September 2022 Information Technology Committee Meeting
Welcome, and thank you for joining us today for the meeting of the New York City, health and hospitals, information technology committee, today's meeting is officially called to order next on the agenda. I would like to, uh, have a motion to approve the minutes of information technology committee meeting hell on June, 13, 2022. I will any seconds. i will any seconds Yes, thank you. Uh, does any any committee member has any question concerning the minutes? Now, so I will take a, uh, a poll of all the committee members. Um.
Yes Dr cats. Yes. I also go yes, thank you. The meeting, uh, the minutes are adopted, uh, next we will have the report Kim. Thank you. Mr chairman come in depth here senior, vice president CIO for New York City, health and hospital and I'm joined today starting on my left with Shama, dorie. Who's our chief information security officer next to? Her is a corporate carrier. Who's our AVP for finance and administration immediately to my left is Jeff lots, our chief technology officer who will be working on our technology issues right?
After our meeting here and I'm also joined by Dr Michael. Our chief medical information officer we can oh, thank you. We have our agenda here. We'd like to provide some general updates. Our focus today will be on our data center migration. We have some really good feedback and some updates there as well as we'll highlight some key clinical Informatics and application areas and I'll close with an overview of some of our acknowledgement for our staff work. Um, we can go to the next slide. I've included this slide. This is an alignment of our New York City, health and hospital technology department. 22,022 goals, uh, will not read through all of them, but you can see that. A highlighted to the right of each 1 of the different 5 categories is the alignment with our mission and vision of the organization. Uh, we can go to the next slide.
And here, we'll start with our data center migration just reminding everybody our data center is actually a 2 year project. That is the migration from our 2 data centers uh, who were at end of life and 22, new data centers. Our 1st, 1 is going from, uh. uh Over to the overall project, which started in May of 2021, uh, with the in line for both of them to be, um, on board by May of 2023. we are currently 63% complete on the overall project meeting the 2 data center migrations. However, we are over 90% complete on our 1st transition from over to, and just wanted to pause there and recognize all. over to and just wanted to pause there and recognize all
For our staff members who have. Been working diligently to meet that expectation and we will be transitioning out of, uh, by the beginning of October. We actually had work this weekend that was done by Metro, +, and having some moves and we have completed all of the 13. what we call move ways that was completed by. August 9th, 2022, and currently epic is running over at our which started in July. We've also improve some of our Internet redundancy in some capacity in the month of August. And our focus today. We'll actually be on some of those enhancements of our process, and some new technology that we'll be able to take advantage of, of the new data centers. We can go to the next slide. go to the next slide This is a visual of what I just reported, it gives the overall timelines and how we're tracking to that we remain on target and on budget for the overall project. Thank you.
You know, 1 of our focus in is our ongoing continuous quality improvement to have a reliable in a secure environment looking at enhancing our processes from a specifically around some of the operational areas. Um, and ensuring that we. Keep ourselves abreast of best practices in this area. We will be moving forward with leveraging our Cisco vendor resources as a component of our change management review. Anytime we have a change within our system.
We have a a detailed process so that we are able to have all the stakeholders involved and to ensure that we evaluate, um, the change itself. Any, um, interfacing that might need to be done the training of staff and implementing that. Also part of our, our is the augment of failover capabilities for the data center, and the local facility main distribution framework, uh, capabilities. In addition to that is our review of critical, critical infrastructure and a refresh. As we move each time of the configuration, uh, of our environment, and, of course, the deployment of our future technology and leveraging our new data centers, which I'm going to turn over to Jeff at this point, uh, we can move to the next slide. And we'll have an overview of like, 4 key areas, uh, future technology that we're taking advantage of some of those. Now.
Yes, thank you. Kim and, uh, good morning. All. So, what you see on this line reviews, as Kevin mentioned, some areas that we're able to now with putting in some new equipment as well as with our partnerships with our vendors. To really help to improve the environment both from a performance and a resiliency. Perspective, um, as we move into these new data centers. And at the same point, we can leverage not only in the data centers, the same technology, but we can also leverage it at our facility level as well.
