THE CHALLENGE OF COORDINATING EMR

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1 THE CHALLENGE OF COORDINATING EMR

2 CLINICAL CONNECT: TWO YEARS OF REGIONAL ELECTRONIC HEALTH INFORMATION EXCHANGE NANCY A. LANDMAN, CIO INTERNATIONAL & COMMERCIAL SERVICES, UPMC 10/8/2014 2

3 UPMC Today: Snapshot $12 billion integrated global health enterprise 60,000 employees 22 academic, community, and regional hospitals with more than 4,200 licensed beds More than 187,000 inpatient admissions and 165,000 surgeries performed annually Each year, more than 4.5 million outpatient visits and 480,000 emergency visits More than 40 UPMC Cancer Centers with 180 affiliated oncologists UPMC Health Plan: 2.4 million total members, a network of more than 125 hospitals and other facilities and more than 11,500 physicians

4 The Structure of the UPMC Health System Clinical Services Physician practices Community hospitals Long-term care Rehabilitative care Retail and specialty clinics Insurance Services Payer/provider integration Expansion beyond UPMC facilities International and Commercial Services Clinical services management Infrastructure consultation Strategic/Commercial Product Development Partnerships National Security and Public Health 4

5 Connected Healthcare in Action at UPMC Terabytes of data ,000 Account users Patient records 6.4 million 90+ Clinical source systems Connecting Healthcare Achievements Deployed at 22 hospitals with 45,000 registered users and >6 million patient records Deep integration with EMRs 50+ systems connected 5

6 WPIC SHY SMH PUH PAS NW MER MCK MWH HOR HAM EAST CHP BED ALTOONA** UPMC Inpatient EMR Adoption Model HIMSS ANALYTICS EMR IMPLEMENTATION MODEL - U.S. Hospitals Stage 7 2.2% Stage % Stage % Stage % Stage % Stage 2 8.4% Stage 1 3.5% Data from HIMSS Analytics Database; 2013, Q3 **UPMC Altoona has achieved Stage 6 on non-enterprise applications; planning to convert these to UPMC standard solutions is in process. n= 5,437 6

7 UPMC Ambulatory EMR Adoption Model 7

8 The term "health information exchange" encompasses two related concepts: Verb: The electronic sharing of health-related information among organizations Noun: An entity that provides services to enable the electronic sharing of health-related information 8

9 The Road to ClinicalConnect Six (6) Community Hospitals began discussions around the commonality of performing Open Heart Surgery The Federal Government enacts the Health Information Technology for Economic and Clinical Health Act (HITECH) to establish the meaningful use of interoperable EHRs. Exploration of forming a Health Information Exchange (HIE) with community hospitals. A consulting firm was engaged to study how a HIE could be formed and run by this group 2 models proposed. Created the bylaws, agreements, and model for the Clinical Connect Health Information Exchange (CCHIE)

10 ClinicalConnect HIE Charter Mission To develop and operate a sustainable network to securely exchange health information in western Pennsylvania. Vision To securely provide information to care providers, where they need it, when they need it and how they need it, in a consistent and reliable manner. 10

11 ClinicalConnect HIE Members PHYSICIAN PRACTICE HEALTH CARE SYSTEMS REHABILITATION POST ACUTE CARE

12 ClinicalConnect HIE Benefits Providers Making complete, accurate and searchable health information available at the point of care Enhancing the quality, reliability and continuity of health care delivery not waiting for the exchange of paper records Reducing adverse events, medication errors and eliminating duplicate testing Improving operational efficiency Connecting to other local, regional and national exchanges

13 ClinicalConnect HIE Benefits Patients Not having to wait for mailed or faxed results Not hand-carrying information, such as lab results or x-rays, from appointment to appointment Fewer appointments and less travel Reduce duplicate tests Eliminate unnecessary procedures Safe and secure

14 ClinicalConnect HIE Expanding Membership/Participation Sign a Data Exchange Agreement Annual payment Based on yearly organizational Operating Revenue 14

