the regenstrief experience: integrating data repositories and … · they will share immunization...
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The Regenstrief Experience:The Regenstrief Experience:Integrating Data Repositories Integrating Data Repositories and Real World Examples of and Real World Examples of
Passing “Data Value” to Passing “Data Value” to Caregivers: ImmunizationsCaregivers: Immunizations
Paul Biondich, MD, MSPaul Biondich, MD, MSChildren’s Health Services ResearchChildren’s Health Services ResearchRegenstrief Institute InvestigatorRegenstrief Institute Investigator
What We’ll CoverWhat We’ll Cover
The Regenstrief Indiana Network for The Regenstrief Indiana Network for Patient Care (INPC) Patient Care (INPC) –– backgroundbackgroundCreating Interfaces with CHIRP and Creating Interfaces with CHIRP and the Importance of Standardsthe Importance of StandardsSpecific Examples of Integrating / Specific Examples of Integrating / Enhancing the Clinical Experience Enhancing the Clinical Experience Using These DataUsing These DataImplementation / Integration PearlsImplementation / Integration Pearls
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INPC INPC -- Humble Beginnings Humble Beginnings
In health care settings, information comes from In health care settings, information comes from a host of fragmented sources (lab, radiology, a host of fragmented sources (lab, radiology, registries, etc.)registries, etc.)Regenstrief tasked in 1972 to “stitch” these Regenstrief tasked in 1972 to “stitch” these sources together sources together --> the Regenstrief Medical > the Regenstrief Medical Record System (RMRS/Record System (RMRS/WishardWishard) ) In 1994, began stitching together information In 1994, began stitching together information across institutions (INPC/Indianapolis)across institutions (INPC/Indianapolis)In 2003, working towards stitching the state In 2003, working towards stitching the state together (INPC/Indiana)together (INPC/Indiana)
Indiana Network for Patient Care Indiana Network for Patient Care (INPC)(INPC)
Up and running for more than 9 yearsUp and running for more than 9 yearsStarted with a modest goal (Emergency Started with a modest goal (Emergency Care)Care)Extended by adding projects one step at a Extended by adding projects one step at a timetimeFocus on clinical and public health issues, Focus on clinical and public health issues, particularly electronic laboratory reportingparticularly electronic laboratory reportingWe serve as the “Data Switzerland” for the We serve as the “Data Switzerland” for the city of Indianapolis and the statecity of Indianapolis and the state
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INPC INPC –– Participants Participants
Includes 11 hospitals from the 5 major Includes 11 hospitals from the 5 major Indianapolis hospital systems (95% of nonIndianapolis hospital systems (95% of non--office care)office care)Includes all four homeless care systemsIncludes all four homeless care systemsIncludes county and state public health Includes county and state public health departmentsdepartmentsMany outpatient practicesMany outpatient practicesBoth major cardiologyBoth major cardiologyreferral centersreferral centers
INPC hospital participantsINPC hospital participants
Health DepartmentPractice/ClinicHospital
LabCorpLabCorp
QuestQuest
MCHDMCHD
Rx dataRx data
In p
rogr
ess
Heart Center of Indiana
The Indiana Heart Hospital
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A “Big” EMRA “Big” EMRIn the system:In the system:–– 15 million orders15 million orders–– 300 million coded results300 million coded results–– 5.5 million dictated reports5.5 million dictated reports–– 8.8 million radiology reports8.8 million radiology reports–– 25 million prescriptions25 million prescriptions–– 400,000 EKG tracings400,000 EKG tracings–– 2.3 TB radiology images2.3 TB radiology images
Added Per Year:Added Per Year:–– 600,000 ambulatory encounters600,000 ambulatory encounters–– 50,000 inpatient encounters50,000 inpatient encounters
Added daily:– 40 GB image data
Present Work/CommitmentsPresent Work/Commitments
Indianapolis HospitalsIndianapolis Hospitals–– All Admission/ All Admission/
Discharge SummariesDischarge Summaries–– All Operative NotesAll Operative Notes–– All Radiology ReportsAll Radiology Reports–– All Pathology ReportsAll Pathology Reports–– Inpatient MedicationsInpatient Medications
StatewideStatewide–– Tumor Registry DataTumor Registry Data–– Blood Lead DataBlood Lead Data–– ImmunizationsImmunizations–– Newborn ScreeningNewborn Screening–– Vital StatisticsVital Statistics–– Chief ComplaintsChief Complaints
