A Note from Dr. Bill Feaster, CHOC Children’s Chief Medical Information Officer

The Bill Holmes Tower at CHOC Children’s Hospital is now open, and all of the information technology supporting it is in place.  But, this doesn’t mean all the work on our newly installed information systems is done.  As with any project of this magnitude, there are issues of stabilization and optimization that continue to be addressed.  For example, some interfaces that weren’t developed in time for opening are now being addressed, such as the one between our Olympus endoscopy report generation system, Endoworks, and Powerchart.  We will soon be utilizing the “Depart” process for ambulatory surgical patients, but the tools to activate this are still under construction. 

Bill Feaster, M.D.
Bill Feaster, M.D.

 Another example of work still pending is the implementation of the Bridge transfusion system for nursing.  Like our positive patient ID systems for meds and blood draws which “close the loop” to prevent errors, the same process will be applied to blood transfusions.  Our build on this system is complete, and we expect this to be in place by the end of June.I realize that adapting to all the change over the past few months has been a difficult process.  The ability all of you have shown to adapt to this change and thrive in our new environment makes me very proud to be part of this organization.  It also reassures me that we are well positioned to deal with even more changes facing healthcare in the upcoming years.

Healthcare’s future will alter in a number of ways.  For example, payment reforms will require us to audit and improve the quality and detail of our clinical documentation.  Of course, this is something we should be focusing on anyway to best communicate to our colleagues about the care we’re providing.  APR-DRGs are coming to children’s hospitals this July as California’s MediCal program is changing over from per diem reimbursement to this detailed DRG-based payment mechanism.  The more complete the information about a patient’s care is documented in the chart, the more accurate an APR-DRG can be assigned to each case.  In addition, by next fall we will be shifting from ICD-9CM to ICD-10 diagnostic coding.  ICD-10 is comprised of over 155,000 codes, up from the current 24,000 and will affect all specialty areas.  To help us transition to these new coding systems, we will be starting a Clinical Documentation Improvement (CDI) program at CHOC.  Stay tuned for more information on this important new program.

Another focus over this next year is to continue to improve our communication with our referring physicians.  While for now we must continue to improve our ability to fax results to referring physicians, the complexity of the information contained in the electronic record and the need to start managing populations of patients will mandate new forms of communication, including a more robust Healthcare Information Exchange (HIE) initiative and direct electronic transfer of information to some of the larger groups using CHOC’s facilities.  Both of these and additional approaches are currently being pursued.  Communication with our patients will also undergo change over the next few years as we implement a robust patient portal.

These and additional  projects such as implementing Cerner’s Advanced Medication Reconciliation  software, expanding electronic provider documentation across our remaining paper-based clinics and into inpatient areas, and implementing a sophisticated new case management system, will certainly keep us busy this next year. I would be remiss, however, if I didn’t mention at least one other major initiative already underway.  The true value of all of this electronic information is the ability to analyze and report on all this data to improve the care we provide.   As of the first of the year, Dr. Elizabeth Campbell, medical informaticist at CHOC, joined our IT staff to help us do exactly that.  Dr. Campbell is an expert in data analytics and will help guide and manage our transition to a more clinically-focused data warehouse and analytic capability.  This is a multi-year development project, but we hope to produce a lot of “quick wins” along the way.

If you have any questions, concerns or suggestions related to IT initiatives at CHOC, please feel free to contact me by email at wfeaster@choc.org.