So also, similarly, improving the experience there, uh, for our end users and patients alike in each of these. So, the, the 1st, 1 talks about our configuration. Which basically talks about an application centric infrastructure. Um, so in this 1 is truly built for within the data center. It allows us to do some, uh, basically what they call some segmenting. Um, and. And to prioritize, uh, traffic as well as, uh, break the traffic for each of the applications into smaller groups, uh, that way if something is affected for 1, it doesn't affect everybody else. That's there. Um, the next 2 between the Nexus dashboard and the DNA center. Um.
As well is the ability now to we have as you can imagine thousands upon thousands of these devices that are out there. So anytime we need to make a change previously. It involved a lot of manual effort and having to visit these and touch it and would also be interruptions and then potentially human error involved inside of there. Um, as you're pushing updates or making configuration changes, what this allows us to do now is from a central perspective. Look at those, these changes and push those changes out in a controlled fashion, uh, as well as the reboots restarts of these devices, um, and ensure that we're doing this consistently across the environment as well as give us a better holistic view of the environment much like we do with the, uh, desktops today, we can control when these, when these are pushed as well as, when they're, um, updated and started.
And the final 1 is, um, what they call software defined access um. That allows us now as well as from the application, but then from now, the end user so to say, take things like biomedical devices or other devices that are on there, we can look at and say and prioritize where their traffic is going. So that they're talking to their applications much quicker, and again in a much more stable fashion and give us the visibility. To see, if there's any interruption or issues with those devices specifically, and then thus responding to that, or again approving those performances. So these are some of the new things that we're, we're able to take advantage of uh, not only within the data center.
But as we build that out there, then we can similarly spread that to our end locations. Thank you Joe chairman, I'm gonna pause here for a moment and then we'll move into clinical applications and implemented. Okay. Let me pull the members to see if they have any questions for saying any questions. No, no questions. Thanks. Dr. Questions Thank you. Okay. I just have a question if you go back to the slide of the, uh, network, uh, the, the future technology um. Are these, um, deployment for this technology enable because of the data migration, or they are independence that means that are we going to be able to use this technology? Even during the time of the migration, or we will make use when that data migration is complete.
Great question. So, um. For it, we're able to use it today. Uh, and, uh, the only place that didn't have it because we were moving out of there very quickly was within. Right. Uh, but we but similarly, we have actually made those changes within.
Uh, Jacobi, uh, but, uh, but the, the new data centers will also have them, and we are actually making these changes as well. Um, at each of the, at each of the facilities. I know King's and Bellevue, for example, uh, already have, um, elements of these, uh, pushed out to their. Um, as well, as Coney Island, uh, with their all their new building and everything, we'll, we'll have all of these. So we.
So, we are, we are rolling this out enterprise wide as well. Okay, I will these, uh, technology be able to also allow you to deploy any upgrades to the instrument that are connected. I know that in the past, we have had some presentations about different machines that were connected and will these. Allow you to deploy any security fix or whatever you need to deploy to those machines, or this only are referred to actual PC computers in desktops and. So, this, this, this technology right here only applies to our network infrastructure as well as our voice infrastructure on the back end. So, all of the network gear.
The switches the routers are firewalls as well as the access points as well as our phones. Um, that are currently using voiceover IP Webex. Um, and the, like, those, those are what's what's managed and, uh, pushed. Through through these to these services, it will not it would not unfortunately touch. Um, the BioMed instruments, for example, it, it could help to. Highlight and show where they are, um, and that's what the security technology leverages.
Some of this technology for it, um, as well as. Allows us to place it into a more of a singular view in a bucket for them. So they know everything that's connecting to is connecting in into 1 place, as opposed to today where they could connect to multiple. Um, so so, um, so it's only it's only our network infrastructure as well as their voice, which is also being run through Cisco, is where this is managed. Okay, I are they are we working or do we feel that is a need to look at how to deploy more centralized.
Those equipment, or do you think that the current infrastructure that we have is is is good enough for what we are doing with those equipment? Yeah, I'm going to ask, you know, that's an excellent question. So Sharma actually our our chief security officer we have from our applications already in place you want to speak to that shortly sure. So thank you very much. Um, so basically, we have as part of our layer defense, um, it's several security products that are already rolled out to the enterprise to protect from cyber security incidents specifically with biomedical. We have an inventory tool that assesses. The risk level for all of our BioMed devices that has been deployed and in place for the last year.
