0 1 healthtech council meeting october 21, 2012 jay moskowitz
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HEALTHTECH COUNCIL MEETING
October 21, 2012
Jay Moskowitz
3
Spartanburg Regional Healthcare System
Self Regional Healthcare
AnMed Health
McLeod Health
Greenville Hospital System
Clemson University
Palmetto Health
University ofSouth Carolina
Affiliates…
http://www.healthsciencessc.org/
MUSC
HSSC Overview: HSSC Stakeholders
4HSSC’s Updated Mission Statement: Operational Emphasis
HSSC MISSION STATEMENT (Adopted February 2, 2012)
The mission of the Health Sciences South Carolina is to support our members in improving the health of all South Carolinians by collaborating across the State of South Carolina with the goal of enabling evidence based research. HSSC will achieve this by:
Creating a unique and comprehensive clinical data store which collects data from providers, enhances its usability, and makes it available in an easily accessible form for participants to use for clinical improvement and research purposes;
Developing and deploying information management tools that improve the efficiency and effectiveness of each member institutions research processes, including the ability of researchers across South Carolina to collaborate;
Serving as a convener for the identification, preparation, development and implementation of innovative collaborative research initiatives which have the potential for improving the health of South Carolinians through evidence based biological and clinical research informed by care givers, patients, and providers.
Through its role as a collaborative organization, HSSC will engage and encourage its members to create and develop new products, new jobs, and new industries that positively impact economic growth; contain and reduce health care costs; minimize healthcare disparities; improve patient safety and effectiveness; improve access to healthcare services; and improve the patient care experience.
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Multi-institutional grant opportunity identification
Convener
I2b2 pre-study support
Grant preparation
Mem
ber
Pro
cess
es
HS
SC
Su
pp
ort
Research Implementation Improvement
Aggregated, de-identified clinical data
Analytical tools & support
Research process management tools
Comparative de-identified data
Identifiable clinical data (member’s data)
Analytical tools & support
Grant opportunity identification
Grant management
Institutional studies- comparative effectiveness
Disease management
Evidence based protocols
Population health management
Metrics tracking & management
Rapid-Learning Health System
Education
HSSC Role
HSSC’s role is to support our members and to provide enabling services, assets and tools for translational research initiatives
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StorageCollection Analysis
Data Types: DemographicsDiagnosesProcedures MedicationsLabs
Data Feed Consolidation& Cleansing
HSSC Clinical Data
Warehouse (CDW)
MUSCMUSC
GHSGHS
SRHSSRHS
PHPH
Data Marts &Registries
RE
SE
AR
CH
CLIN
ICA
L
i2b2Cohort
Analysis
MPI
CDW Overview
7HSSC’s Current Research Applications
RPMS
Research Permissions
Hypothesis & cohort analysis
i2b2
Regulatory
eIRB
Services and Budget
SPARC
Data Capture
SCResearch.org
Recruitment
Palmetto Profiles
Research Collaboration
CDWCDWEMPI and DataWarehouse
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Collaboration & Alignment: HSSC Portfolio of Infrastructure Projects