All data is meant to be both received and sent by design
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Importance of StandardsImportance of Standards
The sine qua non for all of this workThe sine qua non for all of this workHL7HL7 is the protocol in which we both is the protocol in which we both receive and export all clinical datareceive and export all clinical dataLOINCLOINC provides us with standard codes provides us with standard codes that define content of each delivered HL7 that define content of each delivered HL7 message..message..–– Protects the same data within two institutions Protects the same data within two institutions
from being labeled different thingsfrom being labeled different things–– DTAP DTAP ImmunImmun vs. DTAP Shot vs. DTAPvs. DTAP Shot vs. DTAP
CHIRP / INPC InterfaceCHIRP / INPC Interface
Bidirectional HL7 interface using the Bidirectional HL7 interface using the immunization standards published by the immunization standards published by the CDCCDCWe will share lead and other “value We will share lead and other “value added” elements as desiredadded” elements as desiredThey will share immunization data with usThey will share immunization data with usNightly batch processNightly batch processImportance of Importance of CHIRP’sCHIRP’s interfaceinterface
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INPC InfrastructureINPC Infrastructure
HL7 Message
Map Code to LOINC
Standardized Institutional Vault
Institutional Source
Network TopologyNetwork Topology
7 T1 Lines
7 T1 Lines
T1T1
T1
T1
T1T1
T1T1T1T1
T1T1
9 Tele Lines
9 Tele Lines
2 Tele Lines
2 Tele Lines
2 ISDN Lines2 ISDN Lines
9 Tele Lines9 Tele Lines
St. VincentSt. Vincent
ShalomShalomWellness andWellness andRoberts ParksRoberts Parks
St. FrancisSt. Francis
St. FrancisSt. FrancisSouthSouth
CommunityCommunitySouthSouth
St. VincentSt. VincentCarmelCarmel
2 Tele Lines
2 Tele Lines
GennesaretGennesaretHomelessHomeless2 clinics2 clinicsMed StudentMed Student
VolunteerVolunteer2 clinics2 clinics
VPNVPN
10 MB 10 MB
Ethernet
Ethernet
T3T3
T1T1
Indiana StateIndiana StateDept HealthDept Health
Marion CoMarion CoHealth DeptHealth Dept
ISDNISDN
T1T1
WHS ClinicsWHS Clinics7 sites7 sites
5 T1 Lines
5 T1 Lines
MidtownMidtownMental HealthMental Health
9 sites9 sites
MidtownMidtownMental HealthMental Health
MeridianMeridian
HospitalsHospitalsClarianClarianMethodistMethodist
ClarianClarianIU/RileyIU/Riley
IUMG ClinicsIUMG Clinics5 sites5 sites
CommunityCommunityEastEast
PeoplesPeoplesHomelessHomeless
9 sites9 sites
CommunityCommunityNorthNorth
WishardWishard
INPCINPC
Fibe
rFi
ber
PittsburghPittsburgh
VPNVPN
One or more clinics/group practicesOne or more clinics/group practices
One or more homeless care sitesOne or more homeless care sites
Public health departmentsPublic health departments
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At the core of the INPC is a At the core of the INPC is a Medical Record SystemMedical Record System
Results retrievalResults retrievalClinical messaging/document deliveryClinical messaging/document deliveryData entryData entryReportingReportingClinical decision supportClinical decision supportData surveying toolsData surveying tools
Specific Implementation ExamplesSpecific Implementation Examples
Florida Marlins Florida Marlins –– A successful A successful implementation.. ;)implementation.. ;)
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Provider AbstractProvider Abstract
Web Inquiry / Web InterfaceWeb Inquiry / Web Interface
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Web Inquiry / Web InterfaceWeb Inquiry / Web Interface
Web Inquiry / Web InterfaceWeb Inquiry / Web Interface
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Examples of Provider RemindersExamples of Provider Reminders
CHIP – 1st
Generation DSS
CHICA CHICA –– 22ndnd Generation DSSGeneration DSS
Child Health Improvement through Child Health Improvement through Computer AutomationComputer AutomationComprehensive Pediatric Preventative Comprehensive Pediatric Preventative Care Decision Support SystemCare Decision Support SystemDesigned around large collection of Designed around large collection of constraints from busy pediatric clinicconstraints from busy pediatric clinic–– Clear tasks that needed improvementClear tasks that needed improvement–– Extremely workflow sensitive personnelExtremely workflow sensitive personnel–– TechnologyTechnology--phobic managementphobic management
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CHICA CHICA -- AttributesAttributes
