The Children's Hospital of Philadelphia
IAIMS Progress Report
April 2005

Background

Over the last three years, The Children’s Hospital of Philadelphia (CHOP) has embarked on an ambitious initiative to support the delivery of optimal care across the enterprise through an enterprise-wide review of its infrastructure across its clinical, research, education, and information technology domains. The goal of this initiative, The Ideal Patient Experience, is to make the CHOP experience easier and more successful for patients, families and employees. In 2002, leadership at CHOP recognized the transformational role the National Library of Medicine’s Integrated Advanced Information Management System (IAIMS) program could play in contributing to the objectives of The Ideal Patient Experience and pursued IAIMS Planning funds to support an enterprise-wide dialogue on how best to leverage anticipated investments in information technology infrastructure. Funding was awarded in September 2002 and planning activities began shortly after that date.  CHOP submitted an Operations phase proposal in February 2005.

Key Accomplishments of IAIMS Planning

A. Library Assessment and Demonstration Projects

Due to clear interest in better access to knowledge resources, the IAIMS Library Working Group participated in several activities to recommend strategies for implementing electronic approaches to distributing digital resources. These activities included:

·        Convening internal digital knowledge team to develop a strategy for delivering content at the point of care

·        Conducting a comprehensive library assessment, including an evaluation and recommendations from an external medical library expert.

·        Identified short, mid-range and long-term goals for the expansion and enhancement of digital resources

·        Administering an online User Survey that included a needs assessment for specific content

·        Creating a web portal for library services linked with CHOP Intranet that includes:

• On-line digital catalogue of holdings
• Literature search requests
• Frequently asked questions

·        Clarifying and strengthening the relationship between CHOP’s user community and the Biomedical Library of the University of Pennsylvania.

 B. Clinical Decision Support Planning Workgroup

Throughout Year Two, an IAIMS Clinical Decision Support (CDS) Planning Working Group met with clinical leaders, researchers, and technology staff to explore and refine the objectives and activities of an Operations Proposal around CDS. Specific outcomes and activities of this group include: 

•  Identifying a methodology for prioritizing CDS interventions. The committee identified Failure Modes and Effects Analysis (FMEA) and adopted it as a method to be used to conduct patient safety analysis that will identify potential adverse events in the process of care at electronic health record (EHR) implementation sites. This method will be used to identify and prioritize the kinds of clinical decision support interventions that will be developed at CHOP.
• The committee conducted an FMEA analysis and identification of potential high risk adverse prescribing events at CHOP and made recommendations for the development of an prescribing alert system in CHOP’s electronic inpatient system.
• Exploring opportunities to integrate growing phenomic database with genomic data
  
  C. Biomedical Informatics
  
  As a result at least in part of IAIMS discussions, Steven Altschuler MD, CHOP’s CEO and IAIMS Principal Investigator, recognized the need for an organized informatics infrastructure, and tasked the head of the existing Bioinformatics Core, Peter White PhD, to develop a plan to create a department of BioMedical Informatics.
  
  Activities are underway to define its scope and configuration and there is commitment to launch this department in 2005. The specific purposes of creating this new department are to:
   
• Provide the infrastructure, tools, knowledge resources and skills necessary to synthesize and analyze available data—including clinical data, laboratory research, medical practice guidelines, and scholarly analysis
• Effectively support physicians and scientists in understanding, treating, diagnosing, and preventing disease.
• Provide an institutional home for clinical and bioinformatics activities and projects including IAIMS.
• Generate the academic curriculum and faculty that will help recruit and nurture the next generation of informaticians at CHOP.
  
   Ongoing Planning Activities

 Planning activities will continue throughout 2005 in anticipation of the activities described in the Operations Proposal.

•  Site visits—to review existing CDS interventions (e.g.,  and digital library projects (e.g., Columbia’s InfoButton), the IAIMS team anticipates conducting visits to several key institutions to discuss successes and barriers to overcome or avoid. Having knowledge about the most current status of these projects will better inform CHOP’s IAIMS team as we begin to develop CDS for the EHR.
• Department of Biomedical Informatics; the IAIMS team will continue to work with institutional leadership in the organization of a formal department structure for informatics which will be inaugurated in July 2005.
• Discussions with the University of Pennsylvania Biomedical Library; rebuilding a closer working relationship with Penn’s Biomedical Library has already yielded improvements for the CHOP user community. Ongoing dialog will focus on streamlining access to the digital holdings, especially for users of the EHR.