CHRISTUS Health, Biosense and NEDSS :

An Administrator’s Perspective

Hank FanbergCHRISTUS Health

May 28, 2008

AGENDA

•CHRISTUS Health background•CHRISTUS IT Infrastructure •The Experience

I wonder what they meant by that?

We just got word this morning that Downstream is having a problem with the format of one of our fields in the OBX4 segment of the Lab Results. We believe that what we are sending is correct (it is what CHRISTUS is sending us), but somebody is going to have to make a change in order for all Lab data to be stored and displayed correctly in the BioSense application.  

Our Healing Ministry

Our Vision What We Are Striving To do.

•Strengthen current ministries and expand into new locations and services

•Implement innovative approaches to caring for the whole person

•Increase access to health care for the poor and underserved through advocacy and other initiatives

•Make significant contributions to creating healthy communities

•Create a work environment filled with hope, dignity and mutual respect

In 1866, Texas was faced with illness, disease and poverty of staggering proportions.

Galveston Bishop Claude M. Dubuis turned to his native France and issued a plea to Religious Sisters for assistance

Three Sisters answered the Bishop’s call, Mother Blandine, Sister Ange, and Sister Joseph

Our Legacy

The Sisters arrived in Galveston in October 1866 and founded the Congregation of the Sisters of Charity of the Incarnate Word.

In 1887 the Sisters opened the state’s first Catholic hospital in Galveston, Charity Hospital.

Mother Madeline, Sister Agnes and Sister Pierre traveled from Galveston to San Antonio in 1869

Within months, the Sisters established Santa Rosa Infirmary in San Antonio.

On the Way to San Antonio 1869

40 hospitals and other health care ministries in more than 70 communities

Dozens of other health services in Texas, Louisiana, Arkansas, Utah, Oklahoma and Mexico

Approximately 27,000 employees

More than 8,000 staffed beds

Cont’d

Facts and Figures - Today

A Snapshot of our Demographics

Texas leads nation in uninsured; Louisiana is third (2005)

Majority are:

- Working families with low and moderate incomes

- Young adults age 19-34

- Disproportionately Hispanic and African-American

- Legal, US residents

Health care coverage is not available from employer or is unaffordable

Sources: Health Policy Institute; The Access Project

CHRISTUS Direction

Comprehensive strategiesto address the symptoms and underlying causes of

health problems.

From To

Community collaboratives that mobilize and build upon existing community assets.

Focus on high cost, ER-based charity care to treat illnesses that

Could have been prevented.

Proprietary approachesto planning andimplementation.

Admission

Prepare for treatment & discharge

Medical or surgical

treatment

Discharge to home and/or

aftercare

CommunityCollaboration

Enrollment

ReferralsSystem

DurableMedicalGoods

PharmaceuticalsAccess

Wellness &Prevention

Medical Home

DiagnosticService

DiseaseManagement

CareManagement

ExpandedInsuranceCoverage

Dental HealthMental Health

Comprehensive Integrated Care

Biosense: Two years in the Making

• Major upgrade of core clinical information system – Convert all facilities to MEDITECH – Three year project

•Had to wait for CHRISTUS human resources availability (team of about 12 people with a changing cast of characters)– Project Manager– Security SME– Architects– Interface engineer– Data manager– Network architect

BioSense: Using Health Data for Early Event Detection and Situational Awareness

Wayne Myers, Project DirectorConstella Group, LLC - Contractor to CDC

Emilie KralicekClinical Specialist

June 15, 2006

Why Participate?

• Two reasons:

– Texas and Louisiana

• Situational Awareness is a good thing

• We participated in a situational awareness project with the city of Houston following 9/11

• But it’s a lot of work

• Requires a lot of resources

• Concerns about privacy and confidentiality

Data Source  

BioSense Messaging Guide Version 1.05

Data Provisioning Database ADB200703.01.00

Introduction

Please answer all quesitons with as much detail as possible in the non-shaded areas.

Please answer the questions in the electronic spreadsheet.

Feel free to add rows as necessary. Please do not add columns.  

Please do not delete rows. Fill in N/A where applicable.  

If you have any questions, please contact your BioSense representative.

Fields Descriptions

Available? Is the item currently available for the BioSense project.

Tab Description

Facilities Information about the facilites, sites and/or clinics

Pre Questionnaire Preliminary questions about the data source

Applications Applications used by the data source

Messages of Interest BioSense messages of interest

Elements of Interest BioSense elements of interest

Elements of Interest - Questionnaire BioSense elements of interest questions.

Contacts Data Source and BioSense contacts

Transaction Volumes Data Source transaction volumes

Ports Data Source ports

Checklists Checklists for requested information from the Data Source

Health Care Landscape

The Healthcare Continuum or Landscape is comprised of various patient demographics, located in multiple settings and includes a population with different economic realties. Across this continuum, we have multiple care

channels that provide a comprehensive and robust inventory of services.

