The Michigan Upper Peninsula Critical Access Hospital HITNetwork Implementation Project
Donald A. Wheeler, FACHEPrimary Investigator
Moving Community Health To the 21st Century
AHRQ 2006 Annual Patient Safety & Health Information Technology Conference
June 5, 2006
Critical Access Hospital HITNetwork Implementation Project
Participants 10 Critical Access Hospitals
Marquette General Health System (MGHS)
Upper Peninsula Health Care Network (UPHCN) A 10-year+ history of working cooperatively Developing shared services and information systems
BaragaMemorial
OntonagonMemorial
MunisingMemorial
HelenNewberry
SchoolcraftMemorial Mackinac
Straits
M arquetteG enera l
(R efera l C ente r)
BellMemorial
Iron CountyMemorial
KeweenawMemorial
Grand ViewHealth System
The Michigan Upper Peninsula HIT Network
The Michigan Upper Peninsula HIT Network
PARTNER HOSPITAL OPERATIONAL INFORMATION
Operational Data BCMH BMH HNJH ICCH KMMC MSH MMH OMH SMHInpt. beds 24 25 25 25 25 25 25 25 25Inpt. Adm. 726 1425 630 1,204 1,475 84 350 600 537
ALOS (days) 2.8 3.1 2.9 3.9 3.7 3.1 2.8 3.0 2.5Outpt. Visits 24,602 58,579 43,661 45,567 36,287 35,056 16,200 20,342 35,480
LTC beds 28 - 48 - - 99 - 46 -Clinics 1 - 4 1 2 4 1 2 2
Active Phys. 8 43 6 9 14 10 7 5 8.5Hosp. FTEs 178 278 246 200 400 200 100 160 208
Afilliations UPHCN UPHCN UPHCN UPHCN UPHCN UPHCN UPHCN UPHCN UPHCNCAH CAH CAH CAH CAH CAH CAH CAH CAH
The Upper Peninsula Health Care Network Formed 1995 Serves 319,000 residents of Michigan’s Upper Peninsula 16 members: all hospitals (-1), tribal health center & mental health agency Elections Each Member has one vote Full-time CEO and support staff Major Committees include:
Business Office Manager Chief Financial Officer Dietary Manager HIPAA Information Systems Workgroup Laboratory Manager Materials Management Regional Medical Control Network Pharmacy Manager Radiology Manager.
UPHCN Collaborative Efforts U.P. Poison Crisis Network Hospital Home Care Network Joint purchasing (materials, rx, lab, rad, etc.) Mobile MRI services Education U.P. Medical Library Consortium Publication of the U.P. Physician Directory Primary care & specialty physician outreach clinics Cardiac services network U.P. Teleradiology, Teleconferencing, Telemedicine Networks Telepathology Remote pharmacy U.P. Regional Blood Center Reference lab outreach network
Information technology.
UPHCNInformation Technology Services
Interface Engine (SeeBeyond/UPCare) HIS (HBOC) LIS (Cerner) MPI (SeeBeyond/UPCare) Claim verification Claim tracking (eBill) E-mail (Lotus Notes) Decision support (EPSi) Knowledge-bases (MicroMedex, etc.) Internet Web-site design/hosting ED Log Practice management information
system (MiSys) Electronic microfiche (Redwood) Tele-Pathology
Tel-EKG Tele-Echocardiograms Tele-EEG Remote Pharmacy Tele-Radiology (Siemens, eWeb) HIPAA coordination MSDS’s (Hazsoft) Michigan Childhood Immunization
Registry (MCIR) Tele-Conferencing (IP) Tele-Medicine (IP) RIS (Cerner->Siemens) Reference Lab Outreach (KliniTek) Wireless patient/visitor access PACS (Siemens Cosmos) EMR (KliniTek UPCARE® eMR).
Identified Needs Caregivers lack accurate and timely patient information when caring
for a patient
When a patient‘s care is transferred from one setting/provider to another, tests and exams are frequently duplicated
There exists a lack of primary care to specialist and specialist to primary care communications and information
Lack of accurate and timely patient information creates serious patient care problems and potential adverse reactions
Inpatient transfers between hospitals and specialty physicians are hindered and delayed due to the need to “track down,” copy and deliver patient records and test/exam results.
The Michigan Upper Peninsula HIT Network
Purpose
“To Improve patient safety and quality of care through the regional planning, development, and implementation of
Health Information Technologies.”
