UPMC

1
UPMC
University of Pittsburgh
Medical Center
Information Services Division
A Practical Guide to LIS Implementations The
LIS and the Hospital CIO Sean ORourke
Pittsburgh, September 9, 2007
2
Overview

• Background (Perspective)
• Operations
• Personnel
• Financial
• Wrap-up

3
Background

• UPMC Environment

4
Clinical Department Systems Supply most of The
Data In An EHR

• Each month at UPMC we perform
• 4,500,000 Clinical Lab Tests
• 86,000 Radiology Exams
• 400,000 Radiology Images
• 13,000 Surgical Pathology Cases
• 17,000 Cytology Exams

All Of That Data Is Available, Immediately Upon
Completion, To Clinicians For On-line Review
Through The EHR Or Other Integrated Enterprise
Systems
5
Clinical Department Systems Supply most of The
Data In An EHR
6
Clinical Department Systems Distribution of the
systems
We are working towards the consolidation of the
different clinical department systems across the
organization
7
Clinical Laboratory Overview Functions Supported

• Chemistry
• Hematology
• Urinalysis
• Special Chemistry
• Endocrinology
• Coagulation
• Specimen Processing
• Phlebotomy

• Microbiology
• Blood Bank
• Reference Testing
• Tissue Typing
• Cell Products Lab
• Tumor Markers
• Research Testing
• Inventory Mgmt

8
Clinical Laboratory Overview System Services

• Client Services Liaison for Laboratories
• Misys Information System Support and Maintenance
• Enhancements Specification, Testing and
  Implementation
• Instrument Interfaces
• Application Interfaces
• Specimen Processing And Tracking
• Automated Testing
• Calculations And Rules
• Quality Control
• Point Of Care Testing
• Charting And On-line Results Reporting

9
Clinical Laboratory Overview System Services

• Quest Diagnostics Venture, Inc.
• Support, maintenance of Misys interface
• UPMC IS liaison for labs/Quest
• Coordination of Quest lab projects at UPMC (ie.
  PCO)
• Department of Health Interface
• Reference Lab Interfaces
• - ARUP/FOCUS/Mayo/Pediatrics (in development)
• Deployment of real-time infection control system
  (TheraDoc)
• Tumor Marker System
• Development, Implementation and Support
• Microbiology/Epidemiology Data Supports Anthrax
  Testing And Other Bioterrorism Initiatives

10
Clinical Laboratory Overview Key considerations

• The Misys application is our Enterprise
  Laboratory Information system.
• Today
• More than 70 of the patient record is composed
  of clinical laboratory data
• Over 1.1 Million of lab orders are generated
  every month
• Over 4.5 Million test are completed every month
• Over 54 Million lab tests are completed per year
  and there is an incredible trend upward of lab
  test volume (20 volume increase during the last
  year)

Laboratory test volumes continue to grow and
services continue to expand
11
Clinical Laboratory Overview Growth in
Laboratory System Use
12
Clinical Laboratory Overview Key considerations

Today we have 4100 Misys users 134 Instrument
Interfaces 13 sites Step increase of service
requests during the last year (average increase
of 60) An average of 10 instrument or
application interfaces per year (new or
replacement)
Laboratory test volumes continue to grow and
services continue to expand
13
UPMC Information Services Division Management Team
Dan Drawbaugh
CIO
UPMC
Bill Hanna VP IT Infrastructure
Jim Bycura CIO, WPIC
John Houston Director Privacy Officer and
Assistant Counsel
Jody Cervenak CIO, Physician Division
Cliff Denholm Bio-Preparedness/PA National Guard
Nancy Landman VP Business Development and
Operations
Jacque Dailey CIO, Childrens Hospital
Sean ORourke CIO Service Lines and Products
Mark Hopkins CIO, Academic and Community
Hospitals
Paul Sikora VP IT Technology Transformation
Deb Salava/Scott Briercheck (interim) CTO,
International and Strategic Business Initiatives
Jay Srini VP Emerging Technologies
Ed McCallister CIO, UPMC Health Plan
Scott Gilstrap VP IMITs Center
Chuck Watson Director, Enterprise Business
Applications
Matrix reporting relationship to Business Unit
Leader
14
Clinical Department Systems The teams
15
Clinical Laboratory Overview On Site Support
16
Clinical Laboratory Overview Key Areas for
Development
Several Opportunities Exist for
Improvements Utilization of SOA/Other
approach(es) to improve implementation time,
reduce maintenance costs for Instrument
Interfaces Standards development and
improvement for interoperability and utilization
of Lab Results New application development to
support diagnostic testing (Molecular
Diagnostics, Flow Cytometry, Cellular
Products) UI/Visualization techniques to
support interpretation for new tests
Increased specificity (personalization) of tests
and results will continue as part of
genomics/proteomics expansion
17
Anatomic Pathology Overview Functions Supported

