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2. 1 HEALTHTECH COUNCIL MEETING October 21, 2012 Jay Moskowitz

3. 2 Spartanburg Regional Healthcare System Self Regional Healthcare AnMed Health McLeod Health Greenville Hospital System Clemson University Palmetto Health University of South Carolina Affiliates…  http://www.healthsciencessc.org/ http://www.healthsciencessc.org/ MUSC HSSC Overview: HSSC Stakeholders

4. 3 HSSC’s Updated Mission Statement: Operational Emphasis HSSC MISSION STATEMENT (Adopted February 2, 2012) The mission of the Health Sciences South Carolina is to support our members in improving the health of all South Carolinians by collaborating across the State of South Carolina with the goal of enabling evidence based research. HSSC will achieve this by:  Creating a unique and comprehensive clinical data store which collects data from providers, enhances its usability, and makes it available in an easily accessible form for participants to use for clinical improvement and research purposes;  Developing and deploying information management tools that improve the efficiency and effectiveness of each member institutions research processes, including the ability of researchers across South Carolina to collaborate;  Serving as a convener for the identification, preparation, development and implementation of innovative collaborative research initiatives which have the potential for improving the health of South Carolinians through evidence based biological and clinical research informed by care givers, patients, and providers. Through its role as a collaborative organization, HSSC will engage and encourage its members to create and develop new products, new jobs, and new industries that positively impact economic growth; contain and reduce health care costs; minimize healthcare disparities; improve patient safety and effectiveness; improve access to healthcare services; and improve the patient care experience.

5. 4  Multi-institutional grant opportunity identification  Convener  I2b2 pre-study support  Grant preparation Member Processes HSSC Support ResearchImplementationImprovement  Aggregated, de- identified clinical data  Analytical tools & support  Research process management tools  Comparative de- identified data  Identifiable clinical data (member’s data)  Analytical tools & support  Grant opportunity identification  Grant management  Institutional studies- comparative effectiveness  Disease management  Evidence based protocols  Population health management  Metrics tracking & management  Rapid-Learning Health System  Education HSSC Role HSSC’s role is to support our members and to provide enabling services, assets and tools for translational research initiatives

6. 5 StorageCollectionAnalysis Data Types: Demographics Diagnoses Procedures Medications Labs Data Feed Consolidation & Cleansing Operational Data Store (HTB) HSSC Clinical Data Warehouse (CDW) MUSC GHS SRHS PH Data Marts & Registries RESEARCH CLINICAL i2b2 Cohort Analysis MPI CDW Overview

7. 6 HSSC’s Current Research Applications RPMS Research Permissions Hypothesis & cohort analysis i2b2 Regulatory eIRB Services and Budget SPARC Data Capture SCResearch.org Recruitment Palmetto Profiles Research Collaboration CDW EMPI and Data Warehouse

8. 7 Collaboration & Alignment: HSSC Portfolio of Infrastructure Projects 7 HSSC ProjectSummaryStatus Research Permissions Management System Web application for collecting permissions in busy clinics using an iPad Permissions data becomes part of the medical record - made available to research (i2b2) In pilot at MUSC and available for use across HSSC in 2012 eIRB HSSC-wide IRB systemCommon system for managing multi-site IRB process Manages operations of (12) IRB committees Live and in use across HSSC Palmetto Profiles researcher networking Enables researcher profiling and collaboration One of the (6) NIH strategic goals to enable shared resource optimization Live and available for use across HSSC Clinical Trials Management Tools (SCTR incubated)  REDCap data capture and survey  SPARC – Services, Pricing, Applications and Request Center  Study Tracker  MAP-R, Research Toolkit, Appsite and SCResearch.org Set of tools to streamline research activities and reduce barriers to translational research Live and in use at MUSC Available for use by all research institutions in 2012

9. 8 8 HSSC ProjectSummaryStatus Master Patient Index (MPI) HL7 Gateway Patient record matching Provides unique patient identifier for HSSC institutions Essential for health information exchange Live Clinical Data Warehouse (CDW) and i2b2 toolset Real time clinical data management Tools for data analysis Initial focus on demographics, labs, procedures, diagnosis and medications Initial application is i2b2 (research) Identified clinical data has been provided by GHS, MUSC, PH and SRHS for project testing phase Completed test implementation Upgrading technology components – schedule to be reviewed on following slides Collaboration & Alignment: HSSC Portfolio of Infrastructure Projects

