MiChart Data Integration Review 25 April 2011. Agenda Welcome & Introduction MiChart Project Milestones Long-Term CDR Plan Overview Changes to Non-CareWeb.

MiChart Data Integration Review

25 April 2011

Agenda

• 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 DataFebruary 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

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Batch-loaded CDR data sources

DATA

RECIPIENTS

Real-time CDR data sources via message-based interfaces

Mi-Chart ADT

Lab[LIS]

Radiology &

NucMed systems

Radiology[RAD IDX]

MPU Provation to CDR

Every 2 hrs, 8am-6pm

CTSTransciption

Lookup Tables

CDR has over 90 tables classified as Lookup tables.

They are loaded via automaticscheduled processes, on request

processes, and manually, dependingon the nature of the data and source.

EEG

Results Reporting source: departmental systems

SCHADT

clr 10/ 27/ 2010

LIS

CareLink

Enterprise Clinical SystemsCDR Production Environment

PulmonaryFunction

Test

FTP dailyWorX

Inpatient Medications

MedRecprocedures

DBLINKEvery 15 min.7am-6pm M-F

DBLINKEvery hour during

business hours, M-FNeurology

Vascular

Applications which DISPLAY data from the CDR:1. At Risk Reports [Office of Clinical Affairs] 17. M-Strides [Psychiatry]2. Cancer Registry 18. Medical School Information System3. CardioVascular Center Chronic Heart Failure 19. Michigan Visiting Nurses4. Central Transcription Services [EditDoc, CPI validation] 20. MNET5. Clinic Business Workflow 21. Neurosurgery application6. Clinic Charge Capture 22. OneStaff [Nursing]7. CORTEX [Neurosurgery] 23. Organ Transplant Information Sys 2 ‘OTIS 2’8. Diet Order Entry System ‘DOES’ [Pt Food & Nutritn Svs] 24. Pediatric Cardiology9. Elec MEd Recd Search Engine “EMERSE” 25. Physician Peer Review10. Emergency Department Patient Name Lookup 26. Public Relations & Marketing Call Center Apps11. Engage [Center 4 Advancement of Clinical Research] 27. Surgery Tracking & Activity Reporting ‘STAR’12. Enterprise Reporting and Analysis 28. UM Endocrine Bank ‘UMEB’13. Geriatrics Patient Arrival System 29. Transplant Billing Workflow14. Health Information Management Reporting 30. Wound Care15. Infusion Patient Arrival System [Cancer Center] 16. Language Service Schedule Support

Mi-Chart Ambulatory Scheduling

daily

MPUProvation

DC N

avig

ator

upd

ate

– fr

om C

DR

Pediatric PFT

Ped Cardiology

FTP8 a.m. daily

Non

-HL7

[ct

sld]

25,0

00 /

day

rea

l ti

me

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

CDR XIInterface Engine

Message parsing andpre-processing

CTS

CDR Staging

EMG-Pro

DBLINKEvery 15 min.

IDX

PA

Pt. accountbalances

WBIInterface Engine

Message Routing

UM- CareLink[OMP]

EMPI Provider

IndexORMIS

Allergi

es – fr

om CDR

All interfaces HL7 unless otherwise noted

Cardio-vascular[CVIS]

Aller

gies –

from

CDR

EmployeeHealth

CDM

ORMIS

FTP daily

FTP daily

The staging database is usedfor all pre-processing, translationand validation of batch loadeddata sources.MESSAGING &

