Transcript Appendix 3 - UCSF Academic Senate

Apex/Epic and Research
Academic Senate Clinical Affairs Committee
October 26, 2011
Seth Bokser
Major Areas Where APeX Will Support Research
 Ensure continued support for functions supported by existing
departmental systems
 Facilitate the use of clinical data in research (i.e. retrospective
data in the IDR)
 Support clinical research
– Compliance
– Billing
– Enrollment
– Clinical Data Capture
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Departmental Systems
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Support for Existing Systems
 Survey conducted this summer and fall of 2010
– 197 Systems were identified
• 11 duplicates removed, 13 added 198 systems
remain.
• 53% systems,47% databases
• 45% patient care, 53% operations,
53% research (most have multiple uses)
 Prioritized for review
– Criteria were implementation date, system function
and sensitivity
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Classification of Systems for APeX Implementation
 Our goal is to ensure continuity in the functionality
 Five categories:
– Replaced by Epic
– Possible scope in optimization phase
– Independent system
– Data and interface conversions - Planned/Underway
– Data and interface conversions - Required
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Systems Review Results
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Replace by Epic
Description
Plan
Examples
•Epic features can replace system’s functions at go-live.
• Implementation teams to be alerted to this work.
Implement replacement of function as part of go-live.
• OB/GYN Access Databases – Used by operations, to
report births to state agencies, and for research. Can be
replaced by worklists, Clarity reports and IDR.
• AccessANYware – Remote access for Coders. Function
to be replaced with Epic Features.
• ED Filemaker system – Replaced by Epic ASAP.
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Possible Scope in Optimization Phase
Description
Plan
Examples
•Epic features can replace this system’s functions, but
work is impractical at this time due to limited data, timing
or scope of implementation. System should be reviewed
after the initial implementation.
• Implement without changing system. Keep a list for
review after implementation.
• EEG Reader in Epilepsy/Clinical Neurophysiology EEG Study data. System is currently independent; No
IDX or UCare interfaces; Would like integration for
viewing and demographics.
• Pediatric Nephrology Database – Screens patients for
research recruitment. Consider migration when
sufficient data is in Epic.
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Independent Systems
Description
•The system is not impacted by APeX
implementation. Typically these systems are not linked to
clinical data; serve a non-clinical function or where Epic
features are not planned for implementation.
Plan
• No APeX action needed. Coordinate system with School
of Medicine as appropriate.
Examples
• QuesGen – collects and stores data about volunteers for
pharmaco-genomic studies
• Airway tissue Bank – Tracks samples for research study.
• CAPSURE.NET Web-site with public information on
Prostate Cancer
• Canfield Scientific – In Plastic Surgery used as an
imaging tool.
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Data and Interface Conversions - Planned or Underway
Description
•An interface or download of Epic Data is needed to
replace an existing download or interface. This work is
underway or planned.
Plan
• Implementation of replacement interface is underway.
Continue on plan.
Examples
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Apollo-related systems in cardiology including
Tumor Registry ADT feed
OmniView Download
IDXRAD – Radiologic Systems interfaces
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Data and Interface Conversions - Required
Description
Plan
Examples
•An interface or download of Epic Data is needed to
replace an existing download or interface. This work is
not underway or planned.
• Assess need for data, ensure a plan is in place to
support data need.
• Dynamic Clinical System – Used in Urology/Oncology as
a pre-appointment screening tool. Currently gets
download from IDX.
• Urology/Oncology Database (Prostate) – Master
Research Database. Need to replace monthly download
from STOR.
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Clinical Research Support
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APeX features at Enterprise go-live (6-2012)
 UCSF will use APeX (Epic) to:
– Identify studies
– Identify patients who are participating in the studies
– Identify which encounters have content for the studies
– Place orders for care related to studies
– Appropriately bill responsible entities (i.e. Personal Family
account or Research account) for the orders.
– Support chart review by clinical monitors
– Identify research patients and include or exclude them from
medical center reports, metrics and statistics as appropriate
 Research features go-live at Enterprise Roll-out
– Interim workflow keeps research orders and billing on
paper. (through June 2012)
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Future directions for Clinical Study Support with APeX
 Implement Epic function to indicate when a patient may
qualify for a particular study (Welcome; MyChart; APeX)
 Integration with :
– Clinical Trials Management Systems (e.g. OnCore)
• We are working with Epic, Forte, U Wisconsin, Yale and U Virginia on HIE Standardsbased approach to interfacing clinical trials activities.
– Research Participant Management System (being scoped
and planned in SOM)
– Clinical trials development process (iMedris, Medicare
Charge Analysis)
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APeX/Epic Staff Activities
 Appropriate Research Staff will:
– Set up clinical studies with assistance of Apex Team
including:
• Identify allowed procedures (including tests and
treatments) for a study
• Determine how study-related orders are entered
• Identify billable entity at time of order
– Enroll Patients
– Identify or confirm that each order is research-related at
time of order entry
– Attend training and adhere to policies and procedures that
support research workflows in Apex.
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IDR Overview
Integrated Data Repository
 School of Medicine based
 Repository for researchers which integrates data
from many source systems
 De-identified data is readily available to
appropriate personnel
 Goal to create research environment that is:
– Accurate, Accessible, Easy to use, Secure
 Target inclusion of initial APeX data November 2011.
IDR & My Research – Big Picture
Red = Currently Integrated
Data Warehousing
Source Systems
UCare
Flowcast
Worx
ED
MAR
Apollo
CoPath
Siemens
Radiology
Security
End User Tools
Terminal
Servers
Epic
UCare
Will be replaced
by Epic
IDXrad
Misys
CTMS
Transplant
VA
Cancer
Registry
VA
Cancer
Registry
Kaiser
Axium
Kaiser
Axium
TSI
PICIS
TSI
PICIS
LPPI
EMR
SFGH
LPPI
EMR
SFGH
CTMS? Transplant?
Audit
DB /
IDR
Proxy process and Load
Will have interfaces
to bring data into
Epic
Cohort
Selection
Tool (i2b2),
SAS,
Extract, Transfer
STOR
Data Warehouse
MyResearch Portal
Epic
Replica
Business Intelligence
SGD
Web top
STATA,
SPSS,
Alias.ti,
Enterprise
Architect
Alfresco
REDCap
Cognos BI
APeX-IDR Information Flow
Medical Center Network
(Requires CHR Approval for Access)
Shadow
Server
Epic
Production Server
(Chronicles Caché)
Patient care
Clarity
(Microsoft
SQL Server)
MyResearch Network
(No CHR Approval Required)
Staging
Server
(Microsoft
SQL Server)
IDR
MyResearch
(HIPAA Limited (Data Marts /
Data Set*)
Ontologies)
• Operational and financial reports
• Government-mandated reporting
* “HIPAA Limited Data Set” = No PHI Except Dates of Service
Research
IDR and Clarity Environments
• Operational, financial and government mandated
reporting out of Epic’s Operational Data Store ‘Clarity’
• HIPAA Limited Data Set (LDS), i.e. no PHI except dates
of service, brought over to IDR for Cohort Selection
• Any PHI data extract for research purposes:
• Requires CHR approval
• Comes from Med Center, not IDR
• Done via separate secure interfaces
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Phase 1 Revised Scope and Deliverables
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Use existing MOU with Medical Center for data use
APeX data available in i2b2 to trained and certified users
Use existing IDR data security and governance
Key data views or marts mapped
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Demographics
Encounter
Disposition/Discharge
Diagnosis
Medications
 Incremental improvements to existing documentation /
training / support
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Questions / Discussion
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