MiChart Data Integration Review

1. MiChart Data Integration Review 25 April 2011

2. 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

3. MiChart Project Milestones

4. 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

5. Planned UMHS Data Environment • Mi-Chart at Stage 4 Go-Live • Data consolidated • CareWeb replaced • CDR archived

6. Changes to Non-CareWeb DataFebruary 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 Description Master) switch from HealthQuest (PA) to MiChart • Medical Record Procedures switch from HealthQuest (MR) to MiChart

8. 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.

9. MiChart Visits and Accounts Patients (EPT) Accounts (HAR) Patient (MRN 123) • 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

10. Data Changes to the Clinical Data Repository – Tables & Views • Tables and views no longer updated after February 2012 • Patient_2_t • Patient_2 • Patient_HIPAA • Patient_visit_msp_answer_t • Patient_visit_msp_answer • Patient_visit_msp_answer_cdr •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.

11. Data Changes to the Clinical Data Repository – Columns • Columns no longer updated after February 2012 • Patientpat_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_employeremploy_to_date • Patient_visitregistration_date, medicare_priority, msp_complete_flag, msp_last_date, msp_bypass_ind • Visit_insuranceppo_code, ins_elig_comment, ins_verif_comment, ins_co_pay, ins_deductible • Insuranceins_type, blue_cross_serv_code, ins_copay • Insurance_contactins_mail_to_name, ins_mail_to_ind • Caregiver_visit_role address seq_nbr is still being investigated • New columns • Patient degree, 20 characters • Patient_visitHAR_nbr, 10 digits

12. 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

13. MC Change Table Schema

15. 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

16. Questions?

17. 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

18. 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

19. 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)

20. 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

21. 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

22. 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…)

23. 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>

24. 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>

25. 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

26. Sample GetPatientReport for Problems

27. Real Time Customers and Data Requirements Based on a recent survey

28. Testing Timeline MiChart Web Services Availability:

29. Questions?

30. 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?

31. 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)