The University of Pittsburgh Medical Center (UPMC) has long been at the forefront of innovation, both in clinical practice and deployment of IT solutions. But when UPMC abandoned its plan for a monolithic approach to IT in favor of a best-of-breed strategy, the organization had no way of knowing it would become a poster child for health care data interoperability.
In the June 2009 issue of ADVANCE for Health Information Executives, UPMC shared insight into its adoption of an interoperability platform designed to support the meaningful exchange of data originating from diverse systems, delivered to clinicians at the point of care. UPMC’s 2006 decision to build a singular interoperability platform around its current and projected clinical IT capabilities was based on a belief that such an approach would accelerate provider adoption, increase utilization and, therefore, be the most economical option in the long run.
In the months that followed, UPMC’s leadership received confirmation from a number of indicators that its approach is sound and highly successful. The model has expanded within its user base, involving an ever-increasing range of clinical systems and data sources, and delivering additional patient information directly to the bedside and exam room.
Semantically organized data
Soon after implementation, UPMC demonstrated the interoperability platform’s potential with a handful of ambulatory care and hospital users. These “early adopters” were given access to a single view of essential data sets such as medications, problem lists, allergies, lab values and demographic information. Success on this limited scale convinced others of the value of semantically organized information, which unifies various nomenclatures and renders data from disparate systems truly usable in meaningful ways.
UPMC was able to build upon this initial foray into interoperability by expanding the information available at the point of care to include other, more complex, data sources: documents such as discharge summaries, pathology reports and immunization data. This capability allows a specialist on rounds to review previously authored notes created in another system -- such as an ambulatory electronic medical record (EMR) -- through a platform from Pittsburgh-based dbMotion, a company in which UPMC invested as part of a strategic, interoperability partnership.
From their offices or other remote locations, physicians similarly can review notes made during a patient encounter in the hospital -- whether performed themselves or by a colleague.
As functionality expanded, usage tripled. As of October 2009, more than 6,000 charts per month were being accessed through the system, compared to 2,000 per month earlier in the year. Meanwhile, user feedback is positive, with physicians indicating that the platform adds greater value to patient safety. In the emergency department, for instance, users are able to access and review critical patient information such as medication lists and allergies, as well as the individual’s last office visit or medical procedure before making potential life-or-death treatment decisions.
Specialists rounding in the hospital indicate they are saving time because they aren’t searching for old records or continually checking in with their office or other colleagues for additional patient data. As UPMC moves forward, the interoperability platform promises real-time data exchange with outside sources such as the Pennsylvania Statewide Immunization Information System (PA-SIIS).
The organization recently completed an automated medication reconciliation technical proof-of-concept that moves medication data from the ambulatory EMR to the hospital EMR in an actionable format. Traditionally, when a patient arrived at the hospital, one of the caregiver’s tasks was to validate and verify the medications the patient was taking prior to arrival. This tedious and time-consuming effort required a physician or nurse to enter the medications via “free text” into the computer and then go through adjudication in a paper-based format.
By using semantic interoperability, however, medication information is grouped by class and medication, and allows for automated, streamlined entry into the EMR. The medications, when moved into the EMR can be viewed on the screen and adjusted, saving caregivers significant time and effort in confirming the patient’s prior medications. This process has the potential to be more accurate, improving patient safety and saving clinician time.
UPMC also has started leveraging its interoperability platform to help manage patient transitions from the ER or OR to an outpatient setting -- circumstances where vital information often falls into a void. By making discharge summaries and follow-up orders accessible, UPMC is better able to deliver quality throughout the continuum of care and advance the concept of connected healthcare throughout the system.
Expanding technologies touched by interoperability
UPMC has found that the platform’s flexibility -- due to its being based upon service-oriented architecture (SOA) -- lends itself well to the introduction of new applications that support clinicians and benefit patients. UPMC is currently piloting a mobility application, for instance, that allows physicians to access a subset of patient data from their BlackBerry hand-held device. Currently 14 physicians are piloting the application, and wider rollout is planned as the solution is refined.
With greater data-aggregation and analytical capabilities, UPMC also expects to improve its population-management efforts. It is adopting a second tool by dbMotion -- the SmartWatch population-management application -- which provides access to semantically organized patient data allowing the clinician to stay abreast of patient compliance (and noncompliance) with preventive services and care management plans.
This functionality will permit caregivers and other health care professionals to continually monitor populations for predetermined criteria of interest, across the health care continuum. Featuring real-time surveillance and instant-messaging capabilities, the tool searches medical records and other data sources, sending alerts in real time to the appropriate individual -- perhaps a clinician, a health coach, a patient, or any combination thereof. A patient who is overdue for her mammogram would receive an e-mail reminder, for example, as would her physician.
To further enhance its IT performance and capacity, UPMC recently completed the virtualization of its server environment; this process identified areas of inefficiency and redundancy. As a result, the organization consolidated applications, not only enhancing EMR and interoperability capabilities, but also creating a framework for outreach efforts such as telemedicine and home care.
A paperless environment
Advancements such as these have helped UPMC’s Children’s Hospital of Pittsburgh in achieving the highest score possible from HIMSS Analytics as a Stage 7 facility in its EMR Adoption Model. UPMC is the third health system and Children’s was the first pediatric hospital in the U.S. to earn this distinction. Unlike most top-ranked hospitals, Children’s does not rely solely on a single EMR system, but utilizes several vendors supported by the interoperability platform. Two UPMC hospitals likewise have earned Stage 6 recognition from HIMSS Analytics.
This recognition highlights UPMC’s physician documentation capabilities with structured templates and full clinical decision support (variance and compliance) capabilities. And signifying UPMC’s commitment to the highest levels of patient safety and outcomes, the organization continues to enhance its EMR functionality and will soon demonstrate its ability to exchange data with outside entities in a CCR or CCD format.
Beyond the benefits enjoyed by the organization, its staff and its patients, UPMC is also positioned to take advantage of the opportunities inherent in the American Reinvestment and Recovery Act (ARRA). While this legislation placed a premium on EHR deployment, it went one step further to call special attention to interoperable technologies: “The focus on meaningful use is a recognition that better health care does not come solely from the adoption of technology itself but through the exchange and use of health information to best inform clinical decisions at the point of care,” a statement from the Department of Health and Human Services said.
The good news is that ARRA is leveling the playing field in health IT, while simultaneously fulfilling the greater mission of reducing costs and encouraging the delivery of better care. Of course, this is only the first step along a longer path, since the government has greater aspirations for health IT that only interoperability will be able to fulfill: a National Health Information Network.
True to its vision and ongoing innovative efforts to leverage IT, UPMC is transforming health care throughout its community by actively pursuing patient-centric health care. Although it may appear to be a revolutionary prospect, UPMC is learning through its own experiences that an integrated medical society may not be as futuristic or daunting as it first appears.
Dr. Martich is chief medical information officer and associate chief medical officer at UPMC, and Dr. Fera is vice president of medical technologies and medical director interoperability for UPMC.
This article is available on-line at Advance.