Interfaces/Conversions High Level Plan 12/12/2012

Definitions/Assumptions CE – Centricity Enterprise (formerly known as Carecast) provided by GE. McKesson – refers to the suite of systems in use at PHSW. All statements throughout the presentation are specific to all of PHMG including PHSW unless specifically called out. A number of specific use systems will be interfaced but are not called out in this presentation as they are grouped under the section of the data that they need to receive from Epic or are sending to Epic (i.e. – Muse, Provation, etc.) Focus primarily on interfaces that affect provider workflow and experience. Manual abstraction conversions from PHSW non-McKesson clinic systems. Conversions from EMR used by the Cardiovascular groups in Eugene and Bellingham are still being investigated

Continuity of Care (CCD) The Continuity of Care Document (CCD) is an electronic document exchange standard for sharing patient summary information. Summaries include the most commonly needed pertinent information about current and past health status in a form that can be shared by all computer applications, including web browsers, electronic medical record (EMR) and electronic health record (EHR) software systems. electronic medical record electronic health record Epic is able to send a CCD and incorporate data from a CCD directly into the Epic McKesson is sending a CCD and will be able to incorporate data in a future release  Functionality to incorporate data in a future release is not yet known GE is not able at this time to send a CCD but will be able to send and also incorporate data in a future release  Custom CCD being created at this time prior to Epic implementation  Functionality to incorporate data in a future release is not yet known

Patient Registration Registration will occur in Epic, CE or McKesson Interfaces will keep patient information in synch across the systems at the patient level No visit level or insurance information will be interfaced or converted Visit level refers to episode level such as ED visit, hospital census and previous clinic visit info Some visit numbers may be interfaced to improve grouping of hospital results in Epic Full conversion of patients from McKesson and CE proposed Patient level data will not be electronically converted from the non- McKesson and non-GE clinic systems used throughout PeaceHealth

Epic schedules will be transmitted to designated downstream systems such as Provation Provider schedules will no longer flow to CE Future Appointments from CB will be converted thru the Boston Software abstraction process. SW systems are being evaluated. No inbound schedules into Epic from other systems is planned Appointment/ Patient Scheduling Data

Allergies 1 Allergies will be documented in Epic, CE or McKesson Allergies entered into CE or McKesson will be available in Epic via CCD Allergies entered into Epic will be available via CCD in McKesson May be interfaced into CE Currently being tested as part of a different project Functionality limitations may limit the feasibility of usage Allergies are planned to be converted from CE and McKesson into Epic. Workflow to require verification when first reviewed by a caregiver may be necessary. Free Text Allergies in CE will be converted thru the Boston Software abstraction process 1.Bi-directional allergies may be possible but is strongly not recommended by Epic

Epic recommendation: Epic retrieves medication history directly from Surescripts and medications are added to the patient’s Epic chart as they are reviewed and confirmed by caregiver. Medications prescribed in Epic would be available in McKesson and GE via CCD inquiry. 2 years of Medications in CE will be converted thru the Boston Software abstraction process for active patients. PHSW currently being investigated. Medications

Immunizations Epic is able to retrieve data directly from the state registries Initial retrieval would populate Epic in lieu of conversions for a number of clinics Immunization history from CE will be loaded into Epic Providers stated that CE is more complete record than state registries Immunizations documented in Epic will be interface to state registries Immunizations documented in Epic will be viewed via CCD in McKesson and CE Immunizations documented in McKesson and GE will be viewed via CCD in Epic Immunizations given in the inpatient environment may be interfaced into Epic  CE documentation processes may need to change

Problem List Problem lists documented in Epic available in McKesson and CE via CCD Problem lists documented in Epic potential to be interfaced into CE Is this clinically valuable?  Untested CE interface  Coding in Epic to occur in ICD10 but interfaced in ICD9 until undetermined date prior to ICD10 Go-Live in October 2014 Problem List, Surgical and Medical History all currently found in CE Problem List will be converted via the Boston Software abstraction process. Looking into PHSW solutions.

