MiChart Data Integration Review
25 April 2011
Agenda
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Welcome & Introduction
MiChart Project Milestones
Long-Term CDR Plan Overview
Changes to Non-CareWeb Data
Break (those not interested in CW data may
depart)
• Changes to CareWeb Clinical Data
• Presentation saved at: S:\MCIT\MiChart\Data
Integration
MiChart Project Milestones
Context – Data in Transition
• Mi-Chart at Stage 2 Go-Live
• Today one CDR, one
analytical reporting
database
• Stage 2 will double our
resources
• Synchronization for
CDRs
• Enriched data for HSDW
Planned UMHS Data Environment
• Mi-Chart at Stage 4 Go-Live
• Data consolidated
•
CareWeb replaced
• CDR archived
Changes to Non-CareWeb Data
February 2012
• ADT feed switch from HealthQuest (PM) to
MiChart (Prelude)
• Scheduling feed switch from PHS (EWS) to
MiChart (Cadence)
• ADT and Scheduling simple, code and description
tables switch from HealthQuest and PHS to
MiChart
• CDM (Charge Description Master) switch from
HealthQuest (PA) to MiChart
• Medical Record Procedures switch from
HealthQuest (MR) to MiChart
Real-time CDR data sources via message-based interfaces
All interfaces HL7 unless otherwise noted
Radiology
&
NucMed
systems
Lab
[LIS]
Radiology
[RAD IDX]
Results Reporting source: departmental systems
DBLINK
Every 15 min.
DBLINK
Every 15 min.
7am-6pm M-F
DBLINK
Every hour during
business hours, M-F
FTP daily
Neurology
EMG-Pro
Mi-Chart
Ambulatory
Scheduling
Mi-Chart
ADT
MPU
Provation
ORMIS
EMPI
Provider
Index
UMCareLink
[OMP]
FTP
every 60 minutes
Cardiovascular
[CVIS]
Pulmonary
Function
Test
WorX
Inpatient
Medications
daily
EEG
Vascular
FTP daily
e–
da t
Na v
igat
or u
p
s
ie
rg
le
Al
m
ro
–f
CD
R
s
gie
er
All
m
ro
–f
CD
R
Lookup
Tables
CTS
Transciption
Message Routing
ORMIS
CareLink
FTP weekly
CDR has over 90 tables
classified as Lookup tables.
They are loaded via automatic
scheduled processes, on request
processes, and manually, depending
on the nature of the data and source.
Non-HL7 [ctsld]
25,000 / day real time
DC
CDR XI
Interface
Engine
WBI
SCH
CTS
CDM
FTP daily
Employee
Health
Interface
Engine
ADT
MedRec
procedures
Pt. account
balances
PA
from
C
[VARIS]
FTP daily
LIS
DR
Scheduling
Ped
Cardiology
FTP
8 a.m. daily
Pediatric PFT
IDX
Rad Onc
MESSAGING &
TRANSFORMATION
TIER
Batch-loaded CDR data sources
Enterprise Clinical Systems
CDR Production Environment
CDR Staging
Message parsing and
pre-processing
The staging database is used
for all pre-processing, translation
and validation of batch loaded
data sources.
MPU
Pro
v
Eve
ry 2 ation t
oC
hrs,
DR
8 am
-6p
m
DataGuard Logical
Realtime Copy
Clinical Data Repository
INFORMATION
TIER
D
A
T
A
R
E
C
I
P
I
E
N
T
S
Applications which DISPLAY data from the CDR:
1. At Risk Reports [Office of Clinical Affairs]
2. Cancer Registry
3. CardioVascular Center Chronic Heart Failure
4. Central Transcription Services [EditDoc, CPI validation]
5. Clinic Business Workflow
6. Clinic Charge Capture
7. CORTEX [Neurosurgery]
8. Diet Order Entry System ‘DOES’ [Pt Food & Nutritn Svs]
9. Elec MEd Recd Search Engine “EMERSE”
10. Emergency Department Patient Name Lookup
11. Engage [Center 4 Advancement of Clinical Research]
12. Enterprise Reporting and Analysis
13. Geriatrics Patient Arrival System
14. Health Information Management Reporting
15. Infusion Patient Arrival System [Cancer Center]
16. Language Service Schedule Support
17.