10. 9 GHS PH MUSC SRHS Master Person Index (MPI)Operational Data Store (ODS)Data Trust GHS PH MUSC SRHS Data Marts/Registries Clinical CDW/MPI HSSC CDW Solution Architecture i2b2 Research Data Intake Data Transformation Data Store & Management Data Delivery Technology Components Interface Engine Current data includes: Patient Demographics, Procedures, Diagnosis, Medications and General Labs Data is organized and integrated using standards that enable aggregation and multi-purpose use The data is made available through data marts & applications I2b2 LDS will be the first application but HSSC is ready to begin detailed planning for clinical applications GHS PH MUSC SRHS

11. 10 Data Fields Available in the CDW DT-Service-In-Patient DT-Service-Provider DT_SVC_DIAGNOSIS DT_SVC_PROCEDURE DT_SVC_LAB_RESULT DT_PATIENT_CONSENT DT_SVC_MEDICATION

12. 11 CDW Scope: Initial Data Feeds Cohort Analysis Multi-site data integration 1 Data Types Clinical Trial Recruitment Inclusion Goal/Result 23 n+ Patient Demographics 1 2 3 Diagnosis Labs Medications Procedures Driving Biomedical Projects n+ 1 Optimizing healthcare research data warehouse design through past COSTAR query analysis. S. N. Murphy, M. M. Morgan, G. O. Barnett, and H. C. Chueh Proc AMIA Symp. 1999: 892–896 Over 90% of research-based queries to an existing clinical database use data elements from sections 1, 2, and 3. 1

13. 12 Data Complexity Labs Meds Diagnoses Problems Diagnostics Orders Results ClinDoc Costs data Claims data eRx Data Practice eHR data Live (MUSC) Pilot Low Difficulty Exploring Unknown ACO Management Population Health Duplicate Service Reduction eRx Reconciliation Death Registry Death Data Comparative Analytics/ Benchmarking Standardized Reporting For External Measures Clinical Decision Support Research CDW/i2b2 Chronic Disease Registries Care Coordination Registry (Automated) Medicare/ Medicaid Data mart and BI All Claims Database Clinical Data Mart & Business Intelligence Tools Enterprise Master Patient Index Individual Member Clinical Data Marts &/or Registries (optional) Integrated Claims and Clinical Data Services (optional) Care Continuum Data Services (optional) ADT CDW Core & Optional Data Services Vision Core CDW Services

14. 13 Core & Optional Services

15. 14 HSSC Information Solutions Approach Information Architecture Clinical Research Solutions Clinical Solutions (Optional) Today6 Months12 - 16 Months Detail Planning

16. 15 Methodology: Phase Detail PhaseDetailed StagesHSSC Resources Site Resources Time Estimate DiscoveryProject Kickoff & Data Call Enterprise Architecture Review Business Process Overview System Lifecycle Roadmaps PM Tech Lead DW Analyst Interface Analyst Champion (5%) PM (10-20%) SME (10-20%) Network Admin (<5%) ~2 weeks Source AnalysisREDCap Questionnaire Source System Interviews Sample Data Feeds/Files Detailed System Understanding PM DW Analyst Interface Analyst Champion (5%) PM (10-20%) SME (20%) HL7 Interface Analyst (25%) ~1-2 months ImplementationDesign Mapping & Translations (ex: RXNorm/LOINC mappings) Configuration PM Tech Lead DW Analyst Interface Analyst Infr/Config Analyst DBA Champion (5%) PM (10-20%) SME (10-20%) Clinical Resource (25%) ~2-3 months TestingInternal testing Beta-User Testing/Validation Institution Sign-off PM QA Analyst Champion (5%) PM (10-20%) User Testers ~1 month RolloutScheduled Deployment Final Sign-off PM Tech Lead Infr/Config Analyst Champion (5%) PM (10-20%) Network Admin (<5%) ~1 week

17. 16 Revised CDW Implementation Timeline 2012 2013 2014 2 nd Hospital Project Started Data Collaboration Agreement must be signed Complete Technology Audit Hospital 1 Data Loaded End-to-end HL7-i2b2 New Vendor Contract Start Conv of Hospital 1 to New System Hospital 2 Data Loaded Start workgroup HSSC affiliate Hospitals Affiliate Hospitals Data Loaded – Q2 2014 Hospital 1 Production on New System Hospitals 3 & 4 Projects Started Hospitals 3 & 4 Projects Data Loaded