• Surgical Pathology
• Cytology
• Autopsy
• Histology
• Transcription
• Pathology Administration and Pathologists
• Molecular Diagnostics
• Bone Marrow and Flow Labs

• Cytogenetics
• Dermatopathology
• Dental Pathology
• Neuropathology
• Transplant Pathology
• Pathology Research and Consultations

Molecular Diagnostics And Cytogenetics Testing
Provide Leading Edge Technology For Diagnosis
18
Anatomic Pathology Overview System Services

• CoPath Plus Pathology Information System Support
  and Maintenance
• Interfaces
• Specimen Accessioning And Tracking
• Lab Automation
• Special Procedure Testing
• Pathology Imaging
• Synoptic Templates For Structured Data Entry
• Diagnostic Support For UPMC Transplant Facilities
  In Telepathology Allows Consultation On Remote
  Cases

Pathology Centers Of Excellence Optimize The Use
Of Technology And Resources Across The Enterprise
19
Anatomic Pathology Overview System Services

• Departmental Support
• PC/Device support coordination in PUH/SHY
• General IS Support for Pathologists
• Web site development and support
• Middleware app development and support

20
Anatomic Pathology Overview Growth in Copath Use
21
Anatomic Pathology Overview Key Areas for
Development
Similar Opportunites as with CP Lab
areas Integrated multi-media reporting in
collaboration with other (image intensive)
services (e.g., Radiology) Standards
development and improvement for interoperability
and utilization of Lab Results New application
development to support diagnostic testing
(Molecular Anatomic Pathology (MAP), Whole slide
Imaging) UI/Visualization techniques to
support interpretation for new tests
http//www.darkdaily.com/laboratory-pathology/inst
ruments-equipment/pathologist-Becich-informatics.h
tm
Increased specificity (personalization) of tests
and results will continue as part of
genomics/proteomics expansion
22
Specialty Laboratories Overview What is SLI
enabling?

• Growing testing volume in specialty laboratories,
  new laboratory information systems
  implementations, increase compliance with FDA
  regulations, need to support increasing
  workloads.
• Consistent testing volume growth in specialty
  laboratories (25 p/year MDx, 25 Tissue
  Typing, etc).
• Effort to consolidate services for laboratories
  not adequately supported by current systems.
• Support to all molecular testing across the UPMC
  laboratories (area with highest growth rates in
  labs)
• Support to key clinical services in the cancer
  center such as bone marrow transplant

Growing testing volume in specialty laboratories,
new laboratory information systems
implementations, increase compliance with FDA
regulations, need to support increasing
workloads.
23
Specialty Laboratories Overview Applications and
Services Supported

• Cerner lab applications in the PathNet platform
  PathNet-HLA, PathNet-GenLab, PathNet-Helix
• Specialized support for niche applications such
  as StemLab and SOPTrak
• Over 80 users supported in 4 different laboratory
  environments
• Expected addition of 1 laboratory per year to
  specialty labs group (at least 20 growth user
  base)

