Executive Summary

The Pediatric Technology Task Force (PTTF) was created by Dr. Thomas Green, Chairman of the Department of Pediatrics at Northwestern University Feinberg School of Medicine (NUFSM) and Chairman of the Department of Medicine at Children's Memorial Hospital (CMH) to address strategic goals concerning improvement of clinical service operation, aligned strategic development, and research growth.

PTTF was charged to:

• Evaluate the utility of information technology as system solutions for clinical and academic program priorities
• Evaluate and recommend hardware, software, and training for implementation of systems
• Lead implementation of information technology and serve as faculty leaders of these initiatives
• Work collaboratively with information technology from the university and CMH to insure the greatest possible integration and highest efficiency
• Advance information technology implementation in the Department to support clinical and academic goals

The PTTF met regularly to review background documents; meet with key stakeholders, vendors, and advisors; create a library of relevant resources at http://stumpf.org/pttf; and formulate opinions and recommendations.

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Key Findings

1. Technology at CMH is ranked poorly by Pediatric division chiefs and clinical practice directors (D grade)
2. There is great interest in and commitment to improve technology by division chiefs and clinical practice directors
3. A faculty email/web survey produced a 75% response (N=196). Results are:
   • 96% use the web
   • Only 55% of surveyed faculty read their CMH email; 41% use NU and not CMH email. Thus, we cannot communicate through a single channel.
   • Billing, chart management, and scheduling were highly ranked priorities for a technology solution
   • Research technology must also advance to support current faculty needs. Advanced computational resources will dominate many clinical and translational research programs.
4. Introducing an EMR was a high priority for Division Chiefs, Clinical Practice Directors and faculty. Greatest needs expressed were for:
   • Clinical medical record (ambulatory and in-patient)
   • Electronic billing and coding
   • Scheduling
5. Comparable and competitive institutions are investing heavily in technology
6. The national healthcare environment has major signals that information technology will become increasingly important
   • The Department of Health and Human Services has mandated the adoption of health data standards and set in motion a fast track process to accomplish this and incorporate them into applications within 24 months; this process is about 20% complete.
   • Congress is expected to pass legislation establishing "Patient Safety Organizations" (PSOs) with legally-protected methods for accumulating patient safety data; physicians and institutions will report to these PSOs.
   • The recent IOM report "Patient Safety: Achieving the Standard for Care" recommends and call upon Congress to mandate an accelerated adoption of standards, implementation of the EMR and development of safety reporting.
   • The ACGME has mandated increased reporting of housestaff experiences using electronic reporting systems. Compliance will be a requirement for recertification of training programs.
   • The PTTF concludes that these national trends will make an EMR an essential tool for remuneration from Federal sources and for compliance with an increasingly data driven regulatory environment.
7. CMH administration
   • CMH does not mention information technology in its strategic planning documents
   • Division chiefs rank CMH administration's commitment to technology solutions as less than their own
   • The CMH Information Management department lacks key personnel and has insufficient resources to accommodate the needs of the faculty in addressing the clinical, educational, research, and advocacy missions of the Department.
8. Although our mission was confined to Pediatrics, PTTF suggests that these finding will be shared by most physicians at CMH. In preliminary discussions with surgical colleagues, PTTF identified common ground on most of these issues.
9. Each of these missions is interdependent

Key Recommendations

A convergence of opinions, ideas, and imperatives has developed, leading us to recommend:

1. Embrace a NEW VISION OF TECHNOLOGY so that technology solutions can be optimally applied to all core missions
   • medicine is a scientific endeavor requiring extraordinary data manipulation
   • the level of complexity of medical information exceeds the capability of human minds
   • managing data is, per se, a core mission requiring the highest priorities
2. An accelerated pace of and higher priority for implementing key technology solutions is urgently needed to
   • ensure patient safety
   • address erosion of our competitive advantage
   • meet the increased information burden related to regulation of clinical care, educational programs, and research
   • address widespread dissatisfaction with current technology limitations
   • improve business operations and financial performance
   • reduce risk of adverse litigation and penalties
3. Administrative reorganization is required
   • Creation of the Children's Computing Resource Center (CCRC) to
     • restructure technology administration to foster collaboration and leverage valuable resources
     • develop business rules governing the management of shared resources and data
     • develop, seek approval, and implement a business model that accommodates the various agendas of participating constituencies
   • Creation of the Pediatric Technology Group (PTG) to
     • advise the chair on technology issues
     • address unresolved, future, and ongoing technology issues
     • enlist participation of and coordination between key constituencies
4. Specific implementation recommendations include:
   • Implement Epic software
     • The PTTF endorses Epic Systems, Inc. as the vendor of the EMR
     • A fast track is required to meet Institute of Medicine guidelines which are driving policy for Congress, regulators, and payers. The IOM proposes a 24 months timeline.
     • Based on rollouts at comparable institutions, an strategic investment of approximately $20,000,000 is required over the course of the project.
     • A successful rollout will require leadership at the highest levels of the organization and espousal of the new vision (see above).
   • Develop a Medical Informatics Program to
     • support the CCRC (see above)
     • develop a cadré of faculty and technical staff to
       • provide a critical mass for academic productivity
       • provide faculty advocates and advisors for technology solutions throughout the academic enterprise
     • foster development of technology solutions and resources for
       • decision support
       • data extraction
       • management of clinical trials
       • support of basic research
       • educational programs
     • provide informatics training for
       • residents and fellows
       • faculty and staff
       • clinical trials and informatics trainees
   • Create a Data Manager Position. While inherent in several recommendations above, the PTTF considered the recruitment of a skilled data manager as a high priority and a necessary prelude to formulating plans for other programs.

PTTF Members
David A. Stumpf, MD, PhD, Chair (Neurology)
Mark D. Adler, MD (Emergency Medicine)
Denise Goodman, MD, MSc (Critical Care)
Vita J. Land, MD, MBA (Oncology; Chair IRB)
Stephen G. Pophal, MD (Cardiology)
Michael Miller, MD, ex officio (CMH IM Medical Director)
Andrea Rahlf, MA, CMPE, ex officio (PFF COO)
Malika Reagon, ex officio (Staff Support)