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HSSC Project Summary Status
Research Permissions Management System
• Web application for collecting permissions in busy clinics using an iPad
• Permissions data becomes part of the medical record - made available to research (i2b2)
• In pilot at MUSC and available for use across HSSC in 2012
eIRB HSSC-wide IRB system • Common system for managing multi-site IRB process
• Manages operations of (12) IRB committees
• Live and in use across HSSC
Palmetto Profiles researcher networking
• Enables researcher profiling and collaboration
• One of the (6) NIH strategic goals to enable shared resource optimization
• Live and available for use across HSSC
Clinical Trials Management Tools (SCTR incubated)
REDCap data capture and survey
SPARC – Services, Pricing, Applications and Request Center
Study Tracker
MAP-R, Research Toolkit, Appsite and SCResearch.org
• Set of tools to streamline research activities and reduce barriers to translational research
• Live and in use at MUSC
• Available for use by all research institutions in 2012
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HSSC Project Summary Status
Master Patient Index (MPI)
HL7 Gateway
• Patient record matching
• Provides unique patient identifier for HSSC institutions
• Essential for health information exchange
• Live
Clinical Data Warehouse (CDW) and i2b2 toolset
• Real time clinical data management
• Tools for data analysis
• Initial focus on demographics, labs, procedures, diagnosis and medications
• Initial application is i2b2 (research)
• Identified clinical data has been provided by GHS, MUSC, PH and SRHS for project testing phase
• Completed test implementation
• Upgrading technology components – schedule to be reviewed on following slides
Collaboration & Alignment: HSSC Portfolio of Infrastructure Projects
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GHS
PH
MUSC
SRHS Mas
ter
Per
son
Inde
x (M
PI)
Ope
ratio
nal D
ata
Sto
re (
OD
S)
Dat
a T
rust
GHS
PH
MUSC
SRHS
Dat
a M
arts
/Reg
istr
ies
Clinical
CDW/MPI
HSSC CDW Solution Architecture
i2b2 Research
Data Intake Data Transformation
Data Store & Management
Data Delivery
Technology Components
Inte
rfac
e E
ngin
e
Current data includes: Patient Demographics, Procedures, Diagnosis, Medications and General Labs
Data is organized and integrated using standards that enable aggregation and multi-purpose use
The data is made available through data marts & applications
I2b2 LDS will be the first application but HSSC is ready to begin detailed planning for clinical applications
GHS
PH
MUSC
SRHS
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Primary KeySVC_INPATIENT_IDForeign Key
DATA_SOURCE_IDSERVICE_IDBusiness DataSRC_ENCOUNTER_IDACCT_NUMADMISSION_DATEDISCHARGE_DATEARRIVAL_DATELENGTH_OF_STAYLOS_HOURSVISITSADMISSION_TYPEADMISSION_TYPE_NAMEADMISSION_SOURCEADMISSION_SOURCE_NAMEADMISSION_SERVICEADMISSION_SERVICE_DESCADMISSION_REFERRAL_SOURCEADMISSION_REFERRAL_SOURCE_NAMEDISCHARGE_SERVICEDISCHARGE_SERVICE_DESCDISCHARGE_STATUSDISCHARGE_FLAGDISCHARGE_DISPOSITIONDISCHARGE_DISPOSITION_DESCDISCHARGE_REFERRAL_SOURCEADMISSION_DRGFINAL_DRGFINAL_DRG_CODEBILLED_DRGAPDRGAPRDRGAPRDRG_SEVERITYHRGCMGMDCMSDRGEPISODEADMITTING_PROVIDER_IDATTENDING_PROVIDER_IDDISCHARGE_PROVIDER_IDPCP_PROVIDER_IDMOTHER_BABY_X_REFMOTHER_MPI_IDBABY_MPI_IDTOTAL_CHARGESBILLED_AMOUNTEXPECTED_PAYMENTTOTAL_ACTUAL_PAYMENTDISCHARGE_CODEDISCHARGE_DESTINATIONCHIEF_COMPLAINTETL ETL_SOURCE_IDETL_DATEETL_JOB_ID
