When Franciscan Alliance, a 13-hospital health system serving Indiana and Illinois, migrated a 140-physician group practice to its new Epic electronic health record (EHR) system, the physicians needed to access vital signs and patient identifiers for 250,000 patients – millions of records that were not part of the initial year-long data conversion project. Using interoperability technology from InterSystems, a global health information technology company, and drawing on the expertise of professional services firm EHR Evolution, Franciscan Alliance found a way to ease the transition.

The scenario is typical, at a time of intensive merger and acquisition activity in U.S. healthcare. As large health systems acquire hospitals, laboratories and physician practices and standardize on a single EHR system, the process of moving millions of patient records from legacy systems to the new EHR can be a data conversion nightmare.

“We have always believed that InterSystems’ proven healthcare informatics technology, combined with our expert implementation partners like EHR Evolution, offer a powerful combination in the service of our customers,” said Joe DeSantis, Vice President, HealthShare Platforms, for InterSystems. “The vital signs project demonstrates the value of delivering the right data to the right person at the right time.”

The new clinician viewer, which appears as a single button within the Epic chart review screen, gives physicians access to critical vital signs data – in the context of the patient’s own electronic health record. The viewer enables the physician or medical assistant to select which of the historical records to push into the Epic EHR system to be part of the patient’s permanent health record.

Working closely with Franciscan Alliance’s IT team, EHR Evolution implemented the innovative solution in just six weeks, building on the InterSystems HealthShare® health informatics and interoperability platform. The clinical viewer was up and running prior to the Epic go-live in August 2015.

The clinical viewer provides custom filters to view the legacy data by provider, encounter date, and vitals type. Data from the prior EHR system is stored on an InterSystems Caché high-performance database and passed on-demand to the Epic EHR. Without leaving the EHR, users can securely access and select data based on their unique credentials, and all data is audited and encrypted within Caché.

“This was an excellent use of the InterSystems HealthShare platform, demonstrating a new and strikingly simple way to think of EHR data conversions. It’s not always necessary to replicate all the data all at once or one time only. This new approach allows data access ‘just in time,’ as part of the physicians’ natural work flow,” said Jill Thompson, Manager, Application Integration Services, for Franciscan Alliance.

“EHR Evolution’s expertise in EHR implementation and optimization was invaluable to us,” Thompson added. “We worked side by side to ensure the project was completed on-time, even testing all day on the Saturday before the launch.”

Rather than converting all the legacy data at once, including potentially “dirty” data, EHR Evolution found a way to give physicians exactly the patient data they needed, without making them toggle back and forth between systems.

Centering Healthcare Institute was looking for a solution to fulfill the business goals of improved security, accessibility and usability of CenteringCounts™, reduced time spent on data entry and administration to focus on care, comprehensive analysis to demonstrate impact of Centering more effectively and efficiently and enhance and/or automate internal processes to free up Centering staff capacities.

Built on InterSystems Health Connect, the CenteringCounts solution has since been migrated to IRIS for Health on Azure. IRIS for Health has provided all of the capabilities for building complex, data-intensive applications including data management, interoperability, transaction processing and analytics in a single product thus reducing the effort to maintain CenteringCounts as it is built on a single integrated platform.

EHRE developed a comprehensive solution for Centering Healthcare Institute to replace their Salesforce and Excel-based CenteringCounts data tool with a web application using InterSystems technologies. This solution integrates their current workflow and enhances their future process. The CenteringCounts Online solution allows Centering sites to report
outcomes in real-time and access detailed benchmark reports for themselves and the wider Centering community. This project is designed to promote the scale and spread of Centering through enhanced data collection, reporting, and dissemination

EHRE followed the Agile software development methodologies based on
iterative development, where requirements and solutions evolved through collaboration between the EHRE team and the CHI teams. The schedule initially suggested was updated based on the changes in design and scope.

To start off the project, the EHRE team did a detailed analysis of the client’s current excel based system and documented the gaps. The company then designed the future state system using InterSystems technologies and including standards and best practices required for the healthcare industry. Receiving the client's sign-off on the architecture, the solution was then developed and tested. Each component of the solution went through multiple iterations and thorough testing before it was finally released to the pilot group of users. The EHRE team then took the feedback from the pilot group and made the appropriate adjustments in time for the move to production. 50 sites were chosen to start using the CenteringCounts online solution. Centering Healthcare Institute continues to deploy the solution at their other sites and has since reached over 600 sites.

Centering is a patient-centered, evidence-based model of group care professionals that have been proven to have a profound positive impact on health outcomes and lowering the risk of preterm birth.
CenteringCounts® comprises a suite of practice management and quality assurance tools designed to help obstetric and pediatric practices:
· Manage scheduling of Centering groups
· Enroll patients into Centering groups
· Track patient attendance at group sessions
· Record patient demographics, birth and health outcomes
· Monitor and report on key model fidelity and sustainability performance
indicators
· Monitor and report on Centering patient outcomes by demographics
· Comply with CHI’s annual reporting requirement to maintain Site Approval
standing
· Compare practice performance relative to established goals, benchmarks and the larger Centering community of practices
· Maintain practice level data such as addresses, contacts, and site level statistics
While CHI hopes that practices will use CenteringCounts to its fullest capabilities, they are free to implement some or all of the functions of the CenteringCounts solution to best suit their needs. At a minimum level, practices will use CenteringCounts to maintain their practice contact data and file requisite annual performance reports with CHI. Ideally, CHI seeks to have practices provide patient outcomes data to support aggregated reporting of Centering patient outcomes against a variety of demographics. CenteringCounts is accessed through the CHI website and mobile applications. It has lessened the burden of data maintenance, increased the quality of data collected, improved reporting compliance, and provided sites, community partners, and policy makers with the evidence needed to support the wider adoption and scale of Centering. Increasing the number of Centering sites has expanded the availability of the model, ensuring that more women, families and communities benefit from the well-demonstrated outcomes of this
unique model of care