Interface to practice Interface to practice –– paper and paper and computer basedcomputer basedCollects data in critical times during Collects data in critical times during patient visit, presents data “just in time”patient visit, presents data “just in time”Decision support all based on pediatric Decision support all based on pediatric preventative care guidelinespreventative care guidelinesHas robust access to INPC data, but can Has robust access to INPC data, but can also run autonomouslyalso run autonomously
SampleSampleProvider Provider
Worksheet:Worksheet:
An example of An example of “Just in Time”“Just in Time”
datadata
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CHICA RemindersCHICA Reminders
Support Staff Support Staff BarcodingBarcoding TemplateTemplate
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Implementation PearlsImplementation Pearls
GembaGemba Kaizen ...Kaizen ...
""GembaGemba" is a " is a Japanese word Japanese word meaning "real place", meaning "real place", where the real action where the real action takes place. In takes place. In business, gemba is business, gemba is where valuewhere value--adding adding activities to satisfy the activities to satisfy the customer are carried customer are carried out.out.
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Immunization Registry Immunization Registry GembaGemba
Practitioners need relief! Provide them Practitioners need relief! Provide them with “just in time” data at point of carewith “just in time” data at point of careDisparate workflows necessitate multiple Disparate workflows necessitate multiple interfaces.. let practices chooseinterfaces.. let practices chooseGive support staff easy ways to capture Give support staff easy ways to capture data electronicallydata electronicallyNeeds drive the technology.. “build Needs drive the technology.. “build hammers for the largest nails”hammers for the largest nails”
The Popcorn Man’s PDA
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More More GembaGemba
Lead the user’s needsLead the user’s needsBe careful asking users what they want initially Be careful asking users what they want initially because what they say they want is not what because what they say they want is not what they will use or what they needthey will use or what they needUsers won’t be critical of the options until they Users won’t be critical of the options until they try to use it; likewise they won’t recognize the try to use it; likewise they won’t recognize the problem areas until they try to use itproblem areas until they try to use itDesign for a casual user and against the power Design for a casual user and against the power user.. Simplify clicks, key presses, page turns, user.. Simplify clicks, key presses, page turns, etc.. give them data quickly!etc.. give them data quickly!
Things to AvoidThings to Avoid
AnythingAnything that slows the provider downthat slows the provider downMaking the computer the “bad guy” (e.g. Making the computer the “bad guy” (e.g. coding, lots of extraneous steps)coding, lots of extraneous steps)Being paperless for the sake of being Being paperless for the sake of being paperlesspaperless–– “My clinic will be paperless the same day your “My clinic will be paperless the same day your
bathroom is”bathroom is”
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Short? Term GoalsShort? Term GoalsShare your dataShare your data–– Build ability to Build ability to exportexport data through standards (HL7, data through standards (HL7,
LOINC)LOINC)–– Value of “decentralization” of data: previous examples Value of “decentralization” of data: previous examples
of data useof data use–– More and more researchers and EMR vendors will More and more researchers and EMR vendors will
want to make use of your hard work!want to make use of your hard work!
Evaluate your systemsEvaluate your systems–– Focus on improving quality of care, less on data Focus on improving quality of care, less on data
quality / completeness of dataquality / completeness of data–– Randomized controlled trials that show impact on Randomized controlled trials that show impact on
immunization complianceimmunization compliance
Questions / Comments?Questions / Comments?
Regenstrief welcomes your questions / Regenstrief welcomes your questions / ideas / examples of implementationsideas / examples of implementations
My My EMailEMail: : pbiondich@regenstrief.orgpbiondich@regenstrief.orgMy Phone: 317My Phone: 317--630630--74007400
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