TRANSFORMATIONTIER

Clinical Data RepositoryINFORMATION TIER

FTPevery 60 minutes

FTP weekly

FTP daily

DataGuard Logical Realtime Copy

Clinical Research Repository

Applications which COPY data from the CDR to another database, for use by the application:1. Anticoagulation 18. Investigational Drug Service2. Audit Database 19. MarketScope [Public Relations & Marketing]3. AviTracks Lab Monitoring System 20. Medical Record Tracking4. Blue Care Network 21. Michigan Care Improvement Registry5. Cardiology Electrophysiology Project 22. MiLES [Mich Inst for Clin Hlth/Research]6. Centricity 23. Nephrology Clinical Database7. Clinical Information & Decision Supp Svcs [CIDSS] 24. OB TraceVue8. Clinical Resource Team [Reg & Insur Verificatn] 25. OBGYN Research9. Direct Access Disch Appt Scheduling [Amb Care] 26. Palliative Care10. Disease Management [Medical Management Ctr] 27. Pediatric Plastic Surgery11. Document Imaging for the Elec Hlth Record 28. Pharmdoc.net12. Document Management System 29. Physician Billing13. Employee Health Service Lab Results 30. Pulmonary Function Testing14. EPSI Cost Accounting System 31. Registration Workflow15. Grateful Patient Database 32. RevRunner [Reg & Insurance Verification]16. Head & Neck Cancer Research 33. UMHS Data Warehouse17. Internal Medicine Consult Billing 34. Urology Prostate Database

Rad Onc Scheduling [VARIS]

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) Accounts (HAR)

Encounter (CSN X)• Documentation• Orders• Medications

Encounter (CSN Y)• Documentation• Orders• Medications

Encounter (CSN Z)• Documentation• Orders• Medications

Account (HAR A)• Charge A • Charge B • Charge C

Account (HAR B)• Charge A• Charge B• Charge C

Patient (MRN 123)

Data Changes to the Clinical Data Repository – Tables & Views

• Tables and views no longer updated after February 2012– 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

• Visit_nbr 4 to 10• Lastname 30 to 50• Full name 60, 90 to 120• Address line 1 30 to 75• Address line 2 30 to 75• CPI to MRN 8 to 9• Financial_class 1 character to 3 digits• Ins_company_id 3 character TPC to 9 digits• Ins_company_name 25 to 35

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MC Change Table SchemaMC_COLUMN_CHANGE

PK col_id

I1 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

MC_OBJECT_CHANGE

PK obj_id

I1 obj_name obj_type obj_owner record_status begin_src begin_date update_src last_updated

MC_CHANGE_XREF

PK change_xref_id

I1 col_idI2 obj_id record_status begin_src begin_date update_src last_updated

MC_DATA_CHANGE

PK data_id

I1 col_id old_value new_value record_status begin_src begin_date update_src last_updated

March 2011 February 2012

March 2011 June 2011 September 2011 December 2011

May 2011IC Changes

August 2011HL7I Integrated Test

September 2011CareWeb Test

February 2012Production

ImplementationCDRQ/CDRP

December 2011Schema Finalized

March - DecemberMi-Chart HL7 to CDRI

December - FebruaryMi-Chart HL7 to CDRD

July 2011HL7 Unit Test

November 2011Customer Test

January 2012Customer Test

November - JanuaryCDRQ DB

January - FebruaryCDRP DB

April 2011Schema Changes

Mi-Chart ADT & Scheduling to CDR Project Milestones

March - AugustCDRI DB Changes

August - NovemberCDRD DB Changes

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 [email protected]

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Questions?

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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)

• 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)

• 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

• 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

Endpointshttps://.../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 Locationhttps://mccpslbd1.umhs.med.umich.edu/Interconnect/wcf/Epic.Clinical.Services/Clinical.svc?wsdl

SOAP Actionurn: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

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

MiChart Web Services Availability:

Questions?

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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 ([email protected])– Brian Braun ([email protected])– John McPhall ([email protected])

• ADT– Mike Muscott ([email protected])– Thomas Greene ([email protected])

• CDR Questions and CDRI Access– Cynthia Russell ([email protected])– Victor Mensah ([email protected])– Linda Xu ([email protected])

• Reporting and Health System Data Warehouse– Phil Hampton ([email protected])– Mark Barlow ([email protected])– Audrey Schmidt ([email protected])