So, that's something that we continue to work with as part of our layer defense and the other portion that Jeff just mentioned these new technologies also help with segmentation as well. So, in the event of a cyber security incident, we could segment off, um, particular devices. If they are affected. Yeah, that helps. I came from the security perspective, that definitely helps and, um, I would love to learn a little bit more. Maybe this can be something that can be set up to learn a little bit more for sales.
So, we like to, uh, but I was actually talking about something a little bit less, um, uh, uh, challenging is like, all those equipment will require some software upgrades. Oh, yeah. So, because of, uh, of. Technology changes and functionalities. Are those deploy kind of centrally or you have to go machine by machine to to do this. Right, no, no, exactly. That at least for this, that's any of the technology that we're rolling out this these days to your point.
It is essentially managed so that we don't have to to go and touch them, you know, individually and configure. Um, and and it's it's definitely the trend in the industry. And, like I said, that not only does it, give us the ability to essentially manage it, but you get all the other bonuses along with that right now it's a consistent environment. We can push the changes quicker. Um, and, you know, we actually have a type in this case, and it's a model we're looking at for a lot of our other.
Critical infrastructure, but with Cisco, we have a very tight partnership where they'll actually help to look at the configurations with us and review best practices. Um, before we push anything. So we can identify issues ahead of time or in the event that we do find those issues. We can either roll them back and we'll work with them very quickly to address. So, yes, so that that's. That's exactly what we're what we're pushing out. Um, and that that's that was a big piece of. Of this network environment that we've been working with Cisco on, to, to ensure, like I said, across every location, including the clinics. So, I don't want to take any more time on this, but I would love to learn a little bit more about these. When you have time on colleagues are able to set it up. Um, thank you Kim, can should we go to the next phase?
Yes, we can move to the next slide and we will turn over to Dr Michael about and we are going to talk about we're going to kick off with an overview of 2 key areas that, from care experience, which is our newly implemented, uh, pumping, uh, as well, as the mitral activation, we'll give an update there across our system and then our recently recertified gold star Yep. From epic. Great. Thank you so much. Can you go to the next part? So it's a little busier slide. Unusual and I'm going to jump into some of the details of our, my chart activation rate right now. We're sitting at 68% of all comers that have come to our that have come to our center and last year are activated with my chart nationally. This puts us in the top 25%. The epic average is 53. when you compare this against other safety net hospitals that average is 46%. So we're doing quite well. six percent so we're doing quite well That said on the on the, I think it's through the right side of your screen. So, the darker blue color, you see, we have heterogeneity and our site by site activation rate. And the reason I'm showing you, the slide on the left is that depending on how you cut the data, it just frankly looks different. And what I mean, by this is the following, when you look at the darker screen, I think it's Harlem and woodhall towards the bottom of the list. But when you slice that data and say, okay of the patients that have a primary care doctor at our institution.
How are they doing and you can see those 2 sites do actually much better when you're only looking at that patient population the reason that I've historically, given the other chart, the darker blue 1 is that does not manipulated data at all. Right? We haven't done anything yet. There's no post processing of it and it just it's, um. It's easier to benchmark where we are compared to where other institutions are they did on the left. We use on a site by site basis to say. You know, Harlem, how are you doing? What is the, what are you, what you improve with with your patients that are in primary care and what should be the site specific performance improvement initiatives at that site? So we have a my chart steering committee centrally and then we also have local at each facility, my chart steering committees, and those local steering committees, choose site specific Pi projects, and they might target your activation of, uh, my chart with primary care patients and another might site.
Very reasonably target something like logins per user, which is data I've shown you before frankly, I think long term I think it's useful to show all of the information and to cut it differently. Um, I think the takeaway, I think is the following though, our activation rate nationally is very, very strong and our log ins per user is not as strong and it's an area that we need to push on and improve. And the way we do that is we add more functionality for our patients, and we respond to them quicker when they talk to us when they, when they. Adjust through my chart so, the darker blue 1, I think is the end state like, how we're doing overall. Uh, kind of, you know, I kind of think of it in, like, the from a page from a physician perspective. I kind of think of it as, like, the hard outcome here. It's the patient centered outcome, but then all the other ones are kind of the process points that go into feeding that. I know. I went to about a fair amount. There's a good amount of data on this slide. So, is there any questions on this 1?