Patients

Age Group

FocusCare Channels

SettingsSocio-

economicStatus

Access Location Provider/Payer Service

Infants

Adolescent

Adult Men

Adult Women

Senior Men

Senior Women

Rural

Suburban

Urban

High

Medium

Low

In Person

Telephonic

Electronic

Home

Rehabilitative

Hospital

Emergency Department

Long Term Care

Clinical

Community

Alliances

Partnerships

Acute

Retail

Non-Acute

Home Health

Traditional Providers

Public/Private Insurers

Alternate Providers

Midlevel Provider

Health Infomediary

GeographicalArea

Local

Regional

National

International

Regional Poverty

Wellness

Laboratory

Municipal

Federal

Proxy

State

Some Key Technologies Needed by Health Systems in General (which we don’t have)

Service Oriented Architecture (SOA)• Allows for effective and affordable business-level interoperability • No application rip and Replace requirements • Enabler of business change (Plug and Play) • Leverage the Web

Enterprise Interface Engine• Exchanges data via HL7 messaging • Standardized communications • Lower long term costs• Enables cross coordination and interoperability

Enterprise Master Person Index (EMPI)• Accurately identify the patient • Deliver comprehensive view of patient• Streamline patient registration across facilities

Clinical Data Repository • Consolidates data from a variety of clinical sources to present a unified view of a single patient • Improve the quality of patient care• Reduces the cost of health care

HIE Infrastructure

CLINIC / HEALTH CENTER

Clinics / Health CentersCloverleaf® Secure Object Client

HOSPITAL

HospitalsCloverleaf® Secure Object Client

Leverage existing Quovadx Infrastructure

Patient Directory

Member DataLinkage Data

Audit Data

HIE Infrastructure

Cloverleaf® Integration Services Identity Services

SDKServices

Web ServicesJava APIC++ API

Initiate Engine

Identity RulesComparison

AlgorithmSecurity &

Access Control

I nitiate™ EnterpriseViewer

Initiate™ Auditor

Protocol Services

TCP/IP (S) SOAPSMTP POP3LU 3

LU6.2 APPC

FileFilesetFTP(S)

HTTP(S) MQ (MQSeries)

JMSMS MQUPoC

PDL Async (RS232)

Message Services

HL7 V2.xHL7 V3.

X12 HIPAANCPDPCeRxXML

UN/EDIFACT Fixed Length

Variable LengthHierarchical

Record Length

Monitoring Services

Network MonitorGlobal MonitorEngine Stats

AuditingEngine Logging

Messages LoggingSystem Alerts

Message Alerts

SecurityServices

Secure Messenger SSL

Basic SecuritySecurity Server

(Advanced)Audit Tracking /

ReportsUser Auth. (x509)Entity Auth. (x509) Access Control List

(ACL)

IHBServices

Web Services Security (WSS 1.0)

ESB Adaptor*ServiceMix Adaptor*Hydra SDO Adaptor*

DatabaseServices

Recovery DbaseError Dbase

Transformation Services

ParsingTranslation

Routing

Implementation Serivces

Patient LookupPatient Update

Patient Registration

IHEServices

PIX/PDQ v2 & v3ATNA

XDS DOC SRC/ CONSUMER

PWPBPPC

XDS-SD

Custom Patient Lookup / Update PortalEMPI Face Sheet

Patient Care Home AssignmentEMPI Patient Lookup

Patient Compliance Review

EMPI – Patient Lookup Portal

eRX Translation Services

EMR/eRx/CPOEHL7 - NCPDP SCRIPT

Health Interoperability Solutions

Medication History Services

Medication Safety Directive

RxHub MEDS

Financial Interoperability

Revenue ManagementDirect & Hub

transaction support

MD Office Connectivity

Secure object ClientCloverleaf® Gateway

Clinical Terminology Service

3M Data DictionaryStandardized terminology

* Current 2007 Development plan

Physicians

Standardization Integration

Business Alignment

IT Governance

The CHRISTUS Health Enterprise GoalS

trat

egic

Goa

ls

Integration

Governance

Standardization

Optimization

Ali

gnm

ent Customer-centric

innovative and integrated

approaches to care delivery

End State Goal: A complete picture of the patient across time and services

Governance Model

Central Leadership–SLT–IMOC

Regional Oversight–Regional CEO–Regional IM Executive

Trans Regional Requirements Planning–Long Term Care–Home Health–Community Health

Local Execution–Acute facility–Long Term Care–Home Health–Community Health–Retail–Non-CHRISTUS local entities

