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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 2 Departmental Systems 3 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 4 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 5 Systems Review Results 6 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. 7 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. 8 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. 9 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 • • • • Apollo-related systems in cardiology including Tumor Registry ADT feed OmniView Download IDXRAD – Radiologic Systems interfaces 10 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. 11 Clinical Research Support 12 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) 13 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) 14 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. 15 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 20 Phase 1 Revised Scope and Deliverables 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 – – – – – Demographics Encounter Disposition/Discharge Diagnosis Medications Incremental improvements to existing documentation / training / support 21 Questions / Discussion 22