THE CHALLENGE OF COORDINATING EMR
CLINICAL CONNECT: TWO YEARS OF REGIONAL ELECTRONIC HEALTH INFORMATION EXCHANGE NANCY A. LANDMAN, CIO INTERNATIONAL & COMMERCIAL SERVICES, UPMC
10/8/2014 2
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
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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
The Structure of the UPMC Health System
Connected Healthcare in Action at UPMC
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Connecting Healthcare Achievements • Deployed at 22 hospitals with 45,000 registered users
and >6 million patient records • Deep integration with EMRs • 50+ systems connected
• Terabytes of data
1.5
• Account users
45,000 • Patient
records
6.4 million
• Clinical source systems
90+
UPMC Inpatient EMR Adoption Model
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ALTO
ON
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CH
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EA
ST
HA
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HO
R
MW
H
MC
K
ME
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NW
PA
S
PU
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SM
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SH
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WP
ICStage 7
2.2%
Stage 6
11.1%
Stage 5
20.9%
Stage 4
15.1%
Stage 3
31.9%
Stage 2
8.4%
Stage 1
HIMSS ANALYTICS EMR
IMPLEMENTATION MODEL -
U.S. Hospitals
**UPMC Altoona has achieved Stage 6 on non-enterprise applications; planning to convert these to UPMC standard solutions is in process.
n= 5,437
Data from HIMSS Analytics Database; 2013, Q3
3.5%
UPMC Ambulatory EMR Adoption Model
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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
The Road to ClinicalConnect
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• Six (6) Community Hospitals began discussions around the commonality of performing Open Heart Surgery.
2007
• The Federal Government enacts the Health Information Technology for Economic and Clinical Health Act (HITECH) to establish the “meaningful use” of interoperable EHRs.
2009 • 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).
2011
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.
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ClinicalConnect HIE Members
HEALTH CARE SYSTEMS
POST ACUTE CARE REHABILITATION
PHYSICIAN PRACTICE
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
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
ClinicalConnect HIE – Expanding Membership/Participation
• Sign a Data Exchange Agreement
• Annual payment
– Based on yearly organizational Operating Revenue
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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
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ClinicalConnect HIE – Technology
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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.
Partners
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
dbMotion provides semantic interoperability and a centralized repository of aggregated, normalized data
ClinicalConnect HIE –Onboarding Phases
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Phase 1: VIEWING
Phase 2: CONTRIBUTING
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
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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):
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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)
• “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.”
•
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A. Thomas McGill, M.D., VP, Quality and Safety and CIO,
Butler Health System
…eliminating the need for the
stress test.
…aiding the physician in a more accurate
diagnosis of the current
problem.
…did not need to repeat the
MRI.
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.
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ClinicalConnect HIE – Clinical Success Stories
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 150-200 times the radiation.1
1http://www.stlamerican.com/your_health_matters/health_news/article_1c643946-76f2-11e0-a40f-001cc4c002e0.html
ClinicalConnect HIE – ROI via End User Survey
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36%
18% 7%
14%
25%
In the last 3 months, how many times have you AVERTED ordering tests due to data found within ClinicalConnect HIE?
2
5
8
10+
None
Avg. # tests averted
(10)
(5) (2)
(4)
(7)
ClinicalConnect HIE ROI – Cost Savings Scenario
• 10 respondents noted they AVERTED ordering 2 tests
• Equals 100 tests saved from just 29 providers
• EXAMPLE:
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http://www.newchoicehealth.com/Directory/CityProcedureType/Pennsylvania/Pittsburgh/15/MRI
*
MRI of Lower Extremity (Pittsburgh PA Cost Average*) =
$1,450.00
2 tests x $1,450.00 x 10 responses = $29,000.00 in
potential cost savings
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
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* As of 8/14/2014
ClinicalConnect HIE Usage – Clinical Views
24%
15%
3% 3%
55%
Encounters
Labs
Medications
Problems
Documents
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Thank you! Grazie! Merci! Gracias! Takk!
Danke!.........