The Michigan Upper Peninsula HIT Network
Long-Term Goals
1. Assess quality of patient care, patient safety, and outcomes through consolidated patient clinical and care measures data collected by the Network HIT applications
2. Provide clinical data sharing among participating entities through high-speed connectivity and data compatibility across the Network Partners I.T. applications to support optimal care delivery.
The Michigan Upper Peninsula HIT Network
Desired Outcomes Provide caregivers with as much information as possible when caring for the
patient Eliminate/reduce number of duplicate tests and exams when a patient‘s
care is transferred from one setting/provider to another Enhance primary care->specialist and specialist->primary care
communications and information Improve care provided in Partner hospital emergency departments Improve inpatient transfers between Partner hospitals, Marquette General
Hospital, and specialty physicians Enable the conduct of medication reconciliation when patients are
transferred between facilities, emergency departments, and specialty and primary care physicians
Eliminate hard-copy reports, paperwork, courier deliveries, and most types of handwritten clinical data by the end of the decade!
The Michigan Upper Peninsula HIT Network
Project Oversight
Upper Peninsula Healthcare Network
HIT Network Implementation Board
Process Workflow Committee
Training Committee
Standards Committee
Quality Assessment Committee
The Michigan Upper Peninsula HIT Network
The Michigan Upper Peninsula HIT Network
Structuring the Solution UPHCN provides the organizational structure to solve technical
issues relative to sharing patient information Across disparate systems Between independently owned/operated organizations
Hospitals use their own Health Information Technology (HIT) within their facility: Registration Scheduling Results Order management Clinical documentation, etc
Hospitals use UPCARE® eMR at their facility to view clinical results on their patient from other participating facilities, including their own.
UPCARE eMR - Phased Timeline10/2005 - 8/2006 5/2006 - 10/2006 Project Year 2 Project Year 3 Project Year 4
Phase 1Phase 1 is complete and includes a master patient index, clinical data repository (CDR), account management, hospital census, general labs (inpatient & outpatient), microbiology, and radiology results.
Helen Newberry Joy Schoolcraft Memorial
Baraga County Memorial Keweenaw Memorial MC Grandview Hospital
Iron County Memorial Mackinac Straights Ontonagon Memorial
Bell Memorial Munising Memorial
Phase 2Phase 2 will include the remaining result sets for transcription, EKG's, and anatomic pathology.
Helen Newberry Joy Schoolcraft Memorial
Baraga County Memorial Keweenaw Memorial MC Ontonagon Memorial Grandview Hospital
Iron County Memorial Mackinac Straights Bell Memorial Munising Memorial
Phase 3Phase 3 will include scheduling MGH appointments for clinicians. MGHS will provide UPCare implementation, training, and first-line support to the CAH hospitals through this model.
Helen Newberry Joy Schoolcraft Memorial
Baraga County Memorial Keweenaw Memorial MC Ontonagon Memorial Grandview Hospital
Iron County Memorial Mackinac Straights Bell Memorial Munising Memorial
The Michigan Upper Peninsula HIT Network
UPHCN Information TechnologyIn the beginning…1995
No connectivity between Members MGHS
“Best of Breed” w/interface engine Upgrading clinical and financial systems Demand for expanding I.T. resulted in growing I.T. staff
Other Members “Best of Breed” w/o interface engine Integrated “IBM 36” type systems for financials – no clinical systems Little or no I.T. staff Demand for I.T., but lacked capital and I.T. talent
MGHS packaged their I.T. services and systems and offered to Members Many early adopters Installed everything from networks to clinical and billing systems Developed much of the data connectivity in use today Established long-term trust and working relations.
UPHCN Information TechnologyToday
Hi-speed, private, secure network 70 physical sites (more than just UPHCN Members) Connects U.P. hospitals, providers, payers, patients
Data needs Video needs
9100+ user accounts Managed through MGHS-IT department Created working model, cost effective mechanism to
access and share a host of systems and services Provide the foundation to build
Local Health Information Technology (HIT) Regional Health Information Organization (RHIO).
Steps leading to full implementation of an electronic medical record, according to a model developed by HIMSS Analytics.
Required for completion
of each stage
% U.S.
Hospitals
MGHS =started
=partial
=full
Stage 1 All three major ancillary clinical systems installed (i.e. laboratory, pharmacy, radiology)
22%
Stage 2 Major ancillary systems feed data to a clinical data repository. 48% ½
Stage 3 Clinical documentation required. First level of clinical decision support is implemented.
