of data centerJeff Szymanski
4:30 p.m. Discussions of UPMC IT systems’ technical underpinningsPaul Sikora
9:15 a.m. Magee-Womens Hospital of Pittsburgh of UPMCoverview and demonstration: PPID (Positive Patient Identification)(Nursing shadowing session)Kim GraceyMichele Steimer
11:30 a.m. Children’s Hospital of Pittsburgh of UPMCoverview and demonstration: CPOE (Computerized Physician Order Entry)(Shadowing session)Jacque DaileySteven DocimoJames LevinJocelyn Benes
2:30 p.m. Tour of Wiser InstituteTom Dongilli
4:00 p.m. Tour of data centerJeff Szymanski
4:30 p.m. Discussions of UPMC IT systems’ technical underpinningsPaul Sikora

September 13, 2007

6:30 a.m. Informal chat session with physiciansRobert KormosVivek Reddy
7:30 a.m. Overview of quality initiatives and TheradocTami Merryman
9:00 a.m. eRecord overviewDaniel Martich
10:00 a.m. dbMotion and intraoperabilityWilliam FeraSean O’Rourke
12:00 p.m. Break
2:00 p.m. UPMC Presbyterian, Physician RoundsRobert Kormos
3:00 p.m. Adjourn information-gathering portion of meeting
2:00 p.m. UPMC Presbyterian, Physician RoundsRobert 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 servicesStanlie Daniels, Deputy Chief Officer, Patient Care ServicesMike Mayo-Smith, Chief Consultant, Primary Care
2:30 p.m. VistA and patient safetyNeil Eldridge, Executive Assistant, National Center for Patient Safety
3:30 p.m. VistA’s information technology architectureJoaquin Martinez, Director, Software Engineering and IntegrationTracie 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’ roundsMedical Service Conference Room
9:00 a.m. Round with nurse or round with teamsFourth Floor
10:00 a.m.Greetings and facility overviewFernando O. Rivera, Medical Center DirectorDirector’s Conference Room
10:30 a.m. Electronic health records (EHR), My HealtheVetRoss Fletcher, Chief of StaffDirector’s Conference Room
12:00 p.m. Lunch
1:00 p.m. Surgical admissions nurseAdmissions Office, First Floor
1:30 p.m. Emergency roomKenneth Steadman
2:00 p.m. PharmacyLinwood 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 roomsRaya Kheirbek, Medical Director
3:45 p.m. Adjourn information-gathering portion of visit
12:00 p.m. Lunch
1:00 p.m. Surgical admissions nurseAdmissions Office, First Floor
1:30 p.m. Emergency roomKenneth Steadman
2:00 p.m. PharmacyLinwood 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 roomsRaya 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 HCAKimberly Lewis, CIO, TriStar Division
9:00 a.m. HCA information technology systemsGeneral 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 CenterDavid Archer, Director, Application Services-TechnicalDarryl Campbell, Director, Application Services-Clinical
10:00 a.m. Session with content development teamMelody Rose, Senior Clinical Analyst
11:00 a.m. Visit medical surgery, ICUKelly Wood, Medical DirectorICU Nurses
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 officerRuth 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
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 officerRuth 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 roundsJohn 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 overviewWilliam W. Stead, Associate Vice Chancellor for Strategy and Transformation
2:30 p.m. Bed managementMarsha Kedigh, Manager, VUH Admitting/ED Registration
3:15 p.m. Operating room schedule coordination and technology-enabled supervisionKen Holroyd, Assistant Vice Chancellor for Research
4:00 p.m. PharmacyDavid Gregory, Assistant Director for Education and Research, Department of Pharmaceutical Sciences
4:45 p.m. Demo-process control dashboards and decision supportNeal Patel, Associate Professor of Pediatrics and Anesthesia
5:30 p.m. Physician work roundsSara Hutchison, Manager, Trauma Unit
6:15 p.m. Evidence-based contentJack Starmer, Assistant Professor of Biomedical Informatics
6:45 p.m. Nursing shift changeSara Hutchison, Manager, Trauma Unit
2:30 p.m. Bed managementMarsha Kedigh, Manager, VUH Admitting/ED Registration
3:15 p.m. Operating room schedule coordination and technology-enabled supervisionKen Holroyd, Assistant Vice Chancellor for Research
4:00 p.m. PharmacyDavid Gregory, Assistant Director for Education and Research, Department of Pharmaceutical Sciences
4:45 p.m. Demo-process control dashboards and decision supportNeal Patel, Associate Professor of Pediatrics and Anesthesia
5:30 p.m. Physician work roundsSara Hutchison, Manager, Trauma Unit
6:15 p.m. Evidence-based contentJack Starmer, Assistant Professor of Biomedical Informatics
6:45 p.m. Nursing shift changeSara Hutchison, Manager, Trauma Unit

November 17, 2007

8:30 a.m. CVICURashid M. Ahmad, Chief Informatics OfficerVanderbilt Heart Institute
9:15 a.m. Emergency DepartmentCorey Slovis, Chair, Emergency Medicine
10:00 a.m. ArchitectureJohn Doulis, Assistant Vice ChancellorChief Operations Officer
10:45 a.m. RHIOMark Frisse, Director, Regional Informatics Program
11:30 a.m. Biomedical InformaticsWilliam W. Stead, Associate Vice Chancellor for Strategy and Transformation
12:00 p.m. Adjourn information-gathering portion of visit
11:30 a.m. Biomedical InformaticsWilliam 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 BWHJeff 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 HospitalHenry Chueh, Director, Laboratory of Computer ScienceChallenges and opportunities for information technology—what has worked at MGH
1:30 p.m. Ambulatory care practice—Internal Medical AssociatesBlair Fosburgh, Internist, IMAWhat are important issues and opportunities for information technology in the practice of medicine?
2:00 p.m. Carol Mannone, Nurse LeaderWhat are important issues and opportunities for information technology in nursing ambulatory care?
2:30 p.m. Virginia Manzella, Administrator, IMAWhat are important issues and opportunities for information technology in nursing ambulatory care?
3:30 p.m. John Goodson, Senior Internist, IMASee 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 systemsGeneral 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 HealthcareOverview of integration of clinical practices with goals, direction, and information systems initiativesBrent Wallace, Chief Medical Officer
11:45 a.m. Discussion with chief quality/safety officerHow 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

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 nursesTopics 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 CenterIntroduction, overview, and quick tourJon Showstack, Michael Kamerick
8:30 a.m. Regulatory overhead in clinical researchJon 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 researchGail Harden
10:45 a.m. San Francisco General HospitalBrief introduction and tour of SFGH neurosurgical ICUGeoff Manley
11:00 a.m. Complexity of data and metadata for querying across heterogeneous databases, especially for translational researchGeoff Manley

B.1.13. Site Visit on January 14, 2008 (PAMF, Palo Alto, California)

12:35 p.m. Palo Alto Medical FoundationWelcome and introductions (including working lunch)Paul Tang
1:00 p.m. Walk-through of ambulatory care settingSteve Hansen
1:30 p.m. Discussion of physician workflow challenges in EHR implementationPaul Tang, Albert Chan, Charlotte Mitchell
2:30 p.m. Pitfalls of deriving quality measures from EHRsPaul Tang, Tomas Moran
3:45 p.m. Billing and administrative costs from careGil 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 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
Copyright © 2009, National Academy of Sciences.
Bookshelf ID: NBK20638
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