MiChart Data Integration Review

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MiChart Data Integration Review

25 April 2011

Agenda


Welcome & Introduction


MiChart Project Milestones


Long
-
Term CDR Plan Overview


Changes to Non
-
CareWeb

Data


Break (those not interested in CW data may
depart)


Changes to CareWeb Clinical Data


Presentation saved at: S:
\
MCIT
\
MiChart
\
Data
Integration


MiChart Project Milestones


Context


Data in Transition


Mi
-
Chart at Stage 2 Go
-
Live


Today one CDR, one
analytical reporting
database


Stage 2 will double our
resources


Synchronization for
CDRs


Enriched data for HSDW


Planned UMHS Data Environment


Mi
-
Chart at Stage 4 Go
-
Live


Data consolidated


CareWeb replaced


CDR archived

Changes to Non
-
CareWeb

Data

February 2012


ADT feed switch from
HealthQuest

(PM) to
MiChart (Prelude)


Scheduling feed switch from PHS (EWS) to
MiChart (Cadence)


ADT and Scheduling simple, code and description
tables switch from
HealthQuest

and PHS to
MiChart


CDM (Charge
D
escription
M
aster) switch from
HealthQuest

(PA) to MiChart


Medical Record Procedures switch from
HealthQuest

(MR) to MiChart


7

Batch
-
loaded CDR data sources
D
A
T
A
R
E
C
I
P
I
E
N
T
S

Real
-
time CDR data sources via message
-
based interfaces
Mi
-
Chart
ADT
Lab
[
LIS
]
Radiology
&
NucMed
systems
Radiology
[
RAD IDX
]
MPU Provation to CDR
Every
2
hrs
,
8
am
-
6
pm
CTS
Transciption
Lookup
Tables
CDR has over
90
tables
classified as Lookup tables
.
They are loaded via automatic
scheduled processes
,
on request
processes
,
and manually
,
depending
on the nature of the data and source
.
EEG
Results Reporting source
:
departmental systems
SCH
ADT
clr
10
/
27
/
2010
LIS
CareLink
Enterprise Clinical Systems
CDR Production Environment
Pulmonary
Function
Test
FTP daily
WorX
Inpatient
Medications
MedRec
procedures
DBLINK
Every
15
min
.
7
am
-
6
pm M
-
F
DBLINK
Every hour during
business hours
,
M
-
F
Neurology
Vascular
Applications which
DISPLAY
data from the CDR
:
1
.
At Risk Reports
[
Office of Clinical Affairs
]

17
.
M
-
Strides
[
Psychiatry
]
2
.
Cancer Registry

18
.
Medical School Information System
3
.
CardioVascular Center Chronic Heart Failure

19
.
Michigan Visiting Nurses
4
.
Central Transcription Services
[
EditDoc
,
CPI validation
]

20
.
MNET
5
.
Clinic Business Workflow

21
.
Neurosurgery application
6
.
Clinic Charge Capture

22
.
OneStaff
[
Nursing
]
7
.
CORTEX
[
Neurosurgery
]

23
.
Organ Transplant Information Sys
2
‘OTIS
2

8
.
Diet Order Entry System ‘DOES’
[
Pt Food
&
Nutritn Svs
]

24
.
Pediatric Cardiology
9
.
Elec MEd Recd Search Engine “EMERSE”

25
.
Physician Peer Review
10
.
Emergency Department Patient Name Lookup

26
.
Public Relations
&
Marketing Call Center Apps
11
.
Engage
[
Center
4
Advancement of Clinical Research
]

27
.
Surgery Tracking
&
Activity Reporting ‘STAR’
12
.
Enterprise Reporting and Analysis

28
.
UM Endocrine Bank ‘UMEB’
13
.
Geriatrics Patient Arrival System

29
.
Transplant Billing Workflow
14
.
Health Information Management Reporting

30
.
Wound Care
15
.
Infusion Patient Arrival System
[
Cancer Center
]

16
.
Language Service Schedule Support
Mi
-
Chart
Ambulatory
Scheduling
daily
MPU
Provation
DC Navigator update


from CDR
Pediatric PFT
Ped
Cardiology
FTP
8
a
.
m
.
daily
Non
-
HL
7
[
ctsld
]
25
,
000
/
day real time
Applications which both
DISPLAY
&
UPDATE
CDR data
:
1
.
CareWeb

Data input to CDR
:

-

Allergies

-

Audit Log

-

Discharge Navigator

-

Immunization

-

Inbox
[
Lab
&
Radiology
]