I'd just like to add a point on the dark side. The what's integrated there from the overall in the in the facilities that are not just at the bottom side of their inventory is the data also includes the emergency department and the inpatient population in addition to if they have ambulatory. Yeah. And so the, the chart on the left is purely our ambulatory facilities looking against each other. It's like an apples to apples, you know, a correlation or overview there comparison. Okay. Thank you. Thank you for the golden really great, um, addition to the chart and provides a better picture of what is happening but let me ask the board members. They have any questions or say any questions. No, no questions. No questions. Thank you.
Dr, I only have a suggestion. I can thank you for the data. This is very, very, uh, illustrative. Um, if we could sort them by the action based on, like, you, are you doing the dark blue? Because I was trying to look at the items that ones and and, and I would like to highlight Lincoln. Um, yeah 90% on primary care while it is 63%. I think it may have to do. have to do
Alert from the number of patients that they see in the I don't know, but that looks like a a conclusion. And also, but they have also a lot of people they are like, maybe the 4th in terms of number because I think. Is the largest. Number with 33,000 then follow.
By we, and then, I think link com, so I think, you know, that that is very impressive, uh, when you're talking about the primary care, thank you for getting this data. And if you can sorted them by activation, that would be great. Thank you. Yeah, thank you. I did think of that after this had gotten to submit it to you. So I've already working on that change and we'll put it in an order to more easily find them all. Alright, you can go to the next slide. So what I'm going to talk about. Here is biometric authentication identification of our patients. Um, we have been rolling out and we are now live at 4 of our acute care facilities with palm vein authentication. Basically, what this is, is that we ask the patient for their date of birth. They put down their Palm, um, the 1st time they actually need to touch the device all sub. Subsequent times. They can actually just hover their palm over the device, and it will read their palm and tell them we can quickly and incredibly accurately.
The patient, when I say incredibly accurately, what I mean is with in combination with date of birth. It's 6 Sigma, and for the emergency department, or in a setting where the patient is unconscious and unable to provide that information, or you're unable to provide any other external information. It is still it's gonna make a mistake and properly identify the patients once out of every more than a 1Million times. So, it is a faster process, and it is a far more accurate process, which will help us reduce our duplication rate, which is the number of patients that have more than 1 chart and our facility. Um, you can see this is. Week by week, the graphic here you're looking at is a week by week trend of our the purple line is the biggest 1 to pay attention to, which is our utilization.
Percentage those are Elmhurst and woodhall are the 1st, 2 that have a higher utilization rate, and they have continued to have a higher utilization. Right? They've done a great job. But I think 1 of the reasons, they've done such. A great job, is that those are the 2 sites. That went live that used it as our proof of concept. So, those both had several months of experience with this before our other sites, our long term goal. When we wrap up this project in February is going to be having everyone be at 75. um, you know, I don't think that's a reasonable short term expectation for everybody. And I'll tell you is in, within each of those there's significant within each site.
There's heterogeneity, but then with insights, there's heterogeneity. heterogeneity Be as well, and what we're doing with our ambulatory care colleagues, and it's primarily ambulatory care. This is in the as well. But it's primarily ambulatory care where the variation is, if we're talking to the departments that aren't using it as much, because a lot of departments are using it. Um, you know, overall, I firmly believe this is going to be a time saving thing for our end user clerks and I think is going to improve our system and really the safety of our system because knowing who the patient is is the way, you know what their past medical history are what their allergies are, and allows us to provide better care. Okay, go to the next slide. I talk about something that, um. Can I ask a question on that? Yes, please. Please. Please. Um, so, so, when I go in and I put my hand down, then somebody tells me welcome Jose to your appointment. And how does that work? I'm trying to understand the process. Do you mind if I actually don't have to try to take a stab at this? 1st, and then you can go with me. So you 1st have to register. You come in, you register the 1st time you put your palm vein down.
It securely attaches to who the patient is and then the next time you come in, you just put your palm down, put in your date of birth, and it says welcome. Welcome, Jose. Okay, but it's, I guess what I'm trying to understand is. Is it are we losing the human interaction? What happens when you go to, uh, to an appointment and. I mean, is it, why is this so much better I guess. Yeah, so we still have registration clerks. The majority of our portals of entry. We also do have kiosks where this is being rolled out, but kiosks were a separate project that this is dovetailing nicely with. We're not we we still have education registration staff so there's still that face to face communication.
