The Michigan Upper Peninsula Critical Access Hospital HIT Network Implementation Project Donald A. Wheeler, FACHE Primary Investigator Moving Community.

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


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.


Purpose

“To Improve patient safety and quality of care through the regional planning, development, and implementation of

Health Information Technologies.”


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.


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!


Project Oversight

Upper Peninsula Healthcare Network

HIT Network Implementation Board

Process Workflow Committee

Training Committee

Standards Committee

Quality Assessment Committee



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.


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.


Baraga County Memorial Keweenaw Memorial MC Ontonagon Memorial Grandview Hospital

Iron County Memorial Mackinac Straights Bell Memorial Munising Memorial


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.


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


Systems Connect

Here

Users Interact

Here

Consolidated Patient

Clinical Data via UPCare

UPCare

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

The Michigan Upper Peninsula Critical Access Hospital HIT Network Implementation Project Donald A. Wheeler, FACHE Primary Investigator Moving Community.

Documents

timely patient information

information lack of

lack of primary care

quality of care

patients care

primary care communications

community health

serious patient care