1

2

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.

5

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

6

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

8

Collaboration & Alignment: HSSC Portfolio of Infrastructure Projects

8

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

9

9

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

10

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

11

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

13

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

15

15

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