There's still, you know, patients are still signing their document. They're still having a conversation with the clerk. It is the identification. Of the patient to make sure that this is the same Jose. On a thing that we don't always think about is, uh, person to person is great. Sometimes our patients object to the possibility that other people are hearing the answers to these questions. Uh, I have 1 patient in particular that I'm thinking of, and 1 of the reasons I like the system. Is that when he comes in, he would just put his pawn out.
As opposed to answering a lot of identification questions, which she's uncomfortable, uh, answering. So it can be in many ways, a more private interactions. Thank you so much for the clarification. Thanks. I would like to add I have used this system and what I find is that for a straightforward registration, it allows you to do what you need to do, and move and the clerics to handle questions and complexity. So, in that case, you don't wait in line when somebody's asking a question.
So I think that, yeah, it's like, simplicity efficiency and I, I agree with Dr cats also privacy. So I, I. They like the 2. Okay, any other questions. No, Victor Baldwin. Great Thank you.
So, the next slide is on our gold stars, which is basically the an epic program that says of all the features that Epic has turned on, that they find highly effective and that other institutions across the country found highly effective. How many do we have on at this point? And what? The level 8 that you're seeing here that puts us in the top 3rd, nationally responded and you can see exactly where on the distribution we fall on the far left. What this is showing is that we're doing a pretty good job of turning on features as they come out. Now. Every time the epic does upgrades every quarter, every quarter, they're coming out with new features and so we're always going to drop down as we address those. And as we add in those new features, but at the end state of this is because we're staying on top of new feature adoption and because we are improving our current features, our system keeps getting better and better. And we keep pace with the other national leaders in this at a future meeting. I'll share with you the other customers. That are at level 8, gold stars, but it's, you know, some of the best places in the country that are that are there from the infomatics perspective and ultimately, the real benefit here is that our providers and our nurses, and everyone else gets a better more functional system and our patients get better care. So this, these are really not.
I T, settings these are things that doctors can use to take better care of their patients, you know, the 1, that kind of comes to mind for me right now is we're working on right now. Something called course instead of writing a progress note, I can just quickly type something on the bottom of my screen and it pops in an auto auto populates my note. Now, that's not on yet, but that's going to come in next and it's probably going to save me, like, 15 seconds. If I try to write up instead of writing a progress note. So, it's a, it's a nice feature, and it's things like that, that we just continually move. We move our, our systems. Better direction, um, go to the next slide. Uh, we, are we continuing to. And the number of epic modules that we use, so previously we used a another vendor for our dental for our dentists, and we have now moved them to wisdom every time that epic names anything they make sure. To give it a cutesy name. And this 1 is wisdom for wisdom teeth for the dental module and we have once again, we have really good adoption of this. Now, we've turned off and a half of our sites we are now live with epic wisdom for our dental clinics. We have really good utilization.
You can see the numbers. The number of completed visits and behind those numbers what we track is how long providers are taking in their notes. How long they're sitting there in basket and on all. Those metrics were in the inter courthouse range and a lot of places. We're already above average, which for right after a go live, which was July. I think it's pretty good. Similarly to that is the next slide, which is the epic willow module, which you might want to. We're willow came from but I think Kim corrected. We are Kim. Knew this last time well, it was a medicinal plant. Better right that's what I was told that at some point, it was used has some medicinal component to it. So I guess that's why they will ambulatory module for pharmacy has that name um, and what this allows most of the features really just improve things for pharmacy. It improves our pharmacy billing.
You can see on that top line of the metrics that are, um, are full time. The number long. How long our patients have to weight has steadily decreased since we went live with this, which is a real benefit I can tell you. As the end user from an emergency perspective, what the main benefit to me, and our patients are is I can more easily see what's in our pharmacy available to prescribe for our patients. And if there is an issue with the prescription, or, you know, I sent something over. That's not quite right. There's pharmacist, and I can have a more direct interaction. So, there's benefits inherently to the pharmacy and also really looping the pharmacy closer into our clinical fold, which is.
