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What the Boston Children’s Physician Leaders Understand about Clinical IT Development—and Where It’s All Headed

April 29, 2013
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The implications of the Boston Children’s innovation for clinical informatics development going forward are tremendous


It was fascinating recently to hear Melvin C. Almodovar, M.D. and Peter C. Laussen, M.D. describe the clinical transformation work that began a number of months ago at Boston Children’s Hospital under their leadership, and is now also spreading to Toronto’s Hospital for Sick Children, Since Dr. Laussen transitioned from Boston Children’s to that hospital last year. As I recounted in a recent article, Drs. Laussen and Almodovar saw the potential to leverage a potential relationship with a software vendor as an opportunity to truly enhance care management for infants in the hospital’s intensive care units, and seized it.

Essentially, Drs. Laussen and Almodovar looked at a problem with the care management of children with congenital heart problems who are cared for in hospital intensive care units—the challenge of having to personally monitor and analyze huge amounts of data derived from patient monitoring machines—and sought a way forward towards pathbreaking innovation. And, having been approached by a software vendor, the Burlington, Mass.-based Arcadia Solutions, they brought the Arcadia people into the discussion, and moved into a co-development initiative that has led to advanced new solutions to support the integration of data from patient monitoring devices into real-time care management in the intensive care unit (ICU) and cardiac intensive care unit (CICU) care areas.

There are several elements to this story that I found both fascinating and well worth pondering for lessons learned. First, the two physician leaders realized that, in order to self-develop, they would need to co-develop: the kinds of innovations they imagined were simply not possible to develop internally, and they needed a vendor partner that could partner with them in the truest sense. Second, very importantly, it was the physicians themselves who conceived of the set of solutions they needed, solutions that were profoundly connected to core clinical processes they wished to improve and whose improvement could potentially improve patient outcomes. Third, they understood that it would take considerable time to develop this new set of solutions, a set of solutions that, as far as these leaders believed, had never been implemented anywhere else. As a result, fourth, they were able to find resources outside their organization’s core IT budget in order to finance development, which was especially important in the early stages of development. Fifth, they persevered, through trial and error and initial development stages, until what they were able to create had become clearer and more achievable. And sixth, in the end, they created something important that is both sustainable and replicable, which means that their achievement could help the entire industry, and therefore, patients across the United States and beyond.

What Drs. Laussen and Almodovar has done, I will be so bold as to predict, represents one element in the wave of the future, insofar as the development of specific clinical informatics innovations is concerned. Now that the vast majority of hospital-based organizations have implemented or are soon to implement the core clinical information systems they must have to participate in the new healthcare—electronic health records, computerized physician order entry, electronic medication administration records, advanced pharmacy systems, and imaging informatics systems—and soon afterwards, the systems that will support accountable care, population health management, and value-based purchasing—data warehouses, performance dashboards, business intelligence and analytics, and so on—it seems clear that some very important remaining innovations will need to be driven by clinicians, including specialist physicians.

And this set of solutions around patient monitoring in the neonatal and pediatric intensive care units is a perfect example of that kind of innovation, one that can’t be achieved without clinicians driving the process from the start and being integral to the management of the process. I also believe that this kind of situation offers CIOs, CMIOs and other healthcare IT leaders wonderful opportunities to collaborate with physicians for truly win-win results.

In sum, this new set of horizons we face, around abundant opportunities to address niched or specific clinical care and care management issues, opens the door on the potential for very significant advances in clinical informatics, advances that ultimately will benefit our entire society. But more and more, these very clinically specialized opportunities will need to be clinician-driven to succeed, or even to be recognized. In that context, what has taken place at Boston Children’s Hospital is definitely a case study for consideration for its broad implications for all of us going forward.