18.
19.
20.
21.
22.
23.
24.
25.
26.
27.
28.
29.
30.
M-Strides [Psychiatry]
Medical School Information System
Michigan Visiting Nurses
MNET
Neurosurgery application
OneStaff [Nursing]
Organ Transplant Information Sys 2 ‘OTIS 2’
Pediatric Cardiology
Physician Peer Review
Public Relations & Marketing Call Center Apps
Surgery Tracking & Activity Reporting ‘STAR’
UM Endocrine Bank ‘UMEB’
Transplant Billing Workflow
Wound Care
Applications which both DISPLAY &
UPDATE CDR data:
1. CareWeb
Data input to CDR:
- Allergies
- Audit Log
- Discharge Navigator
- Immunization
- Inbox [Lab & Radiology]
- Patient Lists
- Problem Summary Lists
2. Respiratory Care System [RCS]
- Orders & billing data
3. Cielo Clinic [Family Medicine]
- Diagnoses for PSL
Clinical Research
Repository
Applications which COPY data from the CDR to another database, for use by the application:
1. Anticoagulation
18. Investigational Drug Service
2. Audit Database
19. MarketScope [Public Relations & Marketing]
3. AviTracks Lab Monitoring System
20. Medical Record Tracking
4. Blue Care Network
21. Michigan Care Improvement Registry
5. Cardiology Electrophysiology Project
22. MiLES [Mich Inst for Clin Hlth/Research]
6. Centricity
23. Nephrology Clinical Database
7. Clinical Information & Decision Supp Svcs [CIDSS] 24. OB TraceVue
8. Clinical Resource Team [Reg & Insur Verificatn] 25. OBGYN Research
9. Direct Access Disch Appt Scheduling [Amb Care] 26. Palliative Care
10. Disease Management [Medical Management Ctr] 27. Pediatric Plastic Surgery
11. Document Imaging for the Elec Hlth Record
28. Pharmdoc.net
12. Document Management System
29. Physician Billing
13. Employee Health Service Lab Results
30. Pulmonary Function Testing
14. EPSI Cost Accounting System
31. Registration Workflow
15. Grateful Patient Database
32. RevRunner [Reg & Insurance Verification]
16. Head & Neck Cancer Research
33. UMHS Data Warehouse
17. Internal Medicine Consult Billing
34. Urology Prostate Database
7
clr 10/27/2010
MRN, CSN, and HAR Terminology
• Medical Record Number (MRN) – The medical record number is a
unique identifier for each patient. It is assigned when a new
patient is created in MiChart.
• Contact Serial Number (CSN) – The contact serial number is a
unique identifier for each patient visit, such as an appointment or
admission. It is assigned at the point of visit creation and is assigned
to all visits, regardless of whether they take place in a hospital or a
clinic setting. Some synonyms for the CSN include visit, encounter,
and contact.
• Hospital Account (HAR) – The hospital account record is used to
group charges for billing purposes. Each HAR is associated with one
or more patient visits in MiChart. It is typically only used in a
hospital setting and is assigned at the point of patient registration.
MiChart Visits and Accounts
Patients (EPT)
Patient (MRN 123)
Encounter (CSN X)
• Documentation
• Orders
• Medications
Accounts (HAR)
Account (HAR A)
• Charge A
• Charge B
• Charge C
Account (HAR B)
Encounter (CSN Y)
• Documentation
• Orders
• Medications
Encounter (CSN Z)
• Documentation
• Orders
• Medications
• Charge A
• Charge B
• Charge C
Data Changes to the Clinical Data
Repository – Tables & Views
• Tables and views no longer updated after
February 2012
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–
–
–
–
–
–
–
Patient_2_t
Patient_2
Patient_HIPAA
Patient_visit_msp_answer_t
Patient_visit_msp_answer
Patient_visit_msp_answer_cdr
Patient_balance_t
Patient_balance
• Patient_visit_contact information is collected at
the patient level in MiChart.
