Interfaces/Conversions
High Level Plan
12/12/2012
Definitions/Assumptions
• CE – Centricity Enterprise (formerly known as Carecast) provided by GE.
• McKesson – refers to the suite of systems in use at PHSW.
• All statements throughout the presentation are specific to all of PHMG including
PHSW unless specifically called out.
• A number of specific use systems will be interfaced but are not called out in this
presentation as they are grouped under the section of the data that they need to
receive from Epic or are sending to Epic (i.e. – Muse, Provation, etc.)
• Focus primarily on interfaces that affect provider workflow and experience.
• Manual abstraction conversions from PHSW non-McKesson clinic systems.
• Conversions from EMR used by the Cardiovascular groups in Eugene and
Bellingham are still being investigated
Continuity of Care (CCD)
The Continuity of Care Document (CCD) is an electronic document exchange standard for
sharing patient summary information. Summaries include the most commonly needed
pertinent information about current and past health status in a form that can be shared by
all computer applications, including web browsers, electronic medical record (EMR) and
electronic health record (EHR) software systems.
• Epic is able to send a CCD and incorporate data from a CCD directly into the Epic
• McKesson is sending a CCD and will be able to incorporate data in a future release
 Functionality to incorporate data in a future release is not yet known
• GE is not able at this time to send a CCD but will be able to send and also
incorporate data in a future release
 Custom CCD being created at this time prior to Epic implementation
 Functionality to incorporate data in a future release is not yet known
Patient Registration
• Registration will occur in Epic, CE or McKesson
• Interfaces will keep patient information in synch across the
systems at the patient level
• No visit level or insurance information will be interfaced or
converted
• Visit level refers to episode level such as ED visit, hospital census
and previous clinic visit info
• Some visit numbers may be interfaced to improve grouping of
hospital results in Epic
• Full conversion of patients from McKesson and CE proposed
• Patient level data will not be electronically converted from the nonMcKesson and non-GE clinic systems used throughout PeaceHealth
Appointment/ Patient Scheduling Data
• Epic schedules will be transmitted to designated downstream
systems such as Provation
• Provider schedules will no longer flow to CE
• Future Appointments from CB will be converted thru the Boston
Software abstraction process. SW systems are being evaluated.
• No inbound schedules into Epic from other systems is planned
Allergies1
• Allergies will be documented in Epic, CE or McKesson
• Allergies entered into CE or McKesson will be available in Epic
via CCD
• Allergies entered into Epic
• will be available via CCD in McKesson
• May be interfaced into CE
• Currently being tested as part of a different project
• Functionality limitations may limit the feasibility of usage
• Allergies are planned to be converted from CE and McKesson
into Epic.
• Workflow to require verification when first reviewed by a
caregiver may be necessary.
• Free Text Allergies in CE will be converted thru the Boston
Software abstraction process
1.
Bi-directional allergies may be possible but is strongly not recommended by Epic
Medications
• Epic recommendation: Epic retrieves medication history
directly from Surescripts and medications are added to the
patient’s Epic chart as they are reviewed and confirmed by
caregiver.
• Medications prescribed in Epic would be available in
McKesson and GE via CCD inquiry.
• 2 years of Medications in CE will be converted thru the Boston
Software abstraction process for active patients. PHSW
currently being investigated.
Immunizations
• Epic is able to retrieve data directly from the state registries
• Initial retrieval would populate Epic in lieu of conversions for a number of clinics
• Immunization history from CE will be loaded into Epic
• Providers stated that CE is more complete record than state registries
• Immunizations documented in Epic will be interface to state registries
• Immunizations documented in Epic will be viewed via CCD in McKesson and CE
• Immunizations documented in McKesson and GE will be viewed via CCD in Epic
• Immunizations given in the inpatient environment may be interfaced into Epic
 CE documentation processes may need to change
Problem List
• Problem lists documented in Epic available in McKesson and CE via
CCD
• Problem lists documented in Epic potential to be interfaced into CE
• Is this clinically valuable?
 Untested CE interface
 Coding in Epic to occur in ICD10 but interfaced in ICD9 until undetermined date prior to ICD10
Go-Live in October 2014
• Problem List, Surgical and Medical History all currently found in CE
Problem List will be converted via the Boston Software abstraction
process. Looking into PHSW solutions.