Lab, Imaging, Pathology and Ancillary Orders Orders placed in Epic will flow to lab, imaging and other ancillary systems Order updates and additions will be transmitted to Epic No inpatient orders will be placed in Epic or viewable in Epic No orders conversion planned

Lab, Imaging, Pathology and Ancillary Results Lab, imaging, pathology and ancillary results will flow to Epic on orders placed in Epic Epic initiated results will be available in CE and McKesson Lab, imaging, pathology and ancillary results ordered in the inpatient environment or sent as copy-to will flow into Epic  In-box functionality for these results to be determined  Current CE FYI alert functionality being investigated for similar functionality in Epic PACS link included in Epic to launch images when needed Conversions in planning from the following key systems: Laboratory and pathology Imaging, digital echo Exact system list to be developed and shared Additional details in later slide

Transcribed Documents (dictations ) Transcribed clinic documents and desired hospital documents will be available in Epic McKesson documents likely to be links to documents in Horizon Patient Folders Desired clinic documents created or edited in Epic will be sent to McKesson, GE and any other downstream systems such as referring provider’s EMR Epic application project team will determine scope of documents to be converted

Scanned Documents Scanned clinic documents and key hospital documents will be available in Epic via integration with Streamline Health Streamline Health will be interfaced to both CE and Epic Historical data currently in Streamline Health will be available in Epic Link to McKesson Patient Folder (HPF) will be available at the patient level Discovery underway to determine if it will be possible to have direct links at the document level. New interface being developed as part of a different project

Conversion Recommendation Data TypeCE clinicsPHSW McKesson*Notes Patient Information (MRNs and key demographics) Convert all PH Patients Future Appointmentsfor active patients**NoneVia BSS Abstraction Process Visits / EncountersNone InsuranceNone Lab Results2 Years3 Years* Pathology Results3 YearsTBD PHSW likely to be links from HPF Imaging Results3 Years3 Years* Mammography Results3 Years3 Years* Transcribed Notes/Transcriptions3 YearsTBD Links from HPF Scanned Documents (Pointers)All historyTBD*Links from HPF Immunizations HistoryAll historyAll history* Clinical Observations (including vitals and patient histories) Selected history for identified patients None Question the value of Vital Signs conversion, but Height, Weight, and Head Circumference could be beneficial for pediatric patients AllergiesAll historyAll history*Free text allergies via BSS Abstraction Process Ambulatory Problem Listfor active patients**None Via BSS Abstraction Process Ambulatory Medications2 Years for active patients** NoneRecommend using Surescripts option – 2 years via BSS Abstraction Process * Still needs to be verified **active patients = seen in two years prior to local go-live or scheduled for visit after local go-live

Manual Conversions/Data Abstraction There are significant limits to the discrete data that can be electronically uploaded from McKesson or CE thru the interfaces. Number of reasons to convert discrete data: To reduce go-live impact on productivity. To quickly ramp-up EP’s to meet MU requirements To quickly ramp up the value of the tools in Epic. Ex. Health Maintenance Alerts Types of discrete data to consider loading: Problem list (with conversion to ICD-10), Past Medical, Surgical and Family History, Immunizations, Allergies, Medications, Health maintenance data, MU, PQRS, DWAP and data for other PH initiatives. Boston Software has been contracted with to help PeaceHealth with these abstraction efforts. This scripting tool will allow for the above discrete data elements to be loaded into the patient record prior to each regions implementation.

Team in place to determine transitions of care and what is impacted –Lead by Kathy Skipper and Marcy McKey Definition of team’s work –PHMG and PH hospitals currently utilize CE for inpatient and outpatient and share data within that environment. Implementing Epic Ambulatory will split this shared clinical data and disrupt workflows between inpatient and outpatient. At PHSW caregivers utilize McKesson for inpatient and multiple EHR in the ambulatory environment. Implementation Epic at PHSW will similarly split clinical data exchange and disrupt workflows between inpatient and outpatient. Purpose –Identify and analyze breakages, design solutions, and implement new processes, tools, and education to ensure patient safety and efficient workflow.

Assessment: –Online survey for PHMG Clinic and PH Hospitals (see hand-out) –Face-to-face interviews for selected clinics –Interviews with Collaboratives –Data review; interface gap analysis Design: –Identify solutions –Obtain approval Build & Implement: –Workflows, interfaces, other tools –Change management, communication, education Team Methodology

Questions / Feedback

Appendix

Screenshots of Epic functionality for CCD retrieval