15 ClinicalConnect HIE Patient Participation Opt-out model (i.e. the data is exchanged unless the patient requests to not participate) Opt-out model is consistent with Pennsylvania state law (ACT 121) Patient s participation decision is captured through each participant s registration system Technically ClinicalConnect HIE tracks all patient decisions and honors the last received 15

16 ClinicalConnect HIE Technology Partners DbMotion technology is used to leverage capabilities of members; it offers semantic interoperability and a centralized repository of aggregated normalized data. IBM Initiate integrates with existing systems and data sources to accurately match and link different representations of provider data to create a master view. 16

17 What does ClinicalConnect HIE look like to a clinician? Clinician logs into member EHR and selects patient record Clinician clicks a link to ClinicalConnect HIE Patient is displayed in context in dbmotion ClinicalConnect HIE node with data from members and UPMC integrated into one view

18 dbmotion provides semantic interoperability and a centralized repository of aggregated, normalized data

19 ClinicalConnect HIE Onboarding Phases Phase 1: VIEWING Phase 2: CONTRIBUTING 19

20 Phase 1: Requirements for Viewing Assessment of patient demographic data to ensure patient linking within the MPI Real-time transfer of patient demographics via an electronic interface from partner registration system (ADT) Application Programming Interface (API) launch from participant s EHR Launch button capability from within partner EHR Security token exchanged to apply login and set patient context 20

21 Phase 2: Requirements for Clinical Data Exchange HL7 interfaces CCD or C-CDA = electronic document exchange standard for sharing Patient Summary information XML-based markup standard Outlines the structure and semantics of a patient summary clinical document for exchange including standard vocabulary Data exchanged in CCD (vocabulary standards): Encounters Medications (RxNorm, NDF-RT, NDC, Medispan, Multum) Allergies (UNII, NDF-RT) Problems (SNOMED-CT, Medcin, ICD-9) Immunizations (CVX) Lab Results (LOINC) Documents (i.e. Discharge Summary, Radiology Report) 21

22 ClinicalConnect allows critical information to move with the patient and lets physicians and nurses focus on providing the best possible care, instead of the time-consuming task of tracking down patient data through phone calls and faxes. A. Thomas McGill, M.D., VP, Quality and Safety and CIO, Butler Health System 22

23 ClinicalConnect HIE Clinical Success Stories eliminating the need for the stress test. did not need to repeat the MRI. aiding the physician in a more accurate diagnosis of the current problem. Had it not been for the ClinicalConnect HIE, the physician would have sent the patient, living in a rural community, to the city of Pittsburgh to be readmitted. 23

24 Health Information Exchange Industry ROI HEALTHeLINK Western New York HIE found that many doctors were failing to use data available in the HIE and thus ordering CT scans that were unnecessary* wasting about $1.3 million over an 18 month period (2,763 CT scans). *CT scans may result in up to 29K cases of cancer in the US, according to researchers at the National Cancer Institute. Compared to a traditional X-ray of the chest, a CT scan of the chest uses times the radiation f2-11e0-a40f-001cc4c002e0.html

25 ClinicalConnect HIE ROI via End User Survey In the last 3 months, how many times have you AVERTED ordering tests due to data found within ClinicalConnect HIE? 25% 14% (7) (4) (2) 7% 18% 36% (10) (5) Avg. # tests averted None 25

26 ClinicalConnect HIE ROI Cost Savings Scenario 10 respondents noted they AVERTED ordering 2 tests Equals 100 tests saved from just 29 providers EXAMPLE: MRI of Lower Extremity (Pittsburgh PA Cost Average*) = $1, tests x $1, x 10 responses = $29, in potential cost savings * ylvania/pittsburgh/15/mri 26

27 ClinicalConnect HIE Current Metrics* >7.2 M unique records in repository > 2.2 M patients are part of the Exchange > 1.7 M records contributed via CCD, CDA or HL7 > 15,000 users >200,000 charts opened in ClinicalConnect HIE * As of 8/14/

28 ClinicalConnect HIE Usage Clinical Views 55% 24% 15% 3% 3% Encounters Labs Medications Problems Documents 28

29 Thank you! Grazie! Merci! Gracias! Takk! Danke!... 29

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