Data Changes to the Clinical Data
Repository – Columns
• Columns no longer updated after February 2012
– Patient pat_preferred_name, bad_address_ind, pat_lang_verified_flag,
smoker_flag, pat_mailing_name, last_reg_rev_date,
last_forms_rev_date, last_addr_rev_date, um_msp_review_date
– Patient_employer employ_to_date
– Patient_visit registration_date, medicare_priority, msp_complete_flag,
msp_last_date, msp_bypass_ind
– Visit_insurance ppo_code, ins_elig_comment, ins_verif_comment,
ins_co_pay, ins_deductible
– Insurance ins_type, blue_cross_serv_code, ins_copay
– Insurance_contact ins_mail_to_name, ins_mail_to_ind
– Caregiver_visit_role address seq_nbr is still being investigated
• New columns
– Patient degree, 20 characters
– Patient_visit HAR_nbr, 10 digits
Data Changes to the Clinical Data
Repository – Data
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Visit_nbr
Lastname
Full name
Address line 1
Address line 2
CPI to MRN
Financial_class
Ins_company_id
Ins_company_name
4 to 10
30 to 50
60, 90 to 120
30 to 75
30 to 75
8 to 9
1 character to 3 digits
3 character TPC to 9 digits
25 to 35
12
MC Change Table Schema
MC_COLUMN_CHANGE
MC_DATA_CHANGE
PK data_id
I1
col_id
old_value
new_value
record_status
begin_src
begin_date
update_src
last_updated
MC_OBJECT_CHANGE
PK col_id
I1
PK obj_id
col_name
col_change_type
col_in_mc_ind
col_data_change_ind
col_change_desc
record_status
begin_src
begin_date
update_src
last_updated
I1
MC_CHANGE_XREF
PK change_xref_id
I1
I2
col_id
obj_id
record_status
begin_src
begin_date
update_src
last_updated
obj_name
obj_type
obj_owner
record_status
begin_src
begin_date
update_src
last_updated
Mi-Chart ADT & Scheduling to CDR
Project Milestones
April 2011
Schema Changes
July 2011
HL7 Unit Test
September 2011
CareWeb Test
May 2011
IC Changes
March 2011
August 2011
HL7I Integrated Test
December 2011
Schema Finalized
November 2011
Customer Test
June 2011
February 2012
Production
Implementation
CDRQ/CDRP
September 2011
January 2012
Customer Test
December 2011
March 2011
February 2012
March - August
CDRI DB Changes
August - November
CDRD DB Changes
November - January
CDRQ DB
January - February
CDRP DB
March - December
Mi-Chart HL7 to CDRI
December - February
Mi-Chart HL7 to CDRD
Query Certification Process
• SELECT No re-certification for any change.
• FROM Re-certification for any change.
• WHERE Re-certification for clause changes
No re-certification for data changes.
Submit changes through COMET or Remedy.
Outside the UMHS network, submit changes to
Linda Xu at lixu@med.umich.edu
15
Questions?
16
Changes to Clinical Data Overview
• When we move from CareWeb to MiChart in the
ambulatory clinics, MiChart becomes the source
system for ambulatory clinical data
• CareWeb and MiChart are separate systems with no
automated data integration
• The CDR will not be a reliable source for CareWeb
clinical data
• Customers who require real time access to existing
CareWeb clinical data will be asked to use MiChart
Web Services
What Data are Impacted
(No longer a reliable source in the CDR)
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Ambulatory Medications
Allergies and Intolerances
Procedures
Health Maintenance Activities
Problem List (Diagnoses)
Immunizations
Vitals and Growth Charts
Outpatient Documentation (Post Go-Live)
Social and Family History
What Data are Not Impacted
(Existing feeds from source systems are maintained)
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Lab Results
Radiology Reports
Other Results (Echo Report, EEG, EMG, NEUR, PCARD, …)
PFT Results
Imaged Documents
Inpatient Documentation
Outpatient Documentation (Pre Go-Live)
Conversion Plan to MiChart
• All Coded Medications, Coded Problems,
Allergies, Immunizations, Vitals, and Growth
Charts
• Some Health Maintenance Items (TBD)
• No Procedures, Family History, or Social
History
• No Documentation
Accessing Data in the MiChart Environment
• Customers who require real time clinical data which is