No, uh, uh, a big win for us as a system and I think I'm going to hand it back to you Kim. Thank you um, I'm sorry any questions on any I just covered, um. Jose, any questions? Nope, no questions. Dr cats no questions. I just have a comment saying, like, uh, I really appreciate how you are. Ensuring that the technology is to the service of our patients, not just for technology sake because if you look at a gold star in the key, that this is a way for them to encourage more of the use of the technology, because you're competing on features. But I think you're focusing on what is important to your patients. And I think that's very important. I really like the deployment of, uh, wisdom and.
Thank you Dr modern. Uh, thank you. Going back to you, thank you. Uh, we can move to the next side, and I will just say, you know, 1 of the components there is for the gold star, is that we did look for a metric. That was a national metric. Um, because 1 of our goals that align with the mission. And vision is the usability.
You know, of our electronic health record, and we felt that this and Mike talked about and has been championing that with great spirit. I guess the 1 thing I add in is that when we set our goals level 8, we didn't say we want to be level 9th cause. There's also a level 9. there's level 10. we looked at the features and said, what are the features that are gonna be valuable to us and then set our goal right? That it wasn't the other way around. It wasn't the number. 1st, it was the features, which is, I think it's, it's keeping our patients and our staff. staff Center of this right. And bringing our our councils together to make those decisions. So I, I am going to close with some acknowledgement of our team.
Um, just briefly 1 is our, we can move to the next slide please is our application learning team and this. I used to be the epic training team, and we've actually expanded their title as they've transitioned from a strictly implementation across our system to a more sustainable model for all new staff members who were coming on. In addition to that, they have been, uh, they were critical to on boarding, um, our page, our supplemental staff.
To in response to covid 19. um, but also, um, they have added new services and training, uh, we call it the thrive program. So, you know, we can keep things moving and continual, uh, ongoing learning experience. Uh, 1, such program is, uh, we've supported with, uh, Hillary is the, uh, joint commission readiness so that individuals are having right at their fingertips, some training, uh, so that they are able to easily navigate through. They know where to go how to go and that makes that survey experience a lot more pleasant. Um, that's just 1 example. Um, also they support during our upgrades and any new application, such as wisdom and, uh, that we are moving out. And then you can see at the bottom, we're, they're not just epic. We have actually transitioned them to our learning team to help with some of our other clinical applications.
1 is the, the dragon system, which is the physician dictation or provider. Patient all the way up to Omni cell, which will be coming out in 2023, which is our medication administration initiative. So, overall you can see, they've trained over 20,800 in users in 3000+classes. We can go to the next slide. thousand plus classes we can go to the next slide Uh, highlighting our amazing pmo or project management office team. Um, there is a link there, um, that outlines all of the work that they've done, but in short, I will say in we take it over 2000, it related projects. projects
Every year, and that has been sustained over the last couple of years, um, more happening from an optimization perspective with vaccinations, et cetera in the last year or so. But this, uh, these are small projects or projects, that may be, uh, very large in scope that take 1 to 2 years to move forward. So, excellent team, um, supporting. And then, uh, I just wanted to say, you probably might have noticed that, um, our, our chief application officer who was John Kennedy was. Here today, and it is, because we had to say farewell, and thank you to Shawn as he transitioned to a new position outside of New York City, health and hospital, and he and relocated. So, we have a stabilization plan, which is moving quite well and we were Sean very well. And I will close just by saying that on the 21st of this month is national ity, professional day. And I just want to thank my entire team. team
I hear in New York City, health and hospital, and I'll close there. Okay, thank you Kim. Really appreciate your presentation. And I would like to ask, uh, the members if there is any question I'll say. Thanks, man, thank you so much for the update. Dr. cats no, thank you for the update as well.
Again, I also want to echo canceling and concise comments and thank you for that day. I always appreciate how you always connect your activities to this, that the plan and the pillars and the values that are very important to the system, and they sign meeting which you present a technology. I think that I appreciate that. I'm really excited about the work that they're doing everyone so thank you. You so much I wanted to ask if there is any old business that we. Have to address any new business. Well, being a further discussion, I would like to adjourn this meeting. Thank you everybody and we got 60 minutes back. We should run all meetings going for.