Lab, Imaging, Pathology and Ancillary Orders
• Orders placed in Epic will flow to lab, imaging and other ancillary
systems
• Order updates and additions will be transmitted to Epic
• No inpatient orders will be placed in Epic or viewable in Epic
• No orders conversion planned
Lab, Imaging, Pathology and Ancillary Results
• Lab, imaging, pathology and ancillary results will flow to Epic on
orders placed in Epic
• Epic initiated results will be available in CE and McKesson
• Lab, imaging, pathology and ancillary results ordered in the
inpatient environment or sent as copy-to will flow into Epic
 In-box functionality for these results to be determined
 Current CE FYI alert functionality being investigated for similar functionality in Epic
• PACS link included in Epic to launch images when needed
• Conversions in planning from the following key systems:
•
•
•
Laboratory and pathology
Imaging, digital echo
Exact system list to be developed and shared
• Additional details in later slide
Transcribed Documents (dictations)
• Transcribed clinic documents and desired hospital documents will be
available in Epic
• McKesson documents likely to be links to documents in Horizon
Patient Folders
• Desired clinic documents created or edited in Epic will be sent to
McKesson, GE and any other downstream systems such as referring
provider’s EMR
• Epic application project team will determine scope of documents to be
converted
Scanned Documents
• Scanned clinic documents and key hospital documents will be
available in Epic via integration with Streamline Health
• Streamline Health will be interfaced to both CE and Epic
• Historical data currently in Streamline Health will be available in
Epic
• Link to McKesson Patient Folder (HPF) will be available at the
patient level
• Discovery underway to determine if it will be possible to have direct
links at the document level.
• New interface being developed as part of a different project
Conversion Recommendation
Data Type
CE clinics
PHSW McKesson*
Notes
Patient Information (MRNs and key
demographics)
Convert all PH
Patients
Convert all PH
Patients
Future Appointments
for active patients**
None
Visits / Encounters
None
None
Insurance
None
None
Lab Results
2 Years
3 Years*
Pathology Results
3 Years
TBD
Imaging Results
3 Years
3 Years*
Mammography Results
3 Years
3 Years*
Transcribed Notes/Transcriptions
3 Years
TBD
Links from HPF
Scanned Documents (Pointers)
All history
TBD*
Links from HPF
Immunizations History
All history
All history*
Clinical Observations (including
vitals and patient histories)
Selected history for
identified patients
None
Question the value of Vital Signs conversion, but
Height, Weight, and Head Circumference could be
beneficial for pediatric patients
Allergies
All history
All history*
Free text allergies via BSS Abstraction Process
Ambulatory Problem List
for active patients**
None
Via BSS Abstraction Process
Ambulatory Medications
2 Years for active
patients**
None
Recommend using Surescripts option – 2 years via
BSS Abstraction Process
Via BSS Abstraction Process
PHSW likely to be links from HPF
* Still needs to be verified
**active patients = seen in two years prior to local go-live or scheduled for visit after local go-live
Manual Conversions/Data Abstraction
• There are significant limits to the discrete data that can be electronically
uploaded from McKesson or CE thru the interfaces.
• Number of reasons to convert discrete data:
• To reduce go-live impact on productivity.
• To quickly ramp-up EP’s to meet MU requirements
• To quickly ramp up the value of the tools in Epic.
• Ex. Health Maintenance Alerts
• Types of discrete data to consider loading:
• Problem list (with conversion to ICD-10), Past Medical, Surgical and Family History,
Immunizations, Allergies, Medications, Health maintenance data, MU, PQRS, DWAP and data for
other PH initiatives.
• Boston Software has been contracted with to help PeaceHealth with these
abstraction efforts. This scripting tool will allow for the above discrete data
elements to be loaded into the patient record prior to each regions
implementation.
•
Team in place to determine transitions of care and what is impacted
–
•
Lead by Kathy Skipper and Marcy McKey
Definition of team’s work
– PHMG and PH hospitals currently utilize CE for inpatient and outpatient and share
data within that environment. Implementing Epic Ambulatory will split this shared
clinical data and disrupt workflows between inpatient and outpatient. At PHSW
caregivers utilize McKesson for inpatient and multiple EHR in the ambulatory
environment. Implementation Epic at PHSW will similarly split clinical data exchange
and disrupt workflows between inpatient and outpatient.
•
Purpose
– Identify and analyze breakages, design solutions, and implement new processes,
tools, and education to ensure patient safety and efficient workflow.
Team Methodology
Assessment:
– Online survey for PHMG Clinic and PH Hospitals (see hand-out)
– Face-to-face interviews for selected clinics
– Interviews with Collaboratives
– Data review; interface gap analysis
Design:
– Identify solutions
– Obtain approval
Build & Implement:
– Workflows, interfaces, other tools
– Change management, communication, education
Questions / Feedback
Appendix
Screenshots of Epic functionality for CCD retrieval