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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

cayerhart@gbhs.on.ca

Peggy Millar

Corporate Manager Computer Applications

pmillar@gbhs.on.ca