Molecular testing volumes continue to grow and
other specialized laboratories will need to be
serviced by the Specialty Labs Informatics group
24
Specialty Laboratories Overview Ongoing projects
Implementation of StemLab for Hematopoietic
Stem Cell and Cellular Therapies Laboratories
(UPCI) Implementation of SOPTrak for
Hematopoietic Stem Cell and Cellular Therapies
Laboratories (UPCI) Implementation of
PathNet-Helix for Molecular Diagnostics
Laboratory Optimization of PathNet-HLA in
Tissue Typing Laboratory Planning to support
Cytogenetics, Flow Cytometry and Molecular
Anatomic Pathology for FY08 implementations
Introducing significant efficiencies in the
workflow of the supported laboratories,
optimizing current systems and enabling cost
savings in new laboratory technologist hires
25
Specialty Laboratories Overview Volumes
26
The SLA Approach Commitment to our customer base

• Common base of understanding
• Problem categories
• Expected response times
• Expected follow up
• Problem escalation procedure
• Mission critical hours
• Disaster Recovery plans
• Identify processes
• Align resources
• Align Expectations
• Ensure Consistent Service

27
Laboratory Information Systems Which systems
and what is covered (scope)?

• Areas Covered
• Anatomic Pathology
• Clinical Laboratories
• Specialty Laboratories
• Areas to be considered
• Radiology
• Imaging
• Other Ologies
• Cardiology
• Oncology

Systems tailored to support clinical departments
and specialist groups that complement and support
the data, resources and functions available in
the EHR system
28
Operations

• Business Process, Technology

29
Operations Process Technology

• Partnership with operations
• Clinical
• Operations (admin)
• Clear leadership support and involvement
• Identification of specific scope
• Identification of business(es) in scope
• Scope of operations
• Champion(s), Leader(s), Staff engagement

30
Operations Process Technology

• Current State
• Requirements, Nice-to-have, Future
• Cost per volume driver(s)
• Test
• Procedure
• IT, SLA
• Future State
• Operational optimization
• Application (joint) development
• Imaging
• Integrated CP, AP, other ologies
• Cost per process projected, SLA costs

31
Operations Process Technology

• Clinical operations
• Projected requirements for existing business(es)
• New businesses and/or opportunities
• Reference lab
• Other revenue model(s)
• Analysis of personnel requirements
• Analysis of business model impact
• IT requirements
• Financial assessment

32
Personnel

• Human Resources

33
Personnel Human Resources

• Existing staff skills
• Current state implementation, support and service
  (SLA) model
• Translation to new environment
• Operations
• Technical
• Analytic
• Development requirements
• Operational optimization (internally or
  externally led)
• Application (joint) development
• New technologies and related skills
• Staffing requirements
• IT
• Operations
• Other(s)?

34
Personnel Human Resources

• Training requirements
• Project team
• Customer training
• Additional areas (bio-medical equipment,
  facilities)
• Release time for all affected areas (financial
  impact)
• Availability
• Internal retention, recruitment
• External
• Augmentation
• Consulting
• Market local, regional, national
• New skills
• Costs

35
Financial

• Business Model and Pro Forma

36
Financial Business Model and Pro Forma

• One-time costs
• Expense of outstanding capital
• Conversion (software, hardware)
• Implementation
• Optimization (pre, simultaneous, post)
• Additional feature, function, services
• Point of service
• Robotics

37
Financial Business Model and Pro Forma

• On-going costs
• Maintenance (application, hardware, other)
• Interface maintenance
• Other considerations
• Staffing
• Available
• Augmentation
• Consulting
• Out-sourcing

38
Financial Business Model and Pro Forma

• Innovation
• New instrumentation
• Development
• SOA
• Vocabulary servics/standardization
• Clinical decision suppport
• Imaging
• Specialty lab areas

39
Financial Business Model and Pro Forma

• Financial comparison may not be straight-forward
• Multiple year projections are necessary
• Many costs of innovation and general costs beyond
  one or two years are highly speculative
• Business relationship and alignment of incentives
  are critical
• Partnership (joint ownership)
• Joint investemnt for new development
• Other creativeapproaches

40
Wrap-up

• Questions and Answers