-

Patient Lists

-

Problem Summary Lists
2
.
Respiratory Care System
[
RCS
]

-

Orders
&
billing data
3
.
Cielo Clinic
[
Family Medicine
]

-

Diagnoses for PSL
CDR XI
Interface
Engine
Message parsing and
pre
-
processing
CTS

CDR Staging
EMG
-
Pro
DBLINK
Every
15
min
.
IDX
PA
Pt
.
account
balances
WBI
Interface
Engine
Message Routing
UM
-

CareLink
[
OMP
]
EMPI
Provider
Index
ORMIS
Allergies


from CDR
All interfaces HL
7
unless otherwise noted
Cardio
-
vascular
[
CVIS
]
Allergies


from CDR
Employee
Health
CDM
ORMIS
FTP daily
FTP daily
The staging database is used
for all pre
-
processing
,
translation
and validation of batch loaded
data sources
.
MESSAGING
&
TRANSFORMATION
TIER

Clinical Data Repository
INFORMATION
TIER
FTP
every
60
minutes
FTP weekly
FTP daily
DataGuard Logical
Realtime Copy

Clinical Research
Repository
Applications which
COPY

data from the CDR to another database
,
for use by the application
:
1
.
Anticoagulation

18
.
Investigational Drug Service
2
.
Audit Database

19
.
MarketScope
[
Public Relations
&
Marketing
]
3
.
AviTracks Lab Monitoring System

20
.
Medical Record Tracking
4
.
Blue Care Network

21
.
Michigan Care Improvement Registry
5
.
Cardiology Electrophysiology Project

22
.
MiLES
[
Mich Inst for Clin Hlth
/
Research
]
6
.
Centricity

23
.
Nephrology Clinical Database
7
.
Clinical Information
&
Decision Supp Svcs
[
CIDSS
]
24
.
OB TraceVue
8
.
Clinical Resource Team
[
Reg
&
Insur Verificatn
]
25
.
OBGYN Research
9
.
Direct Access Disch Appt Scheduling
[
Amb Care
]
26
.
Palliative Care
10
.
Disease Management
[
Medical Management Ctr
]
27
.
Pediatric Plastic Surgery
11
.
Document Imaging for the Elec Hlth Record

28
.
Pharmdoc
.
net
12
.
Document Management System

29
.
Physician Billing
13
.
Employee Health Service Lab Results

30
.
Pulmonary Function Testing
14
.
EPSI Cost Accounting System

31
.
Registration Workflow
15
.
Grateful Patient Database

32
.
RevRunner
[
Reg
&
Insurance Verification
]
16
.
Head
&
Neck Cancer Research

33
.
UMHS Data Warehouse
17
.
Internal Medicine Consult Billing

34
.
Urology Prostate Database
Rad Onc
Scheduling

[
VARIS
]
MRN, CSN, and HAR Terminology


Medical Record Number (MRN)


The medical record number is a
unique identifier for each patient. It is assigned when a new
patient is created in MiChart.



Contact Serial Number (CSN)


The contact serial number is a
unique identifier for each patient visit, such as an appointment or
admission. It is assigned at the point of visit creation and is assigned
to all visits, regardless of whether they take place in a hospital or a
clinic setting. Some synonyms for the CSN include visit, encounter,
and contact.



Hospital Account (HAR)


The hospital account record is used to
group charges for billing purposes. Each HAR is associated with one
or more patient visits in MiChart. It is typically only used in a
hospital setting and is assigned at the point of patient registration.


MiChart Visits and Accounts

Patients (EPT)

Accounts (HAR)

Encounter (CSN X)



Documentation



Orders



Medications

Encounter (CSN Y)



Documentation



Orders



Medications

Encounter (CSN Z)



Documentation



Orders



Medications

Account (HAR A)



Charge A



Charge B



Charge C

Account (HAR B)



Charge A



Charge B



Charge C

Patient (MRN 123)

Data Changes to the Clinical Data
Repository


Tables & Views


Tables and views no longer updated after
February 2012


Patient_2_t


Patient_2


Patient_HIPAA


Patient_visit_msp_answer_t


Patient_visit_msp_answer


Patient_visit_msp_answer_cdr


Patient_balance_t


Patient_balance


Patient_visit_contact

information is collected at
the patient level in MiChart.




