UPMC tackles interoperability initiative
ORLANDO–The mission of deploying an electronic health record (EHR) would be an easier task if it could be accomplished from the ground up. That is, if implementation of such technology were to take place in an environment with no other healthcare IT systems in place. However, most facilities function with an amalgamation of systems from a disparate collection of vendors that have been installed over time.

“The University of Pittsburgh Medical Center (UPMC) environment consists of multiple applications from many vendors that create and use clinical information,” said G. Daniel Martich, MD, chief medical information officer for the facility.

Martich, in a presentation at the 2008 HIMSS conference on Monday sponsored by the Society for Imaging Informatics in Medicine (SIIM), described the efforts his institution is undertaking to create a health information exchange (HIE), of which they have recently completed the first phase.

“The goal of interoperability is to enable the doctor, nurse and dietician to better process clinical data because of the interaction with interoperable information technology provides a more complete and accurate understanding of that data than without it,” he said.

UPMC is the second-largest non-governmental employer in Pennsylvania, with approximately 48,000 employees and annual revenues of $6 billion, Martich noted. The facility is spearheading an interoperability initiative to create an integrated patient record composed of a patient’s medical data maintained at facilities that otherwise have no common technology through which to share data.

“Our goal is to dramatically improve patient care and safety by allowing data to be easily retrieved, shared and understood across our 20 hospitals, 400 outpatient sites and doctors’ offices and other care facilities,” he said. “This is one of the largest projects ever for creating true interoperability in healthcare.”

Systems in place throughout the enterprise include 610 interfaces and 200 clinical healthcare IT products from vendors such as Cerner, Epic, McKesson, Siemens Healthcare, Misys, Quest Diagnostics, Philips Healthcare, and Meditech, according to Martich.

“After detailed analysis, we realized that no single vendor can or will meet all of UPMC’s needs,” Martich said. “Currently, ambulatory and inpatient EMRs are provided by two different, major vendors. Also, psychiatry, oncology, and ICUs do not use either of those solutions for their EMR. Thus, multiple clinical decision-support systems exist within UPMC and ambulatory, in-patient, and infection control data exist in separate databases.

“Additional EMR applications are used by non-employed physicians, who currently treat 40 to 50 percent of patients referred to UPMC, and various clinical applications are used in the region that would be encompassed by a UPMC-centered regional health information organization (RHIO).”

Martich and his team selected an interoperability platform based on service oriented architecture (SOA) from Hod HaSharon, Israel-based dbMotion. The firm’s platform creates an integrated patient record composed of a patient’s medical data maintained at facilities that otherwise have no common technology through which to share data and is accomplished without the replacement of existing information systems.

In the first phase of the interoperability initiative that went live earlier this month, UPMC physicians and other clinicians in two emergency departments, two primary-care ambulatory practices and a medical clinic gained access to a single view of medical data. This includes such clinical categories as medications, allergies, and labs. Previously, this information was available in disparate systems across UPMC’s network and was cumbersome to retrieve, compare and analyze.

The early phase also includes a first implementation of semantic interoperability, or the integration of data coded in different systems to ensure that the true meaning of the information is presented to clinicians within their normal workflow, Martich said.

“Semantic interoperability may be distinguished from other forms of interoperability by considering whether the information transferred has, in its communicated form, all of the meaning required for the receiving system to interpret it correctly, even when the algorithms used by the receiving system are unknown to the sending system,” he said.

Formally announced in October 2006, the UPMC-dbMotion initiative also includes a joint development partnership and an approximate $35 million investment in dbMotion by UPMC as part of $84 million committed to the project, according to Martich. The next steps in the project include expanding to more users, adding more clinical systems and data sources and progressing to higher levels of semantic interoperability.

“UPMC is engaged in a multiyear, multimillion dollar interoperability project, and it is one of the largest undertakings thus far in the field of interoperability,” he said. “We’re making a strategic investment in this field that will lower the investment threshold for others.”