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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EA

ST

HA

M

HO

R

MW

H

MC

K

ME

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NW

PA

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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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Danke!.........