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