10%
Stage 4 Computerized physician order-entry available for use by any practitioner.
2.5%
Stage 5 “Closed loop” medication environment fully implemented in at least one patient-care service area.
<0.1%
Stage 6 Full physician documentation/charting is implemented for at least one patient-care service area.
0% Plan
Stage 7 Hospital has a paperless EMR environment and is capable of sharing data with a regional network.
0%
Note: Based on information from more than 4,000 hospitals in the HIMSS Analytics database.Some 17% of U.S. hospitals have not achieved Stage 1.
Current:9 ½ stars
EMR Development & MGHS Conclusions
Big vendor systems costly: $10’s millions dollars Installations are not complete, therefore total costs $$$
unknown Technology platforms tend to be “closed” vs. “open” Limited by what vendor decides to do with product, i.e.,
little to no control over how product is developed Purchase 80% of what you don’t need or can’t use… …and only 20% of what you can use.
Buy “Best-of-Suite”, Develop, and Integrate option Purchase clinical ancillary systems Build a Clinical Data Repository (CDR) Interface ancillary systems to the CDR Develop web-based user interface/application to access data in CDR Develop web-based order management & other EMR functions
MGH aligned w/KliniTek to develop an EMR that would work across the U.P.
Live on first version of UPCARE® eMR 6/04 Today MGH has signed-up
65% physicians/allied health professionals 80% nursing professionals 1,219 UPCARE eMR users
10 Critical Access Hospitals 2 Pilots in-progress.
EMR Development &MGHS Direction
UPCARE® eMRFramework
Master Clinical Data Repository (CDR) Contains the ‘regional’ data elements, logic, and security for the system Built on industry standards: 100% HL7 compliant, LOINC, ICD9
Master Person Index (MPI) Maintains a unique, ‘regional’ identifier for every patient in the U.P. Provides the matching logic to ensure data is associated with correct patient Cross-reference database to track all patient identifiers
Interface Engine (SmartIE™) Connects systems to UPCARE Formats data and ensures it is accurately stored in the CDR
User Interface (UI) Screens used by clinicians to access & enter data 100% web-based, i.e. thin, portable, mobile, single UI
Security Role-based, manages who has access to what information and when HIPAA compliant
Inference/Rules Engine – Object Logic Engine™ Clinical decision support Intelligent alerts/reminders.
Electronic Medical RecordElectronic Medical Record
Patient census Results Order management
General/nursing CPOE
Common registration Bridge IP & OP settings Provide common account number for same visit to store results
Scheduling Enterprise procedures Office appointment
Account Maintenance Ensuring results are associated with correct patient
100% Web-based Single UI Ultra-thin client Fast Portable & mobile.
Electronic Medical RecordElectronic Medical Record
UPCARE eMRFunctionality
OS (Microsoft Internet Explorer)
MergeMove
SchedulingOrderEntry
CommonRegistration
Census Result Admin ChargesAppLayer
OrderEntry
Result Scheduling CPOE RegistrationBusinessLayer
Object Logic™ (proprietary rules engine) .NET 2.0 (Microsoft)Platform
HL7 MPIBusinessProcess
DecisionSupport
InterfaceEngine
Analyzer Security Life CycleFrameWork
MessageDispatcher
LoggingSchedule
Core
UPCARE eMRSystem Architecture
Electronic Medical RecordElectronic Medical Record
Systems Connect
Here
Users Interact
Here
Steps leading to full implementation of an electronic medical record, according to a model developed by HIMSS Analytics.
Required for completion
of each stage
% U.S.
Hospitals
MGHS =started
=partial
=full
Stage 1 All three major ancillary clinical systems installed (i.e. laboratory, pharmacy, radiology)
22%
Stage 2 Major ancillary systems feed data to a clinical data repository. 48%
Stage 3 Clinical documentation required. First level of clinical decision support is implemented.
10%
Stage 4 Computerized physician order-entry available for use by any practitioner.
2.5%
Stage 5 “Closed loop” medication environment fully implemented in at least one patient-care service area.
<0.1%
Stage 6 Full physician documentation/charting is implemented for at least one patient-care service area.
0% Plan
Stage 7 Hospital has a paperless EMR environment and is capable of sharing data with a regional network.
0%
Note: Based on information from more than 4,000 hospitals in the HIMSS Analytics database.Some 17% of U.S. hospitals have not achieved Stage 1.
2007:15 stars