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1 HEALTHTECH COUNCIL MEETING October 21, 2012 Jay Moskowitz 1 HEALTHTECH COUNCIL MEETING October 21, 2012 Jay Moskowitz

HSSC Overview: HSSC Stakeholders Clemson University Spartanburg Regional Healthcare System Greenville Hospital System Palmetto HSSC Overview: HSSC Stakeholders Clemson University Spartanburg Regional Healthcare System Greenville Hospital System Palmetto Health University of South Carolina MUSC §http: //www. healthsciencessc. org/ 2 Affiliates… Self Regional Healthcare An. Med Health Mc. Leod Health

HSSC’s Updated Mission Statement: Operational Emphasis 3 HSSC MISSION STATEMENT (Adopted February 2, 2012) HSSC’s Updated Mission Statement: Operational Emphasis 3 HSSC MISSION STATEMENT (Adopted February 2, 2012) The mission of the Health Sciences South Carolina is to support our members in improving the health of all South Carolinians by collaborating across the State of South Carolina with the goal of enabling evidence based research. HSSC will achieve this by: § Creating a unique and comprehensive clinical data store which collects data from providers, enhances its usability, and makes it available in an easily accessible form for participants to use for clinical improvement and research purposes; § Developing and deploying information management tools that improve the efficiency and effectiveness of each member institutions research processes, including the ability of researchers across South Carolina to collaborate; § Serving as a convener for the identification, preparation, development and implementation of innovative collaborative research initiatives which have the potential for improving the health of South Carolinians through evidence based biological and clinical research informed by care givers, patients, and providers. Through its role as a collaborative organization, HSSC will engage and encourage its members to create and develop new products, new jobs, and new industries that positively impact economic growth; contain and reduce health care costs; minimize healthcare disparities; improve patient safety and effectiveness; improve access to healthcare services; and improve the patient care experience.

HSSC Role 4 HSSC Support Member Processes HSSC’s role is to support our members HSSC Role 4 HSSC Support Member Processes HSSC’s role is to support our members and to provide enabling services, assets and tools for translational research initiatives Research Implementation Improvement § Grant opportunity identification § Disease management § Metrics tracking & management § Grant management § Evidence based protocols § Rapid-Learning Health System § Institutional studiescomparative effectiveness § Population health management § Education § Multi-institutional grant opportunity identification § Aggregated, deidentified clinical data § Convener § Analytical tools & support § I 2 b 2 pre-study support § Grant preparation § Research process management tools § Comparative deidentified data § Identifiable clinical data (member’s data) § Analytical tools & support

CDW Overview Collection Storage Analysis Data Feed Consolidation & Cleansing MPI MUSC PH HSSC CDW Overview Collection Storage Analysis Data Feed Consolidation & Cleansing MPI MUSC PH HSSC Clinical Data Warehouse (CDW) CLINICAL Data Marts & Registries GHS SRHS i 2 b 2 Cohort Analysis RESEARCH Data Types: Demographics Diagnoses Procedures Medications Labs 5

HSSC’s Current Research Applications Regulatory 6 Recruitment Research Permissions e. IRB SCResearch. org RPMS HSSC’s Current Research Applications Regulatory 6 Recruitment Research Permissions e. IRB SCResearch. org RPMS CDW Hypothesis & cohort analysis i 2 b 2 EMPI and Data Warehouse Services and Budget Data Capture Research Collaboration SPARC Palmetto Profiles

7 Collaboration & Alignment: HSSC Portfolio of Infrastructure Projects 7 HSSC Project Summary Status 7 Collaboration & Alignment: HSSC Portfolio of Infrastructure Projects 7 HSSC Project Summary Status Research Permissions Management System • Web application for collecting permissions in busy clinics using an i. Pad • In pilot at MUSC and available for use across HSSC in 2012 • Permissions data becomes part of the medical record - made available to research (i 2 b 2) e. IRB HSSC-wide IRB system • Common system for managing multi-site IRB process • Live and in use across HSSC • Manages operations of (12) IRB committees Palmetto Profiles researcher networking • Enables researcher profiling and collaboration Clinical Trials Management Tools (SCTR incubated) • Set of tools to streamline research activities and reduce barriers to translational research §REDCap data capture and survey §SPARC – Services, Pricing, Applications and Request Center §Study Tracker §MAP-R, Research Toolkit, Appsite and SCResearch. org • One of the (6) NIH strategic goals to enable shared resource optimization • Live and available for use across HSSC • Live and in use at MUSC • Available for use by all research institutions in 2012

8 Collaboration & Alignment: HSSC Portfolio of Infrastructure Projects HSSC Project Summary Master Patient 8 Collaboration & Alignment: HSSC Portfolio of Infrastructure Projects HSSC Project Summary Master Patient Index (MPI) • Patient record matching HL 7 Gateway Status • Live • Provides unique patient identifier for HSSC institutions • Essential for health information exchange Clinical Data Warehouse (CDW) and i 2 b 2 toolset • Real time clinical data management • Tools for data analysis • Initial focus on demographics, labs, procedures, diagnosis and medications • Initial application is i 2 b 2 (research) • Identified clinical data has been provided by GHS, MUSC, PH and SRHS for project testing phase • Completed test implementation • Upgrading technology components – schedule to be reviewed on following slides 8

