At health systems with varied electronic health records (EHRs), converging patient data from different systems into one application can often be challenging. But at the 20-plus-hospital University of Pittsburgh Medical Center (UPMC) health system, a new application has been developed to do just that.
Debuted at HIMSS14 in Orlando, Fla. last week, UPMC and Caradigm—a Bellevue, Wash.-based healthcare analytics and population health vendor—are developing a mobile, Windows 8.1 tablet-based platform, called Convergence, that lets physicians, with the touch of a screen, instantly switch among different clinical applications while maintaining patient context. The interoperability platform is being developed with support from Microsoft and Intel Corporation.
According to Rasu Shrestha, M.D., vice president, medical information technology at UPMC, while data interoperability has been going on for years, most existing platforms only get the end user so far. “Most don’t address the workflow aspect,” Shrestha says. “You can view the data but it doesn’t answer the ‘now what’ question. Now I need to place an order, now I need to put in a documentation, discharge summery, or post-op note. We have pushed the agenda beyond where data interoperability has brought us—to user experience interoperability,” he says.
Rasu Shrestha, M.D
The idea for the application, which was created in UPMC’s Technology Development Center, stemmed from the notion that the patient never really resides in one silo, Shrestha says. “We need to enable that level of visualization around the patient’s record, and bring the patient’s story to life. But also, we need to ensure that the core clinical care pathways, as well as the workflow aspect of what I do as a clinician, becomes embedded into the fabric of that visual layer,” he says.
To that end, Shrestha says he currently spends too much time piecing together information from several different silos. “Right now, I’m supposed to navigate through a window, scroll through screens, and go from application to application. I’m playing the role of detective rather than clinician,” he says. But with the Convergence platform—what Shrestha calls a “revolutionary approach to healthcare”—UPMC is approaching interaction with its data silos that it has come to love and implement, but also is continuing to push collaborative care and value-based healthcare forward. “Right now, [the process of] piecing that information together may be complete and may be ‘just enough’ information, but that’s not good enough healthcare,” Shrestha says. The idea is not to replace the EHR by any means, but instead seamlessly integrate all of the information, he notes.
IN PILOT MODE
Currently, cardiologists at UPMC’s biggest hospital, UPMC Presbyterian, are testing the platform and its ability to navigate seamlessly among Cerner’s EHR and two new UPMC-developed applications that allow physicians to easily see relevant patient information pulled from multiple data systems and to follow a recommended clinical pathway to treat a patient for certain diseases.
Shrestha says an example of how the Convergence platform would be used is if he were looking at a patient’s record and saw an abnormal lab value, as well as a couple of abnormal vitals around the patient. “If that patient has an increased heart rate and an increased respiratory rate, and I’m seeing elevated D-dimer values, my first thought is that this patient might have pulmonary embolism (PE), which could kill him or her. And remember, all of this information [the increased rates] can be coming in from different silos,” Shrestha says. “So I need to put in an order for a CT angiogram of the patient’s chest to rule out the PE,” he explains. “I swipe up and that immediately brings up Cerner’s order screen, and it brings up everything I have found so far right away. I click the order button directly in Cerner; it really makes it so much easier working in just one application.”
Shrestha says that the application was originally for the iPad, but the challenge was that the functionality was very limited. And the same was true for Android tablets, he says. “You can have that patient’s story in front of clinician, but there’s not much more you can do in terms of interacting with legacy EHRs. These systems we have don’t reside on iPads or Android tablets, but they do reside on Windows desktops. You have your touch-enabled systems, but you also have your legacy desktop where you could run these systems. We see it as the best of both worlds.”
OPENING THE EHR
Going forward, UPMC’s plan is to essentially commercialize the solution, says Shrestha, though that is not being pursued right now. The goal today is to perfect it and hone it, he reveals. “The idea is to take this out and make it more broadly applicable outside of our system. We saw a ton of interest at HIMSS showing it at the Microsoft and Caradigm booths—clinicians came in and asked, “When can I get this?”
A unique challenge when dealing with data interoperability is that you are almost going up against EHR companies, Shrestha conveys. “Because what you’re saying is, ‘we are trying to decouple your data from your EHR.’ In reality, we’re telling the EHR vendors to do more of what they’re good at. We’re just going to piece it all together to make it easier for the clinician. If anything, it brings more value back into the EHR,” he feels.
The general consensus in the industry, and seen at HIMSS, is that it’s really important for EHRs to be more open, Shrestha notes. The Office of the National Coordinator for Health IT (ONC) is pushing that notion of openness in terms of other platforms, and meaningful use is pushing these vendors towards the adherence of data exchange standards as well, Shrestha explains. “There is a growing trend to having EHRs being much more open, and we want to leverage that and have them play nice with each other.”