Diane Michalec MSN, BSN, RN
Director of Interoperability
A Reflection on Connection: UPMC and the dbMotion Solution
2
International
Enterprises
Insurance Services
ProviderServices
UPMC’s IDFS
$20 billion world-
renowned health
care provider and
insurer
UPMC Today: Snapshot
87,000
employees
More than 60 UPMC
Cancer Centers with
200 affiliated
oncologists
600 doctors’ offices
and outpatient sites
employing 4,900
physicians
Insurance division is
largest medical
insurer in western PA
with 3.5 million
members
International
program spans four
continents
40 academic,
community
and specialty
hospitals; 8500
licensed beds338,000 Inpatient visits
5.5 million outpatient
visits
1.1 million ER visits
750,000 Home Health
visits
• Best-of-suite EMR strategy– Connect patient information across UPMC
– Carnegie Mellon Software Institute Evaluation
• Data harmonization
• Service Oriented Architecture (SOA) based interoperability platform
• Joint Venture with dbMotion– Pilot deployment in February 2018
– Six data domains
– Full application deployment in June 2018
Overview of UPMC Interoperability
Demographics
• Encore• Epic• Healthmedx
• Healthplan• Homehealth• Medipac• SAH McKesson
• Cerner Adult• Cerner CHP• Epic
dbMotion
• Cerner Adult• Cerner CHP• Epic
• CVIS• Mars - EF• Vivify
Diagn
osis
• Cerner Adult• Cerner CHP• Epic
• Healthmedx• Homehealth• SAH McKesson
• Cerner Adult• Cerner CHP• Epic• SAH
• Frameworks Meds
• Healthplan
• Healthplan• Histotrac• Labcorp• Misys• Orchard Labs• Questhub
• Orchard• Safetrace• SUSQ• Vision Glucose• Vivify
• Cerner Adult• Cerner CHP• Epic
• Healthplan• PASIIS Immun.• Varian
• Encore• Homehealth• Healthplan
• Medipac• SUSQ
• Apollo• Audbase• Canopy• Cerner Adult• Cerner CHP
• Compas• CoPath• CVIS• EMG-Viking• Epic
• Helix• Histotrac• Homehealth• HPF• iGene
• Epiphany• GE EP Labs• H1
Powerforms• Healthmedx
• MUSE• Pedcath• Prosolv• Provation• Scottcare
• SUSQ• Vascupro• Xcelera• Xper
• Apollo• CVIS• Epiphany• GE EP Labs• Imagecast
• Imagecast• Labcorp• Logicare• Muse• Nuance
• OB Ultrasnd• Pedcath• PIMS• Prosolv• Provation
• SAH Mckesson• Scottcare• SUSQ• Varian• Vascupro
• Viasys• Vivify• Xcelera• Xper
Data Aggregation: dbMotionCurrent Active Sources
As of 8/22/2018
• Encore• Homehealth
• Healthplan• Medipac
• SAH McKesson• SUSQ
• SUSQ• SMS Jameson• Vivify
• Achieve• Encore• Epic• Healthmedx
• Healthplan• Homehealth• Medipac• SAH
McKesson
• SMS Jameson• SUSQ• Vivify
Additional 31 Retired Sources
Data Harmonization
Harmonize and standardize discrete content from various clinical systems utilizing multiple reference
terminologies
– Supports a platform to seamlessly exchange and integrate information in a meaningful way
– Creates a foundation for moving from data centric to knowledge centric intelligent healthcare
models
Allergies
• Clinician opens EHR and selects patient record• Clinician clicks a link to dbMotion• User is automatically logged in• Patient is displayed in context in dbMotion
Clinical Views
• Smart view of patient information not immediately available on patient chart access in the native EMR
• Unobtrusive View – Allows clinicians to stay in their EMR while accessing the HIE
• Usability – Allows the user to navigate the EMR while providing a side-by-side comparison of data
• CCOW compliant – Creates a seamless integration by sharing user and patient context
• Semantics – Enhanced semantic capabilities to streamline presentation of the data
• Actionable – Import data into the EMR from the EHR Agent