Data Fields Available in the CDW
DT-Service-In-Patient
Primary Key
SVC_PROVIDER_IDForeign KeyDATA_SOURCE_IDSERVICE_ID
PROVIDER_IDBusiness DataSERVICE_PROVIDER_TYPE_CD_ORIGSERVICE_PROVIDER_TYPE_CODESERVICE_DATEETL ETL_SOURCE_IDETL_DATEETL_JOB_ID
DT-Service-Provider
DT_SVC_DIAGNOSISPrimary KeySVC_DIAGNOSIS_IDForeign Key
DATA_SOURCE_IDPROVIDER_IDSERVICE_IDBusiness DataDIAGNOSIS_MASTER_IDDIAG_PROVIDER_IDDX_SEQUENCEDX_CODEDX_CODE_TYPEDX_SITESVC_DX_TYPE_ORIG
SVC_DX_TYPEPRESENT_ON_ADMISSION_ORIGPRESENT_ON_ADMISSIONNODES_STAGEMETASTASIS_STAGETUMOR_STAGESTAGE_GROUPM_STAGET_STAGE
DIAGNOSIS_SYMPT_ONSET_DATEDIAGNOSIS_DATEDIAGNOSIS_RESOLVE_DATEDX_STATUS_ORIGDX_STATUSDX_SEVERITY_ORIGDX_SEVERITYN_STAGEETL ETL_SOURCE_IDETL_DATEETL_JOB_ID
SVC_PROCEDURE_IDForeign Key
DATA_SOURCE_IDPROC_PROVIDER_IDSERVICE_IDBusiness DataPROC_MASTER_IDPROC_SEQUENCEPROC_CODEPROC_CODE_TYPEPROC_START_DATEPROC_END_DATE
MODIFIER_1MODIFIER_2MODIFIER_3MODIFIER_4SVC_PROC_TYPE_ORIGSVC_PROC_TYPEPLACE_OF_SERVICE_CODEETL ETL_SOURCE_IDETL_DATEETL_JOB_ID
DT_SVC_PROCEDUREPrimary KeyLAB_RESULT_IDForeign Key
DATA_SOURCE_IDLAB_PROVIDER_IDLAB_CODE_MASTER_IDSERVICE_IDBusiness DataLAB_ORDER_NUMTEST_NAMETEST_DESCTEST_CODETEST_CODE_SYSTEM
TEST_CODE_ORIGTEST_CODE_SYSTEM_ORIGCOLLECTION_TIMETEST_TIMERESULT_VALUERESULT_STATUSRESULT_UNITRESULT_VALUE_TYPEREF_NORMAL_MIN
REF_NORMAL_MAXREF_RANGE_EFF_DATEABNORMAL_FLAGETL ETL_SOURCE_IDETL_DATEETL_JOB_ID
DT_SVC_LAB_RESULT
Primary KeyPATIENT_CONSENT_IDForeign Key
DATA_SOURCE_IDPATIENT_IDBusiness DataCONSENT_CODECLINICLOCATION_IDSERVICE_ID
FORM_IDCONSENT_IDPRESENTATION_TYPECHOICE_INDCONSENT_GRANTED_INDTRANSACTION_DATECONSENT_START_DATECONSENT_END_DATECONSENT_STATUSETL ETL_SOURCE_IDETL_DATEETL_JOB_IDVERSION
DT_PATIENT_CONSENT
Primary KeySVC_MEDICATION_IDForeign Key
DATA_SOURCE_IDORDERING_PROVIDER_IDMEDICATION_MASTER_IDSERVICE_IDBusiness Data
PLACER_ORDER_NUMBERRECORD_TYPESTART_DATEEND_DATEBRAND_NAMERX_CODE_ORIG
RX_NAME_ORIGRX_CODE_SYSTEM_ORIGRX_CODERX_NAMERX_CODE_SYSTEMQUANTITYQUANTITY_MAXQUANTITY_UNITTAKE
DOSEDOSE_UNITDOSE_FORMDOSE_STRENGTHDOSE_STRENGTH_UNITDISPENSE_QUANTITYDISPENSE_QUANTITY_UNITROUTEREFILLSDURATIONDURATION_UNITFREQUENCYFREQUENCY_UNITPRN_FLAGPRN_REASONSUBSTITUTION_FLAGMAX_DAILY_DOSEMAX_DAILY_DOSE_UNITPRESCRIBED_FLAGPATIENT_EDUCATED_FLAGIS_COMPONENT_FLAGINSTRUCTIONSETL ETL_SOURCE_IDETL_DATEETL_JOB_ID
DT_SVC_MEDICATION
Primary KeyPATIENT_NUM
CONCEPT_CDPROVIDER_IDMODIFIER_CDSTART_DATEBusiness DataENCOUNTER_NUMVALTYPE_CDTVAL_CHARNVAL_NUMVALUEFLAG_CDQUANTITY_NUMINSTANCE_NUMUNITS_CDEND_DATELOCATION_CDCONFIDENCE_NUMOBSERVATION_BLOBETL UPDATE_DATEDOWNLOAD_DATEIMPORT_DATESOURCESYSTEM_CDUPLOAD_ID
12CDW Scope: Initial Data Feeds
CohortAnalysis
Multi-site dataintegration
1
Data Types Clinical Trial
Recruitment
InclusionGoal/Result
2 3
n+
Patient Demographics
1
2
3
Diagnosis
Labs
Medications
Procedures
DrivingBiomedical
Projects
n+1 Optimizing healthcare research data warehouse design through past COSTAR query analysis. S. N. Murphy, M. M. Morgan, G. O. Barnett, and H. C. Chueh Proc AMIA Symp. 1999: 892–896
Over 90% of research-based queries to an existing clinical database use data elements from sections 1, 2, and 3. 1
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Data
Complexity
Labs
Meds
Diagnoses
Problems
Diagnostics
Orders
Results
ClinDoc
