Monday, January 4, 2010

Atrius Integration is Live

Today, BIDMC began its new collaboration with Atrius Health, linking clinical care and the IT systems of a major ambulatory multi-specialty practice with a tertiary hospital.

I outlined our plan in an earlier blog.

Here's how it looks in practice.

Emergency Department
The BIDMC Emergency Department Dashboard is filled with new Atrius features including automated flagging of Atrius patients and clinicians, so that we ensure each patient's clinical summary from Epic is retrieved via Citrix by our ED unit coordinators and attached to the ED chart. We defined a clinical summary as

Patient Demographics
Problem list
Recent labs/rads
Encounters for the last 30 days

We also ensure followup with the Atrius PCP by showing their office numbers/contact information on screen in the Dashboard and requiring ED clinicians to document their PCP discussions.

We went live with health information exchange via NEHEN for Atrius PCPs. Whenever an ED or Inpatient discharge occurs, a care summary is sent electronically using the standards required by HHS regulation (CCD, SOAP 1.2) to the Atrius HIM department for incorporation into Epic (this will happen automatically when the next version of Epic is implemented at Atrius this summer) or to a PCP's secure email box - it's Atrius' choice by PCP how to deliver these summaries. There are no workflow changes on our side - it's invisible to the user.

Ambulatory Care
Our self built EHR, called webOMR, now includes flags for Atrius patients and links to Epic via Citrix from within the Patient Summary screen (the screenshot above), so that clinicians do not have to leave our EHR to access Epic information.

Inpatient Care
When a patient is admitted (or has observation/ED observation status), the patient appears on a new Atrius Census report, which is updated every 15 minutes. BIDMC and Atrius clinicians, case managers, and others as needed to coordinate care have access to this report which we've integrated into our web-based Capacity Dashboard.

Our self-built Provider Order Entry system now includes flags for Atrius patients and links to Epic via Citrix within POE.

Atrius Viewing of BIDMC data
By working with Epic and Atrius, we enabled a "Magic Button" inside Epic that automatically matches the patient and logs into BIDMC web-based viewers, so that all Atrius clinicians have one click access to the BIDMC records of Atrius patients. From a security perspective, we record an audit trail of every access using the Epic username of the Atrius provider doing the lookup. Only Atrius patients can be viewed, so we have limited the possibility of privacy breaches. We've also made our ED Dashboard available to those at Atrius with a need to access this information.

We've linked our two Microsoft Exchange 2007 email systems via TLS to ensure all email sent between the organizations is secure.

One major project remains. The COO of Epic has agreed to work with Atrius and BIDMC to an enable a standard Epic option for a web-based viewer of Atrius data from Epic so that our POE, webOMR, and ED Dashboard users will no longer have to use Citrix. Epic and Atrius are working on the necessary implementation steps to make that happen.

With ED, Ambulatory, and Inpatient data sharing between the two organizations, we're ready for the arrival of Atrius patients. Thanks to everyone at Atrius and BIDMC for making this happen!


Frank Opelka, MD FACS said...

Hi John, Great work. I am curious if you have tried to develop a specific dashboard which looks at a given condition for quality performance measurements linked to per capita costs (payer expense) for a full cycle of care? For example, all patients with newly diagnosed breast cancer - for 18 months - have you looked at a dashboard which would note stage specific quality metrics and cost metrics?
Best wishes in 2010.

John Halamka said...

Per our data analysis folks:

Did something a little like this several years ago for breast cancer. We looked at a year of "downstream" financial data for newly diagnosed patients... per patient financial performance for different components of care, i.e. chemo, XRT, surgery etc.

76 Degrees in San Diego said...

As a primary care physician who also practices in the hospital, it is tiresome to have to write out discharge medications in the hospital, then have to go to the office EMR and have to reenter the same data. If the discharge medicine list/Rx could be written in the hospital, and then electronically transferred to the outpatient record, it would deserve applause...

76 Degrees in San Diego said...

There is another way around it. If the B-I hospitalists were given a security level for prescription writing in the outpatient EMR, Epic in this case, they could write the DC med list there....then have it transferred electronically to the hospital record. But this is more complicated because of the security issues/license issues involved...

hitgypsy said...

I hope you don't mind that I linked my blog to yours as an inspiring one for what is possible earlier this week. You are an inspiration to many...may 2010 continue to bring us all the new benefits that can be achieved with ARRA/HITECH!

Unknown said...


From your description, it appears that pre-defined Clinical Summaries are moved from EPIC to BICMC's system (now manual, later automated?); ED and Discharge Summaries will be sent to EPIC (again, manual now, automated later), and the "magic button" opens a Citix session for EPIC users to access BIDMC? I think this is a very creative solution, but there is still a lot of data movement back and forth. Curious to know if you explored any services solutions with EPIC that would have eliminated so much data movement?