Client Story
A decade of interoperability success
Harmonizing data for a massive health system
When launching an interoperability project in the mid-2000s, the UPMC team recognized it needed a solution that could work with multiple electronic health record (EHR) systems.
UPMC adopted a multi-EHR platform approach with Cerner in the inpatient areas and Epic in the ambulatory areas. "We needed to find a way to make these systems talk with each other," Director of Interoperability Diane Michalec, MSN, RN, said. "Software engineering consultants recommended that we find a solution with strong capabilities in data harmonization."
UPMC began working with dbMotion on a joint venture to develop a solution that would power a patient-centered record across the organization. The UPMC Interoperability platform went live in February 2008. It enabled tight connectivity to Epic, Cerner and Varian, as well as about 45 additional source systems.
Improving care decisions
A UPMC survey found that two out of three clinicians report that accessing comprehensive patient data changed care decisions
Access to complete patient data
UPMC clinicians access the interoperability patient record an average of 125,000x per month
Integrated multiple data sources
UPMC has 78 systems contributing data and 133 interfaces with dbMotion
Million unique patient records
Manages a comprehensive lifetime record of care for patients across western Pennsylvania
Three systems, one seamless user experience
Senior Manager of Interoperability Sandra Sentner-White explains that "The application composed of three separate instances of dbMotion. One that aggregates all UPMC clinical information. A second system houses the clinical claims information for the UPMC HealthPlan," she said. "UPMC hosts and shares the same platform for Pennsylvania's HIE, called ClinicalConnect HIE. The Western Pennsylvania ClinicalConnect HIE is a separate entity that began in 2011." These three systems integrate to create a seamless single system experience for the users.
Data exchange went live among ClinicalConnect HIE members in June 2012 and currently integrates data for its member organizations: 11 hospitals or healthcare systems (one of which is UPMC), one Federally Qualified Health Center (FQHC), two independent physician practices, three skilled nursing facilities and one pediatric rehab facility.
"Leaders of six area hospitals and UPMC came together to form ClinicalConnect HIE for the good of the community, which is how ClinicalConnect HIE was born," ClinicalConnect HIE Client Services Manager Laura Mosesso said. "Because UPMC had already proven that dbMotion could aggregate data from multiple sources, ClinicalConnect HIE implemented its own instance of dbMotion to aggregate data across all our HIE Member organizations."
Distinct databases enable the three organizations to meet legal requirements for data storage and more precisely manage user permissions. "We can manage which users can access which sets of data, and this structure makes it easier to do that," Systems Analyst Expert Suzann Bridge said.
The databases share information through federation. "The end users don't see any of the technical separation," Michalec said. "To them it's all just CCHIE, and it's seamless."
Mosesso agrees that dbMotion presents aggregated data in a usable, meaningful way to clinicians. "ClinicalConnect HIE is bringing data to UPMC from all the other HIE organizations, it doesn't matter who the source is…the fact that, for example, they can see all medications for their patients across a multitude of data sources is very valuable to providers."
UPMC providers find immeasurable value
With a robust interoperability solution, providers have quick access to more complete information about the patient-such as allergies, medications, lab results, past hospitalizations, and other data important to clinical decision making. UPMC assigns dbMotion accounts to clinicians and other users, including, but not limited to, registration team members, infection control staff, pharmacists and social workers.
From a clinical perspective, the value that an interoperability platform brings is immeasurable. "Seamless connectivity between unrelated health systems through a standardized data exchange platform reduces duplicative tests, delays in care and administrative overhead costs associated with paper-based chart requests," Dr. Kristian Feterik said. "Interoperability is the foundation of a well-functioning and efficient electronic health record system."
There are unexpected benefits of making an interoperability solution available to a wide range of users. Physicians are clinical decision makers however information gatherers are everywhere. An example of this can be found in the Emergency Department at UPMC's Childrens' Hospital. Staff members from the UPMC Injury Prevention Center are able to review information found in CCHIE and determine if there is a commercial product that contributed to, or was responsible for, the incident that brought a patient to the UPMC Childrens' Hospital Emergency Department.
UPMC conducted a survey to evaluate what information clinicians found most useful. "Clinicians use dbMotion for many reasons, some of the top reasons include finding lab results-and being able to trend those over time, which they can't do in the EHR," Michalec said. "All types of providers are finding it useful in ways we couldn't have predicted."
Access to this data influences care delivery. Another UPMC survey revealed that two out of three providers reported the data they see in dbMotion directly affects clinical decision making and helped determine their plan of care.
What's next for UPMC
The interoperability team continues to find ways to add value, including, expanding integrations with health data exchanges, deeper integration of the data into the clinical users workflow and exploring secondary use of the data.
"Our growing focus is connecting to other state and national HIEs," Sentner-White said.
UPMC relies on Altera as a trusted partner. "We can really work with Altera to solve issues when they come up," Bridge said. "We still have input with the solution, and our input is valued…we can bring clinical perspectives and know that dbMotion will meet those needs."
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