EHR Agent
Point of Care Application Deployment
Development
dbMotion on the Blackberry - “dbMobile”
Search for patient and access to Clinical Views
Data integrated for Personal Health Records
CCR, Labs, Medications, Immunizations
Discharge Summaries
•Deep EMR Integration
•OB Ultrasound
•Cerner All Documents & All Immunizations MPage
Data Embedded into EMR: Clinical Workflow and SDK Apps
All Documents
All Immunizations
All Documents Cerner MPageUsability – Seamless and integrated workflow keeping clinicians in their HER
Accessibility - Navigate to see information from the various other data tabs outside of documentsAccess to External Documents through the EMR– Access to non-UPMC contributors via the national and state HIEs* This implementation is the highest utilization of
dbMotion at UPMC
• Integration using the CDC Immunization schedules for recommended immunizations by age - immunizations populate the grid in the appropriate cell by age
• Date of administration is displayed in the grid• Drill down available to view immunization details
All Immunizations Cerner MPage
Western PA HIE Node UPMC Provider Node UPMC Health Plan Node
UPMC Interoperability
• Regional HIE
• 18 Members
• Opt-out Consent Model
• Clinical Claims
• UPMC Health Plan
Members Only
• 1st Payer/Provider
Integration
• Hospitals
• Ambulatory
• Cancer Center
• Urgent Care
• ED
• Home Health
PA-SIIS
External Exchanges
External Exchange Partners: data from the national eHealth Exchange and the PA State HIE (P3N) are presented via clinical summaries or Continuity of Care Documents (CCDs)
National eHealth
ExchangeAffiliated
practices
Source System Data
Western PA CCHIE
Members
PA SIIS
Community Connections
External labs
UPMC Health
Plan
MARS
UPMC Interoperability Ecosystem
Systems Sourcing Data
OB
Ultrasound
Cerner
MPages
Home Health Skilled Nursing
Facilities
Laboratory
UPMC ProviderUPMC
Health Plan Western PA HIE
Semantically Harmonized
PA State
HIE
HISP
(Direct
Messaging)
Epic: Data Reconciled
Federatedquery
Response
Gateway
State & National exchanges
Information is View Only
UPMC
CommonWell
WPA CCHIE
Cerner Data
Reconciliation
Epic Data
Reconciliation
UPMC Current State
HEALTHeLINK
NY HIEKeyHIE
SureScripts SureScripts
Carequality
Epic Care
Everywhere
Epic
Care EverywhereEpic Care
Everywhere
Other
Cerner Clients
HISP
(Direct
Messaging)
HISP
(Direct
Messaging)
HISP
(Direct
Messaging)
Epic: Data Reconciled
Carequality
Federatedquery
Response
Gateway
State & National exchanges
Information is View Only
UPMC WPA CCHIE
Cerner Data
Reconciliation
Epic Data
Reconciliation
HEALTHeLINK
KeyHIE
SureScripts
SureScripts
UPMC Future State
Epic Care
Everywhere
Other
Cerner Clients Epic Care
Everywhere
Epic
Care Everywhere
• Agent HUB deployment and sunset Clinical Views
• Single connection to Carequality/CommonWell
• Deduplication of data returned to EMRs
• Integration with health systems new to UPMC
• UPMC integration with multiple HIE’s
The Road Ahead
Director
Sr. Manager
11 Systems Analyst
– 5 Data Analyst
– 5 App Analyst
– 1 Data/App Analyst
Informatics Nurse
UPMC Interoperability Team
Meaningful Contextual Information at the Point
of Care
The Right Information…
…to the Right Stakeholder…
…in the Right Format…
…through the Right
Channel…
…at the Right Point in the Workflow
The
Form
ula
fo
r Su
cce
ss:
The
Five
Rig
hts
21
”We need to learn
to set our course
by the stars,
not by the lights of every passing ship.”
Omar Nelson Bradley