Creating ACO Infrastructure at UPMC

April 10, 2013
University of Pittsburgh Medical Center (UPMC) health system leaders describe the federated view they've created of their clinical IS.

In its November 2011 issue, Healthcare Informatics described the move to a federated view of diagnostic images at the University of Pittsburgh Medical Center (UPMC) health system.

Rasu Shrestha, M.D., vice president for medical information technology and medical director for interoperability and imaging informatics, talked about the development of SingleView, which allows physicians to bring up different radiological reports from other hospitals within the enterprise, and from other PACS systems that previously did not talk to each other.

On Dec. 14, Shrestha gave a talk on the bigger interoperability picture at UPMC, an integrated network that encompasses 20 hospitals, 400 outpatient sites, nearly 50,000 employees and a health plan.

Speaking in an eHealth Initiative webinar setting, Shrestha talked about how the work UPMC has done to stitch together data from more than 25 clinical systems and claims data from its health plan is building the foundation for accountable care. He noted that while it is difficult to create a holistic view of the patient, it is impossible to reach the type of data sharing necessary for ACOs unless you can overcome silos within your own systems. Otherwise you are just looking at slivers of data. “Information exchange between providers and payers also becomes imperative,” he said.

Since 2008, UPMC has been working with a company called dbMotion to integrate and aggregate data from more than 25 major clinical systems, such as laboratory test results, problem lists, and documents into a unified structure. The system transforms disparate medical data maintained in different formats and structures at multiple facilities into an integrated patient record. The more tightly integrated systems provide the foundation for performing advanced analytics, clinical decision support and population management.

 “Semantic interoperability is the foundational layer for what we are trying to achieve,” Shrestha said.

He and Anne Docimo, M.D., chief medical officer of UPMC Health Plan, described how a recent step has been to integrate payer and provider data across UPMC. Physicians have the ability to see a unified view of information on patient services inside and outside the UPMC network via the UMPC Health Plan, Docimo said. For instance, the claims data view may show a physician that the patient had several other emergency room visits she was unaware of previously, or that a patient went to a hospital in Florida on vacation for a heart condition and received medication. This more complete picture of the patient enhances disease management capabilities and may reduce duplicative tests and hospitalizations, she said. It also provides physicians access to health plan predictive models for more proactive medicine. (The clinical and health plan data must be stored in two separate nodes to be HIPAA-compliant, they noted.)

The dbMotion solution is also at the heart of a recently announced health information exchange effort in Western Pennsylvania.

The collaboration, formally known as ClinicalConnect, comprises Altoona Regional Health System, Armstrong County Memorial Hospital, Butler Health System, Excela Health, Heritage Valley Health System, Jefferson Regional Medical Center, St. Clair Hospital, The Washington Hospital and UPMC.

“This is not a UPMC effort,” Shrestha noted. “But the collaboration is going to create a network with data from a wide variety of systems aggregated on the dbMotion platform.”

All of these changes are in support of a new era in healthcare, Shrestha said. “You hear the term meaningful use, but what we need is meaningful data. Best guesses and good intentions are not enough. The previous model was document-centric. But I don’t want stacks of paper. I want actionable data.”

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