Data Changes to the
Clinical
Data
Repository


Columns


Columns no longer updated after
February
2012


Patient

pat_preferred_name
,
bad_address_ind
,
pat_lang_verified_flag
,
smoker_flag
,
pat_mailing_name
,
last_reg_rev_date
,
last_forms_rev_date
,
last_addr_rev_date
,
um_msp_review_date


Patient_employer

employ_to_date


Patient_visit

registration_date
,
medicare_priority
,
msp_complete_flag
,
msp_last_date
,
msp_bypass_ind


Visit_insurance

ppo_code
,
ins_elig_comment
,
ins_verif_comment
,
ins_co_pay
,
ins_deductible


I
nsurance

ins_type
,
blue_cross_serv_code
,
ins_copay


I
nsurance_contact

ins_mail_to_name
,
ins_mail_to_ind


C
aregiver_visit_role

address
seq_nbr

is still being
investigated


New columns


Patient

degree, 20 characters


Patient_visit

HAR_nbr
, 10 digits


Data Changes to the
Clinical
Data
Repository


Data


Visit_nbr

4 to 10


Lastname


30 to 50


Full name


60, 90 to 120


Address line 1


30 to 75


Address line 2


30 to 75


CPI to MRN


8 to 9


Financial_class


1 character to 3 digits


Ins_company_id

3 character TPC to 9 digits


Ins_company_name


25 to 35



12

MC Change Table Schema

MC
_
COLUMN
_
CHANGE
PK
col
_
id
I
1
col
_
name

col
_
change
_
type

col
_
in
_
mc
_
ind

col
_
data
_
change
_
ind

col
_
change
_
desc

record
_
status

begin
_
src

begin
_
date

update
_
src

last
_
updated
MC
_
OBJECT
_
CHANGE
PK
obj
_
id
I
1
obj
_
name

obj
_
type

obj
_
owner

record
_
status

begin
_
src

begin
_
date

update
_
src

last
_
updated
MC
_
CHANGE
_
XREF
PK
change
_
xref
_
id
I
1
col
_
id
I
2
obj
_
id

record
_
status

begin
_
src

begin
_
date

update
_
src

last
_
updated
MC
_
DATA
_
CHANGE
PK
data
_
id
I
1
col
_
id

old
_
value

new
_
value

record
_
status

begin
_
src

begin
_
date

update
_
src

last
_
updated
March
2011
February
2012
March
2011
June
2011
September
2011
December
2011
May
2011
IC Changes
August
2011
HL
7
I Integrated Test
September
2011
CareWeb Test
February
2012
Production
Implementation
CDRQ
/
CDRP
December
2011
Schema Finalized
March

-

December
Mi
-
Chart HL
7
to CDRI
December

-

February
Mi
-
Chart HL
7
to CDRD
July
2011
HL
7
Unit Test
November
2011
Customer Test
January
2012
Customer Test
November

-

January
CDRQ DB
January

-

February
CDRP DB
April
2011
Schema Changes
Mi
-
Chart ADT
&
Scheduling to CDR
Project Milestones
March

-

August
CDRI DB Changes
August

-

November
CDRD DB Changes
Query Certification Process


SELECT No re
-
certification for any change.


FROM


Re
-
certification for any change.


WHERE Re
-
certification for clause changes



No re
-
certification for data changes.


Submit changes through COMET or Remedy.
Outside the UMHS network, submit changes to
Linda Xu at
lixu@med.umich.edu


15

Questions?


16

Changes to Clinical Data Overview


When we move from CareWeb to MiChart in the
ambulatory clinics, MiChart becomes the source
system for ambulatory clinical data


CareWeb and MiChart are separate systems with no
automated data integration


The CDR will not be a reliable source for CareWeb
clinical data


Customers who require real time access to existing
CareWeb clinical data will be asked to use MiChart
Web Services


What Data are Impacted

(No longer a reliable source in the CDR)


Ambulatory Medications


Allergies and Intolerances


Procedures


Health Maintenance Activities


Problem List (Diagnoses)


Immunizations


Vitals and Growth Charts


Outpatient Documentation (Post Go
-
Live)


Social and Family History

What Data are Not Impacted


(Existing feeds from source systems are maintained)


Lab Results


Radiology Reports


Other Results
(Echo Report, EEG, EMG, NEUR, PCARD, …)


PFT Results


Imaged Documents


Inpatient Documentation


Outpatient Documentation (Pre Go
-
Live)

Conversion Plan to MiChart


All Coded Medications, Coded Problems
,
Allergies
, Immunizations, Vitals, and Growth
Charts


Some Health Maintenance Items (TBD)