Costs data
Claims data
eRx Data
Practice eHR data
Live
(MU
SC)
Pilo
tLo
w D
ifficu
ltyEx
plor
ing
Unk
now
n
ACO Management
Population Health
Duplicate Service
ReductioneRx
ReconciliationDeathRegistry
Death Data
Comparative Analytics/
Benchmarking
Standardized Reporting
For External Measures
Clinical Decision Support
Research CDW/i2b2
Chronic Disease Registries
Care Coordination
Registry(Automated)
Medicare/Medicaid
Data mart and BI
All Claims Database
Clinical Data Mart & Business
Intelligence Tools
Enterprise Master Patient
Index
Individual MemberClinical Data Marts &/or Registries (optional)
Integrated Claims and Clinical Data Services (optional)
Care Continuum Data Services (optional)
ADT
CDW Core & Optional Data Services Vision
Core CDW Services
14Core & Optional Services
Core
Research Support Administration &
Management:
Grant opportunity identification
Coordination on multi-institutional grants
Grant PreparationData Services:
CDW: I2B2 access to research data base
CDW: BI tool and clinical data access
Optional Research Support Services:
Federated bio-repository (information management)
Clinical Trial support (data analysis; recruiting support)
Grant administration
Optional Data Services:
eIRB
SPARC
Study Tracker
Registries
Hospital management reporting
Benchmarking
ACO reporting
Population health management
Out of Scope Research Support Services:
Centralized bio-repository tissue management
Clinical Research Organization (CRO)
Out of Scope Data Services:
Integrated clinical decision support
All-Claims database
Optional Out of Scope
Other Out of Scope:
Clinical Protocol development
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HSSC Information Solutions Approach
Information Architecture
Clinical Research Solutions
Clinical Solutions (Optional)
Today 6 Months 12 - 16 Months
Detail Planning
Detail Planning
16Methodology: Phase Detail
Phase Detailed Stages HSSCResources
SiteResources
TimeEstimate
Discovery • Project Kickoff & Data Call
• Enterprise Architecture Review
• Business Process Overview
• System Lifecycle Roadmaps
PMTech Lead
DW AnalystInterface Analyst
Champion (5%)PM (10-20%)SME (10-20%)
Network Admin (<5%)
~2 weeks
Source Analysis • REDCap Questionnaire
• Source System Interviews
• Sample Data Feeds/Files
• Detailed System Understanding
PMDW AnalystInterface Analyst
Champion (5%)
PM (10-20%)SME (20%)HL7 Interface Analyst (25%)
~1-2 months
Implementation • Design
• Mapping & Translations (ex: RXNorm/LOINC mappings)
• Configuration
PMTech LeadDW Analyst
Interface Analyst
Infr/Config Analyst
DBA
Champion (5%)PM (10-20%)
SME (10-20%)Clinical Resource (25%)
~2-3 months
Testing • Internal testing
• Beta-User Testing/Validation
• Institution Sign-off
PMQA Analyst
Champion (5%)PM (10-20%)
User Testers
~1 month
Rollout • Scheduled Deployment
• Final Sign-off
PMTech LeadInfr/Config Analyst
Champion (5%)PM (10-20%)
Network Admin (<5%)
~1 week
17Revised CDW Implementation Timeline
2012 2013 2014
2nd HospitalProject Started
Data Collaboration Agreement must be signed
CompleteTechnologyAudit
Hospital 1 Data LoadedEnd-to-end HL7-i2b2
New Vendor Contract
Start Conv of Hospital 1 to New System
Hospital 2 Data Loaded Start
workgroup HSSCaffiliate Hospitals
Affiliate Hospitals Data Loaded– Q2 2014
Hospital 1 Production on New System
Hospitals 3 & 4Projects Started
Hospitals 3 & 4Projects Data Loaded
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