Implications

Differing IT Systems & Applications

Multiple views of the same patient

Fragmented Data

Higher IT Costs

Higher Acute care costs

Strained and reduced resources

Geographical disparity of care

Disparate, uncoordinated enterprise systems

Functional silos

Cross functional inefficiencies

Disconnected business decisions

Providers Providers

Insurers Insurers

Alliances Alliances

Partnerships Partnerships

Shared IT InfrastructureShared IT Infrastructure

Common IT Governance

Service DeskIncident

Management Problem

Management

Configuratio

n

ManagementChange

Management Release

Management

Capacity

Management

Availability

ManagementService

Continuity

Service Level

Acute Care Non-Acute Care

Home Care

International

HL7 ITS DSM EDITCP/IP HTML

Sta

nd

ard

s /

Inte

rfac

es

HD

W &

SF

TW

ITIL

Pro

cess

es

GLGeneral Ledger

MMMaterials

Mgmt

PPPayroll and Personnel

• Community health

• Physician Partnerships

• Geriatric Care

• Palliative Care

• Retail

• Wellness

• Hospice

• Behavioral Care

• Rehabilitative Care

QM / RMQuality / Risk Management

BARBilling / Accounts

Receivable

APAccounts PayableB

usi

nes

sF

un

ctio

ns

GL|AP|AR|PP|MM|BAR|MM|QM

Clin

ical

Ser

vice

s

• Intensive Care Unit• Cardiac life support • Trauma Life Support• Basic Life Support• Advanced Life Support• Emergency medical service• Child Birth• Radiology• General Surgical• Pediatrics• Trauma• Oncology

Cu

sto

mer

s an

dC

on

sum

ers

GL|AP|AR|PP|MM|BAR|MM|QM

• Extended Care• Geriatric Care

• Patient Administration• Intensive Care Unit• Cardiac life support • Trauma Life Support• Basic Life Support• Child Birth• Surgery• Pediatrics• Obstetrics• Radiology• Chronic Care• Extended Care

Patients Patients

X12DRGASTM XML

Santa Rosa Health Care

Spohn Health System Ark-La-Tex Gulf Coast

Central Louisiana

NorthernLouisiana

SouthwesternLouisiana

SoutheastTexas

Reg

ion

alE

xecu

tio

n

En

viro

nm

ents

CHRISTUS Health Model (Today)

Long Term Care

USFHP

Long Term Health Care

Managed Care

Physicians

Patient Care

BioSense Technical Approach

Data Source Systems

Applications

CDC BioSense

Interface

Engine

Or ToolsBioSense

Integrator Transport

Queue

PHINMS

Receiver

BioSense

Applications

Other

BioSense

Data Feeds

Vocab

Mapping

Linker

Database

Web

Viewer

Existing

New

PHINMS

Sender

LocalPublicHealth

Internet(SSL)

BioSenseData Warehouse

Difference

• CHRISTUS needs a unified view of the patient (a lot of information about one person)

• Biosense and NEDSS need a little bit of information about everyone

CHRISTUS Health Enterprise View – TomorrowIt’s not about me, It’s about us

Customer ChannelsCustomer Channels

Non-Acute CareNon-Acute Care

Acute CareAcute Care

Patient Portal Referral Kiosk

Patient Portal Referral KioskAmbulator

y

Ambulatory

Retail

Re

tail

Inte

rna

tio

na

l

ServicesServices

Serv

ice

sS

ervic

es

Serv

ice

sS

ervic

es

CHRISTUS Digital Nervous System

SOA ArchitectureVal

ue

Ad

ded

Ser

vice

sV

alu

e A

dd

ed S

ervi

ces

Val

ue

Ad

ded

Ser

vice

sV

alu

e A

dd

ed S

ervi

ces

Customer ChannelsCustomer Channels

Standardized Products across

Services and Regions

Standardized Products across

Services and Regions

Optimized Products,

Services and Processes

Optimized Products,

Services and Processes

Integrated Products and

Services

Integrated Products and

Services

Aligned Strategic Goals, Strategies and IT Services

Aligned Strategic Goals, Strategies and IT Services

Medical Travel

Personal Health Record

Clinical DataRepository

Enterprise Master Person

Index

Analytics• Clinical• Business

Patient• Single View• Quality Care

• Uniform face to the customer• Standardized language• Tools point of need, when, where needed

Good document is critical

BioSense Team meeting: Progress since our last meeting. Closed Items:MOU sent to CHRISTUS HealthHardware configuration approved by CHRISTUS Health Solution ArchitectsSNOMED Codes received. Requirements further refined. Met with Peter V to confirm a number of key technical assumptionsTechnical design featured by CDC in presentation at AMIAApproval given by CHRISTUS Health to collapse NEDSS-ELR project into the overall CHRISTUS Health BioSense project.

Key outstanding items on for the CHRISTUS Health Hardware installationValidating test scripts and working with CHRISTUS Health to verify that they are part of integration testingCoding in the BioSense IntegratorConfirmation of SNOMED codes required by the stateDelivery and confirmation of business requirements to TDSHSSOW in final stages of development/review/approval processRisk: Upgrade activation date set for CHRISTUS Health MediTech upgrade (BioSense dependency on this date) The upgrade is date driven, and is set for 2/14/08. 11/16: CHRISTUS Health project members confirm that the project is on schedule.

We had challenges

A lot had to do with our MEDITECH conversion

But we persevered

And just became certified

QUESTIONSQUESTIONS