Leapfrog has a proposal to expand their reporting requirement of BCMA to procedural areas. In giving this some serious thought, a number of challenges become apparent and I'd like some feedback from the MSOS community to better understand if these are specific or general challenges.

There's no question regarding the benefit of expansion of BCMA into the procedural areas - and it is largely implemented in our facilities. The true challenge comes with reporting BCMA activity, and that strikes at the heart of Leapfrog's query: should reporting be expanded to include these areas?

The reporting challenges we've encountered are multifactorial. The way our EMR handles patient location is entirely dependent on the procedural area when inpatients have procedures done. In most cases, the patient's location does not change for minor procedures, such as endoscopy, but will change for major procedures such as surgery. BCMA reports consistently underrepresent these patients when filtered by procedural location.

Another challenge is patient status. Current Leapfrog reporting can be found entirely within the inpatient population. The proposed reporting includes a mix of inpatient and outpatient records, which may reside in different databases depending on the procedure.

Another challenge is that some of our procedures are outsourced to third party vendors with proprietary equipment and documentation systems.

Another challenge is that documentation software in some procedural areas connects to our EMR through an interface which puts drug administration data into a different data table - and may not pass the scanned state.

Another challenge is that procedural areas have a relatively higher proportion of urgent/emergent situations with corresponding verbal orders which do not normally require barcode scanning. This happens on the inpatient floors at a frequency that is non-contributory to the overall metrics, but may be significant for procedural areas.

Finally, some procedures have sterility requirements or radiation fields which must be respected, which create significant barriers to traditional BCMA.

In many of these cases, BCMA is being performed, but generating an accurate report by a geographic area is challenging. How many of these challenges are other facilities likely to encounter when considering expanded reporting of BCMA into the procedural areas?