UCSF Health System CTG – April 3, 2013 Project: UCSF IDEAS Integration to/from APeX Department: OBGYN/RS – Center for Reproductive Health Project Sponsors: Marcelle Cedars, M.D.,Victor Fujimoto, M.D. Primary Business Contact: Kimberly Price BCD Project Manager: Sheryl Shah UCSF Health System

2 The presenter: Dr. Victor Fujimoto The ask: At the end of this presentation, we will request this committee to prioritize phase 1 of this project. 1. Scope: a) Phase I – 2014 (see Appendix for detailed HL7)  ADT HL7 (Selective Patient & Visit files) outbound interface to IDEAS from APeX  SCHED HL7 outbound SIU - Appointment records will be created, modified or removed in response to received scheduling information interface to IDEAS, from APeX b) Phase II – to be advised  Transcriptions (Progress Notes/Documents) interface inbound to APeX, from IDEAS  Orders outbound interface to Ideas (copy of SQ feed), Export results interface to IDEAS from APeX: Lab, Rad., CoPath, & External Labs 2.Size (IT/CS): Small (492 Hours) 3.Costs: $90,420 first year + $6000/Year for vendor license renewal 4.Funding:  OBGYN/RS Department: $64,500 FY 2014 (2 mos.) / 2015 (3 mos.) + $6000/Year for vendor license renewal  IT/CS Department (Project Management Cost Absorbed): $25, Department Preferred Timeline/Golive: May 2014 – September 2014 (5 mos.); Target golive – end of September IT/CS Preferred Timeline/Golive: April 2015 – October 2015; Target Golive – October 2015

3 Project Drivers:  Elimination of errors due to duplicate data entering  Transparency of medical records in IDEAS to be available to all of the Medical Center as well as other affiliates  Charge capture efficiencies, reduction of errors, & less manual edits  Increased practice charge capture efficiency  Increased utilization of APeX as primary charge capture/appointment scheduling software  Potential for increased MyChart enrollment and better patient engagement through use of MyChart  Increased practitioner and employee productivity, due to reduction in time using two EMR systems; reducing double entry  Increased patient, practitioner and employee satisfaction

4 Context or Background: CYCLE SUMMARY  APEX limitations  IDEAS more robust functionality  Magnitude of double entry required  Need for streamlining workflow & increase efficiencies

Change Management:  Affected Locations:  Clinics: REI – Center for Reproductive Health, Cancer Center and Departments requiring clinical information from IDEAS (e.g. OB/GYN/RS)  Hospitals: All  Personnel Impacted: 100+  Administrative: Clinic, Reproductive Lab, & Perioperative Unit  Front Office, Call Center, Schedulers, & Patient Care Coordinators  Finance and Revenue Cycle Teams  Billers & Coders; Patient Navigators  Physicians (11); Pre-cycle RNs & LVNs, In-cycle NP, RNs, & MAs; Lab Embryologists & Andrologists; Genetic Counselors & Perioperative Nurses  Practice Managers and other Administrative Support Specialists  Training Required:  Who: All IDEAS and APeX RNs, LVNs, & lab staff end users may require minimal training in Cadence  Method: In service, Classes, Job Aids 5

6 Recap: We are requesting this committee to prioritize this project. 1.Scope:  Phase I – 2014 (see Appendix for detailed HL7)  ADT (Selective Patient & Visit files) outbound interface to IDEAS from APeX  SCHED outbound SIU - Appointment records will be created, modified or removed in response to received scheduling information interface to IDEAS, from APeX 2.Size (IT/CS): Small (492 Hours) 3.Costs: $90,420 first year + $6000/Year for vendor license renewal 4.Funding:  OBGYN/RS Department: $64,500 FY 2014 (2 mos.) / 2015 (3 mos.) + $6000/Year for vendor license renewal  IT/CS Department (Project Management Cost Absorbed): $25, Department Preferred Timeline/Golive: May 2014 – September 2014 (5 mos.); Target golive – end of September IT/CS Preferred Timeline/Golive: April 2015 – October 2015; Target Golive – October 2015

APPENDIX 7

Appendix: IDEAS-APeX HL7 Interfaces  Inbound (to IDEAS) outbound APeX ADT - Selective processing of messages for relevant patient files  Demographical field updates are based on a Registration ID match, otherwise, new patient file records will be created  Clinic-defined field elements may be matched optionally using look-up codes, as applicable  Inbound (to IDEAS) outbound APeX SIU - Appointment records will be created, modified or removed in response to received scheduling information  Events will be matched based on a one-to-one relationship with APeX definitions  Person record identification will be attempted based on Provider No. matches  Related cycle associations will be determined using the same default value algorithm employed in the IDEAS Appointment Diary 8

Funding/Costs Summary: 9 Funded by: OBGYN/RS Department & IT/CS Vendor Hardware/Software & Labor Costs: Vendor: Mellowood $ 30,000 Total Vendor Costs $ 30,000 IT/CS Labor, by team: IT Interface Team (SCHED & ADT) $ 18,900 CS APeX Access Team $ 10,800 IT QA/Testing Team $ 4,800 IT PMO (Cost to be absorbed by IT PMO)$ 25,920 Total IT/CS Labor $ 60,420 Total Cost of Project: $ 90,420 first year OBGYN/RS Department Cost:$ 64,500 first year IT/CS absorbed cost:$ 25,920 first year Plus, Annual Maintenance Fee (Mellowood): $6,000 end of first year forward Assumptions: 1)OBGYN/RS resources and decision makers required to do the analysis, testing and issue resolution are committed to working with the IT/CS teams on this project during the timeline indicated. 2)A PMO PM will be made available to manage the project without cost (.2 FTE; ~ 8hrs/wk). 3)Should significant alteration of HL7 messages be required of interface team, labor costs will be adjusted. Same if less effort than estimated. 4)Should significant APeX build changes be required of the APeX teams, labor costs will be adjusted. Same if less effort than estimated.