no longer available within the CDR will be asked to use
MiChart Web Services (based on Epic’s InterConnect
software)
• If real time data is not required, customers have the
option to work with the reporting team to get a prior
days snapshot data
• The MiChart technical team will work with each
customer individually to implement these services
within their application
• If Web Services are not technically viable, an
abstraction layer may be provided via CDR Views
Available Web Services
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GetPatientDemographics
GetActiveProblemList
GetActiveAllergies
GetActiveMedications
GetFamilyHistory
GetMedicalHistory
GetSurgicalHistory
Other types of clinical data can be made available on
request (i.e. Immunizations, documentation, etc…)
Sample Request for GetActiveAllergies
Endpoints
https://.../Interconnect/wcf/Epic.Clinical.Services/Clinical.svc/basic (wsHttpBinding – SOAP 1.1)
https://…/Interconnect/wcf/Epic.Clinical.Services/Clinical.svc (wsHttpBinding – SOAP 1.2)
WSDL Location
https://mccpslbd1.umhs.med.umich.edu/Interconnect/wcf/Epic.Clinical.Services/Clinical.svc?wsdl
SOAP Action
urn:epicsystems-com:Clinical.2009.Services.GetActiveAllergies
<GetActiveAllergies xmlns="urn:epicsystems-com:Clinical.2009.Services">
<PatientID>
<ID>60000359</ID>
<IDType>UMHS MRN</IDType>
</PatientID>
<UserID>
<ID>1</ID>
<IDType>External</IDType>
</UserID>
</GetActiveAllergies>
Sample Response for GetActiveAllergies
<GetActiveAllergiesResponse xmlns="urn:epicsystems-com:Clinical.2009.Services">
<GetActiveAllergiesResult xmlns:i="http://www.w3.org/2001/XMLSchema-instance">
<Allergies>
<Allergy>
<AllergenDescription>WASP VENOM</AllergenDescription>
<AllergenName>WASP VENOM</AllergenName>
<DateEntered>03/28/2011</DateEntered>
<DateNoted>05/04/2007</DateNoted>
<ReactionComment>Carries Epi-pen</ReactionComment>
<Reactions xmlns:a="http://schemas.microsoft.com/2003/10/Serialization/Arrays">
<a:string>Hives</a:string>
<a:string>Diarrhea</a:string>
</Reactions>
<Severity>High</Severity>
<TimeEntered>10:35 AM EDT</TimeEntered>
<Type>Intolerance</Type>
…
</Allergy>
</Allergies>
</GetActiveAllergiesResult>
</GetActiveAllergiesResponse>
Using Web Services to Generate Reports
• The GetPatientReport service can generate and
retrieve HTML reports
• HTML is pre marked up to have the same
appearance as you would see in MiChart
• Reports can be customized to fit the needs of the
customers
• Ideal choice if discrete data elements are not
required and your application only needs to
display clinical data to your users
Sample GetPatientReport for Problems
Real Time Customers and Data
Requirements
Based on a recent survey
Testing Timeline
MiChart Web Services Availability:
Test patients in a development environment:
5/30/2011
All patients in a test environment:
12/05/2011
All patients in the Production environment:
TBD
Questions?
29
Considerations for Web Service Usage
• What is your development platform (e.g. Java/.NET)? Is it
browser based?
• Do you currently access Web Services within your application?
• Are you familiar with any Web Service technologies/terms
(spring-ws, JAX-WS, CXF, REST, SOAP, WCF)? Any preference?
• Do you need discrete data elements for processing?
• What data are you looking for? (Use “What Data are Impacted” slide as
a reference)
• Any issues regarding the implementation timeline?
Contacts
• Real time data access – for clinical data moving from CDR to MiChart
– Stephen Fayz (sfayz@med.umich.edu)
– Brian Braun (bbraun@med.umich.edu)
– John McPhall (mcphall@med.umich.edu)
• ADT
– Mike Muscott (muscottm@med.umich.edu)
– Thomas Greene (greenet@med.umich.edu)
• CDR Questions and CDRI Access
– Cynthia Russell (cynthiar@med.umich.edu)
– Victor Mensah (vmensah@med.umich.edu)
– Linda Xu (lixu@med.umich.edu)
• Reporting and Health System Data Warehouse
– Phil Hampton (phampton@med.umich.edu)
– Mark Barlow (msbarlow@med.umich.edu)
– Audrey Schmidt (audreys@med.umich.edu)