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TRANSCRIPT
Data Integration in the CommunityChrystelle Ayerhart
Interface Systems Analyst
Peggy MillarCorporate Manager Computer Applications
Grey Bruce Health Services
Making DI/Lab Results and Transcribed Documents Available
Electronically to Community Physicians
Grey Bruce Information Network (GBIN)
• Approximately 9000 sq. km (3,475 sq. miles)
• 3 corporations• 11 hospital sites• 1 outpatient clinic site
Strategic Goals (Technology)
• Grey Bruce Health Services will utilize technology as it becomes available if it improves efficiency and safety, and enhances our service
• We will create mechanisms to share information to support a seamless care experience for the patient and to improve system efficiency
Operational Goals
• Reduction of paper • Enter data once, reduce the effort• Reduce labour • Sharable data • User friendly applications• Efficiencies • Less steps for clinical staff
Provider Benefits
• Reduced turn-around time for results• Faster diagnosis and treatment• Results requiring follow up are flagged• Time and labour savings – decreased manual
handling of result• Decreased paper, decreased physician storage
required• Vendor neutral• Ease of connection
EPR PyramidFamily
Physician
GeneralLab
Notes
Dictation&
Transcription
Peri-OperativeCare
PatientScheduling
ChartTracking
ChartCoding &
Abstracting
ChartDeficiency
ChartViewer
Radiology&
Nuclear Med.
PatientRegistration
BloodBank
ChronicDisease
Mgt
PACS
ManagementReporting
ElectronicSignature
Pathology
OrdersAutomationPharmacy
EDPatient
Tracking
DocumentImaging
CardiacCareMgt
CriticalCare
System
ProblemList
BedsideCare
Rules &Alerts
ClinicalDocumentation
ClinicalPathways
CommonChartingPractices
CommunityServices
HomeCare
RegionalHospitals
LTC Facilities
AdverseDrug
Events
ClinicalDecisionSupport
PhysicianOrderEntry
Previous Process
• Lab, DI and Medical Transcription documents produced in hard copy
• Results are sorted, mailed or faxed to physician offices
• Document handling:– Must be printed– Filed in the patient’s physical chart– Possibly scanned into electronic format
Project Specific Objectives
• Improve the method of sending results to local physician clinics
• Produce standard method of communication
• Have a flexible, scalable solution – recognized the need to send to multiple locations
Design Approach
• Potential to apply technology to many locations is apparent
• Opted for single interface working with a 3rd party gateway
• Burden of processing and maintenance occur at gateway
Design Approach Continued
• Standardized message structure makes system vendor-neutral
• Gateway alerts of errored messages or dropped connections
• Interface maintenance handled completely in-house
Build Steps
• Resources– Technical Coordinator– Interface Systems Analyst– Representative from 3rd party vendor
• Physical Resources– Servers (production and test)
• We were the driving force behind 3rd party vendor’s functionality
Testing, Testing, Testing
• Phase 1– Between Cerner and gateway only– Simulated receiving clinics– Set up scenarios to test gateway alerts
• Phase 2– Contacted alpha clinic software vendor– Set up testing environment with them– Tested modality by modality
Implementation
• One modality, one message at a time• Daily status calls• Vendor/Customer gave approval to send next
modality messages• 3rd party gateway vendor remote support
• Initially needed to work closely with gateway system’s vendor– Now only require very basic maintenance
support
Timeline
• Initial timeline 2 months• Chose alpha site and went live in 2004• Present state, new clinic go-live can be
done in three days:1. Clinic contacts HIS with list of physicians
(dependent on their hardware/software setup)– HIS sets up VPN and builds physicians on gateway
2. Send test messages to check connectivity
3. Go-live
Current Process
• Verified result or posted transcribed note triggers result message that is routed to interface
• Interface sends all messages to gateway• Gateway prunes messages and routes
only to participating physician offices• No paper, scanning or filing is required
at either the hospitals or clinic• Multi site : multi clinic
Transcription
Lab
DI
Particulars
• System send 4800+ messages daily to gateway
• After pruning, gateway distributes 2000+ messages to clinics
• 90 physicians practicing at 12 clinics receive electronic reports
• Many have opted out of paper reporting
Particulars Continued
• Each clinic is free to choose whatever office management package is suitable
• 4 different vendors are connected, representing approximately 80% of available vendors
• Physician account builds and maintenance are very easy, nothing changes at interface level
Legend - included in Data Integration initiative
- complete
- future
EPR Pyramid Now
GeneralLab
Notes
Dictation&
Transcription
Peri-OperativeCare
PatientScheduling
ChartTracking
ChartCoding &
Abstracting
ChartDeficiency
ChartViewer
Radiology&
Nuclear Med.
PatientRegistration
BloodBank
ChronicDisease
Mgt
PACS
ManagementReporting
ElectronicSignature
Pathology
OrdersAutomationPharmacy
EDPatient
Tracking
DocumentImaging
CardiacCareMgt
CriticalCare
System
ProblemList
BedsideCare
Rules &Alerts
ClinicalDocumentation
ClinicalPathways
CommonChartingPractices
CommunityServices
HomeCare
RegionalHospitals
LTC Facilities
AdverseDrug
Events
ClinicalDecisionSupport
PhysicianOrderEntry
FamilyPhysician
Lessons Learned • We started before the wave of office
management vendors hit clinics
• Control of hardware/software set up and configuration at the clinics is not in our hands
• The time spent creating standard specifications is key to success
Lessons Learned Continued• Maintaining constant connectivity
through VPN problematic
• Distributed data model by far most robust
• Consistent change control from vendors is required
Lessons Learned - Clinics• Vendor support• Type of connection required
– Centralized server is most stable at this point
• Talk to other clinics that are live with Cerner feeds
• Talk to hospitals that are sending Cerner results
Next Steps
• Expect to perform routine hardware and software upgrades
• Seeing more inquiries from more clinics
• Can envision same model to send messages to other corporations, hospitals, LHINs
• No limit on message types
Questions?
Chrystelle Ayerhart
Interface Systems Analyst
Peggy Millar
Corporate Manager Computer Applications