No Procedures, Family History, or Social
History


No Documentation



Accessing Data in the MiChart Environment


Customers who require real time clinical data which is
no longer available within the CDR will be asked to use
MiChart Web Services (based on Epic’s InterConnect
software)


If real time data is not required, customers have the
option to work with the reporting team to get a prior
days snapshot data


The MiChart technical team will work with each
customer individually to implement these services
within their application


If Web Services are not technically viable, an
abstraction layer may be provided via CDR Views

Available Web Services


GetPatientDemographics


GetActiveProblemList


GetActiveAllergies


GetActiveMedications


GetFamilyHistory


GetMedicalHistory


GetSurgicalHistory


Other types of clinical data can be made available on
request
(i.e. Immunizations, documentation, etc…)

Sample Request for
GetActiveAllergies

Endpoints

https://.../Interconnect/wcf/Epic.Clinical.Services/Clinical.svc/basic (wsHttpBinding


SOAP 1.1)

https://…/Interconnect/wcf/Epic.Clinical.Services/Clinical.svc (wsHttpBinding


SOAP 1.2)


WSDL Location

https://mccpslbd1.umhs.med.umich.edu/Interconnect/wcf/Epic.Clinical.Services/Clinical.svc?wsdl


SOAP Action

urn:epicsystems
-
com:Clinical.2009.Services.GetActiveAllergies


<GetActiveAllergies xmlns="urn:epicsystems
-
com:Clinical.2009.Services">


<PatientID>


<ID>60000359</ID>


<IDType>UMHS MRN</IDType>


</PatientID>


<UserID>


<ID>1</ID>


<IDType>External</IDType>


</UserID>

</GetActiveAllergies>

Sample Response for
GetActiveAllergies

<GetActiveAllergiesResponse xmlns="urn:epicsystems
-
com:Clinical.2009.Services">


<GetActiveAllergiesResult xmlns:i="http://www.w3.org/2001/XMLSchema
-
instance">


<Allergies>


<Allergy>


<AllergenDescription>WASP VENOM</AllergenDescription>


<AllergenName>WASP VENOM</AllergenName>


<DateEntered>03/28/2011</DateEntered>


<DateNoted>05/04/2007</DateNoted>


<ReactionComment>Carries Epi
-
pen</ReactionComment>


<Reactions xmlns:a="http://schemas.microsoft.com/2003/10/Serialization/Arrays">


<a:string>Hives</a:string>


<a:string>Diarrhea</a:string>


</Reactions>


<Severity>High</Severity>


<TimeEntered>10:35 AM EDT</TimeEntered>


<Type>Intolerance</Type>





</Allergy>


</Allergies>


</GetActiveAllergiesResult>

</GetActiveAllergiesResponse>

Using Web Services to Generate Reports


The GetPatientReport service can generate and
retrieve HTML reports


HTML is pre marked up to have the same
appearance as you would see in MiChart


Reports can be customized to fit the needs of the
customers


Ideal choice if discrete data elements are not
required and your application only needs to
display clinical data to your users

Sample GetPatientReport for Problems

Real Time Customers and Data
Requirements

Based on a recent survey

Testing Timeline




Test patients in a development

environment:


5/30/2011

All patients in a test environment:


12/05/2011

All patients in the Production environment:


TBD

MiChart Web Services Availability:

Questions?


29

Considerations for Web Service Usage


What is your development platform (e.g. Java/.NET)? Is it
browser based?


Do you currently access Web Services within your application?


Are you familiar with any Web Service technologies/terms
(spring
-
ws
, JAX
-
WS, CXF, REST, SOAP, WCF)? Any preference?


Do you need discrete data elements for processing?


What data are you looking for?
(Use “
What Data are
Impacted” slide as
a reference)


Any issues regarding the implementation timeline?

Contacts


Real time data access


for clinical data moving from CDR to
MiChart


Stephen
Fayz

(
sfayz@med.umich.edu
)


Brian Braun (
bbraun@med.umich.edu
)


John
McPhall

(
mcphall@med.umich.edu
)


ADT


Mike
Muscott

(
muscottm@med.umich.edu
)


Thomas Greene (
greenet@med.umich.edu
)


CDR Questions and CDRI Access


Cynthia Russell (
cynthiar@med.umich.edu
)


Victor Mensah (
vmensah@med.umich.edu
)


Linda Xu (
lixu@med.umich.edu
)


Reporting and Health System Data Warehouse


Phil Hampton (
phampton@med.umich.edu
)


Mark Barlow (
msbarlow@med.umich.edu
)


Audrey Schmidt (
audreys@med.umich.edu
)