HSSC CDW Solution Architecture 9 Technology Components Data Intake Data Transformation Data Store & HSSC CDW Solution Architecture 9 Technology Components Data Intake Data Transformation Data Store & Management Data Delivery Data Marts/Registries SRHS Data Trust MUSC Research i 2 b 2 Operational Data Store (ODS) PH Interface Engine GHS Master Person Index (MPI) CDW/MPI GHS PH PH MUSC SRHS Current data includes: Patient Demographics, Procedures, Diagnosis, Medications and General Labs Data is organized and integrated using standards that enable aggregation and multi-purpose use The data is made available through data marts & applications I 2 b 2 LDS will be the first application but HSSC is ready to begin detailed planning for clinical applications Clinical

Data Fields Available in the CDW 10 DT-Service-In-Patient DT_SVC_MEDICATION DT_SVC_DIAGNOSIS DT_SVC_PROCEDURE DT_SVC_LAB_RESULT DT_PATIENT_CONSENT DT-Service-Provider Data Fields Available in the CDW 10 DT-Service-In-Patient DT_SVC_MEDICATION DT_SVC_DIAGNOSIS DT_SVC_PROCEDURE DT_SVC_LAB_RESULT DT_PATIENT_CONSENT DT-Service-Provider

CDW Scope: Initial Data Feeds 11 n+ Over 90% of research -based queries to CDW Scope: Initial Data Feeds 11 n+ Over 90% of research -based queries to an existing clinical database use data elements from sections 1, 2, and 3. 1 3 2 Labs Diagnosis 1 Medications Patient Demographics Data Types Inclusion Goal/Result 1 Optimizing Procedures Multi-site data integration Cohort Analysis Clinical Trial Recruitment Driving Biomedical Projects 1 2 3 n+ healthcare research data warehouse design through past COSTAR query analysis. S. N. Murphy, M. M. Morgan, G. O. Barnett, and H. C. Chueh Proc AMIA Symp. 1999: 892– 896

Low Difficulty Exploring Unknown CDW Core & Optional Data Services Vision Data Practice e. Low Difficulty Exploring Unknown CDW Core & Optional Data Services Vision Data Practice e. HR data Costs data Claims data Death Data e. Rx Data Integrated Claims and Clinical Data Services (optional) Medicare/ Medicaid Data mart and BI Death Registry Care Coordination Registry (Automated) e. Rx Reconciliation Diagnostics Clin. Doc Results Orders Clinical Data Mart & Business Intelligence Tools Comparative Analytics/ Benchmarking Live (MUSC) Pilot Problems Chronic Disease Registries Diagnoses Meds Labs ADT Research CDW/i 2 b 2 Enterprise Master Patient Index 12 Care Continuum Data Services (optional) Population Health ACO Management Duplicate Service All Claims Reduction Database Standardized Reporting For External Measures Clinical Decision Support Individual Member Clinical Data Marts &/or Registries (optional) Core CDW Services Complexity

Core & Optional Services 13 Core & Optional Services 13

14 HSSC Information Solutions Approach Today 14 6 Months 12 - 16 Months Information 14 HSSC Information Solutions Approach Today 14 6 Months 12 - 16 Months Information Architecture Detail Planning Clinical Research Solutions Detail Planning Clinical Solutions (Optional)

Methodology: Phase Detail 15 Phase Detailed Stages HSSC Resources Site Resources Time Estimate Discovery Methodology: Phase Detail 15 Phase Detailed Stages HSSC Resources Site Resources Time Estimate Discovery • Project Kickoff & Data Call Enterprise Architecture Review Champion (5%) PM (10 -20%) SME (10 -20%) ~2 weeks • PM Tech Lead • Business Process Overview • System Lifecycle Roadmaps • REDCap Questionnaire • Source System Interviews • Sample Data Feeds/Files • Detailed System Understanding • Design • Mapping & Translations (ex: RXNorm/LOINC mappings) Source Analysis Implementation • Configuration DW Analyst Interface Analyst Network Admin (<5%) PM DW Analyst Interface Analyst Champion (5%) PM Tech Lead DW Analyst Champion (5%) PM (10 -20%) Interface Analyst ~1 -2 months PM (10 -20%) SME (20%) HL 7 Interface Analyst (25%) ~2 -3 months SME (10 -20%) Clinical Resource (25%) Infr/Config Analyst DBA Internal testing Beta-User Testing/Validation • Rollout • • Testing Institution Sign-off • Scheduled Deployment • Final Sign-off PM QA Analyst Champion (5%) PM (10 -20%) ~1 month User Testers PM Tech Lead Infr/Config Analyst Champion (5%) PM (10 -20%) Network Admin (<5%) ~1 week

Revised CDW Implementation Timeline 16 Affiliate Hospitals Data Loaded – Q 2 2014 New Revised CDW Implementation Timeline 16 Affiliate Hospitals Data Loaded – Q 2 2014 New Vendor Contract 2012 Hospital 1 Data Loaded End-to-end HL 7 -i 2 b 2 Complete Technology Audit Data Collaboration Agreement must be signed Hospital 2 Data Loaded 2 nd Hospital Project Started 2013 Start workgroup HSSC affiliate Hospitals Start Conv of Hospital 1 to Production New System Hospitals 3 & 4 Projects Started Hospitals 3 & 4 Projects Data Loaded 2014