10 Appendix: Funding/Costs in detail: APeX - IDEAS HL7 Interface- Hardware/Software & Labor Costs Vendor - MellowoodIT Interface Team CS APeX Access TeamIT QA TeamIT PMO H/Software, LaborLabor HL7 Interfaces 1) ADT outbound interface from APeX to IDEAS 2) SCHED outbound interface from APeX to IDEAS $30,000.00$18,900.00$10,800.00$4,800.00$25, Project Total First Year $90, OBGYN/RS Department Cost First Year $64, IT/CS Absorbed Cost First Year $25, Notes: $30,000 includes the first year of support for these interfaces; Plus, Annual Maintence Fee of $6,000 ( or 20% of project) end of first year forward 140 Hours (80 for ADT and 60 for rate of $135 per hour 80 rate of $135 per hour 40 rate of $120 per hour 192 rate of $135 per hour. Cost will be absorbed by IT PMO.

Appendix: The UCSF Center for Reproductive Health offers a comprehensive range fertility treatment services, for both men and women, including donor. 11 Comprehensive Range of Fertility Treatment Services Infertility Evaluation and TreatmentIn Vitro Fertilization (IVF) Donor Sperm InseminationGestational Surrogacy Intra-cytoplasmic Sperm Injection (ICSI)Male Reproductive Laboratory Pre-Implantation Genetic Diagnosis (PGD)Tubal Ligation Reversals Intrauterine InseminationPolycystic Ovarian Syndrome Program Fertility Preservation (embryo, sperm, oocyte and ovarian) Male Infertility Evaluation and Treatment (including vasectomy reversal, testicular evaluation and biopsy) Reproductive Surgery: Endometriosis, uterine fibroids, & congenital abnormalities Ovum Donor/Cryo Banking Program

12 Appendix: IDEAS to/from APeX today 1. Patient Referrals Physician notes are copy/pasted from APeX into IDEAS 2. Clinic registration (x4) is performed in both IDEAS and APeX Patient and Partners/Donors are registered in both IDEAS and APeX 3. Clinic schedulers record appointments in IDEAS first Detailed Assisted Reproductive Technology “ART” patient “Cycles” are scheduled in IDEAS Patient appointments are later duplicated in APeX Cadence the day before the scheduled appointment to record arrival and subsequent charge capture 4. Patient insurance information is entered into IDEAS first and later duplicated and expanded in APeX to insure accurate charge capture IDEAS software is used to communicate unique revenue capture information from the billing staff to front office staff to support accurate point-of-service revenue collections for all scheduled patient office visits, procedures, labs, & associated medications, if applicable

13 Appendix: IDEAS to/from APeX today 5. All clinical data is documented in IDEAS; limited clinical data is documented in APeX  Notes: Patient intake forms are data entered as discreet values into IDEAS only; not into APeX. External medical records are scanned into IDEAS only; not into APeX. Practice is currently developing an online Patient Portal in IDEAS (similar to one being considered for UCSF in APeX) to enable self patient registration. (IDEAS Patient Portal is in the testing phase) Perioperative MRH schedules, arrivals & charge capture activities are all performed in APeX; not in IDEAS 6. Patient encounter documentation  Process is primarily performed in APeX 7. Unique In-cycle (menstrual) clinical information  Is all recorded in IDEAS 8. Front desk staff create appointments for scheduled patients in Cadence  The day before expected patient arrival, which allows practitioner the ability to close encounter enabling appropriate charges to drop into billing work queue.

14 Appendix: IDEAS to/from APeX today: 9. Charge/Coding review  Practice coders must access documentation in IDEAS to proper code charges in APEX. 10. Reproductive Lab Results, 8th floor  On site lab results are copy/pasted into APeX from IDEAS by clinical staff, as needed for male reproductive health and procedural area (HOD)  E.g. Semen Analysis, blood draw, ultrasounds -- creates billing issues (procedural area is an HOD) 11. UCSF Lab interfaces to APeX  UCSF Lab results are copy/pasted by clinical staff into IDEAS from APeX 12. External Labs interfaces to APeX  Quest, LabCorp near term and then will manually need to be entered in IDEAS  Kaiser long term and then will manually need to be entered in IDEAS 13. On Site Radiology: Ultrasounds  Tech enters into IDEAS and images are manually uploaded to IDEAS

15 Appendix: IDEAS to/from APeX today: 14. If interface …UCSF Radiology: Ultra sounds, MRI, Bone Density, CT Scan  Results are printed from APeX and report is entered/scanned by clinical and administrative staff into IDEAS  No images from UC Radiology go directly into IDEAS, only the report 15. If interface …UCSF Pathology  When miscarriage an MUA (DnC) is sent to CoPath  Order is created in APeX, tissue is sent to pathology 16. External Vendors  Specialized genetic tests: endometrial biopsies, PGS  Paper order, results, etc.