Speaker Background Ken Bobis, PhD

Transcription

1 Kaleidoscope: The Use of Wraparound Technology to Form the EMR ( Ken Bobis, PhD John Camoriano, MD Mayo Clinic Scottsdale HIMSS-2002 January 29, 2002 Atlanta, GA #7313: Kaleidoscope 10/14/01 1 Speaker Background Ken Bobis, PhD Chief Technology Officer / Director Advanced Technologies, Mayo Clinic Scottsdale 28 years in information Systems; 18 years in Healthcare Founded HIMSS-AZ, 1993 Ph.D. in Computer Science University of Phoenix faculty since 1995 BSIS, BSIT, MS Nursing, Nursing Informatics, & Online Campus WIU faculty member since 1993 Past-Chair, Health Care Management, Information System Professor, Information Systems, Health Care MBA Keller Graduate School of Management Estrella Mountain Community College 6 other colleges & universities 10/14/01 2 #7313: Kaleidoscope Speaker Background John Camoriano, MD Staff Physician and Assistant Professor of Medicine at Mayo Clinic Scottsdale (MCS) 12 years Chair of MCS Information Systems Steering Committee for 8 years Mayo Graduate School of Medicine with Board Certification in Internal Medicine Hematology Medical Oncology Oversight of Installation of over 37 new systems in 1998 in support of Mayo Clinic Hospital including; PACS EMR ICU EMR Member of Several Mayo Foundation Information Technology Committees and Task Forces for Internet, Security and HIPAA 10/14/01 3 #7313: Kaleidoscope 1

2 Additional Authors Jack Cranmer CIO, Mayo Clinic Scottsdale 31 years experience in Information Systems 15 years serving the healthcare industry. Troy Proudfoot Technical Analyst, Mayo Clinic Scottsdale 13 years experience in Information Systems Five years serving the healthcare industry Major developer of both Kaleidoscope & Apollo. 10/14/01 4 #7313: Kaleidoscope Topics Background Initial Goals & Objectives Implementation Strategy Challenges Faced Problems / Issues Current Status of the Project Lessons Learned Questions 10/14/01 5 #7313: Kaleidoscope The Mayo Foundation Largest private health care organization in the US 2,000 physicians & 35,000 allied health staff 500,000 patients annually Locations Rochester, MN; Jacksonville, FL; Scottsdale, AZ; All organizations are physician-led Mayo Health System Serving more than 60 communities in Iowa, Minnesota, & Wisconsin The Three Shields Patient Care, Research & Education 30 individual organizations carry out the mission 10/14/01 6 #7313: Kaleidoscope 2

3 Expansion Background Mid-1980s: Mayo Foundation expanded to a more national scope 1985: Mayo Clinic Jacksonville (MCJ) opens in Jacksonville, FL 1987: MCJ purchased St. Luke s Hospital 1987: Mayo Clinic Scottsdale (MCS) opens in Scottsdale, AZ 1998: Mayo Clinic Scottsdale Hospital (MCH) opens in Scottsdale, AZ 10/14/01 7 #7313: Kaleidoscope The Mayo Clinic Scottsdale Mayo Clinic Hospital Mayo Clinic Scottsdale 10/14/01 8 #7313: Kaleidoscope The Mayo Clinic Scottsdale Opened in 1987 by Mayo Foundation 250 Staff Physicians in 28 Specialties 8 Outpatient Practice Sites Including the Largest Multispecialty Clinic in Arizona New 178 Bed Acute Care Hospital 10/98 Basic Science Research Building w/ 6 Full-time Scientists Full Residency Programs in Medicine, Surgery & Family Practice Started a Managed Care Product 1/98 Annual Patient Visits to MCS 220,000 Total Personnel ~3,000 FTEs Annual Admissions 4,000 10/14/01 9 #7313: Kaleidoscope 3

4 Mayo Clinic Scottsdale Hospital (MCH) High Tech. High touch hospital in Phoenix One of the Nation s first paperless hospitals Designed to include an entirely electronic medical record (EMR) 15 miles from the Mayo Clinic Scottsdale 10/14/01 10 #7313: Kaleidoscope IS Background Staff expanded from 30 to 100 to handle increased hospital operations Selection of a Hospital Information System (HIS) & all the departmental systems 10/14/01 11 #7313: Kaleidoscope HIS Selection Cycare system had to be replaced not Y2K compliant New functionality common registration system, electronic medical record & filmless radiology Legacy functionality (Mayo Clinic Rochester) Lab, radiology reports, surgical reports, clinical notes & pathology reports An HIS by Phamis, Inc. was selected Phamis purchased by IDX, Inc. 10/14/01 12 #7313: Kaleidoscope 4

5 Effects of the Vendor Buyout Opening of MCH set for October, 1998 Would lose $1M for each day delayed IDX could not satisfy the requirements for clinical results reporting Radiology reports, surgical dictation reports, pathology reports, dictated clinical notes, handwritten physician orders and notes, miscellaneous reports (ECHO, EMG, ECG, PFTs, etc) & outside records All of this data was available in various systems in MCS & MCR 10/14/01 13 #7313: Kaleidoscope Initial Goals & Objectives Medical Objectives Establishment of an EMR for both MCS and MCH Provide a single view into the EMR Must be conducive to the Practice Users would include doctors, nurses, physician extenders, secretaries & desk personnel Must be able to view and print from the same application To be the primary source for printing the medical record as used in correspondence with patients, third parties & referring physicians MCH to be an entirely paperless hospital Physical plant did not allow for paper record storage 10/14/01 14 #7313: Kaleidoscope Initial Goals & Objectives Technical Objectives Three-tiered client-server design Constructed with off-the-shelf Microsoft technology Utilize inexpensive personal computer hardware Provide a EMR viewer application All patient data would remain in its respective source system The viewer will wraparound the disparate source systems Redundancy between MCS and MCH Named Kaleidoscope or KScope 10/14/01 15 #7313: Kaleidoscope 5

6 Kaleidoscope Architecture 10/14/01 16 #7313: Kaleidoscope Implementation Strategy 12 month project timeline $200,000 budget Iterative, prototyping methodology Small development team (3 members) Internal Staff Project Management Requirements Design Programming Contract Staff Programming 10/14/01 17 #7313: Kaleidoscope KScope - Phase 1 KScope - October, 1998 Technologies Microsoft SQL Server v7.0 Microsoft DCOM Microsoft MTS ODBC Windows NT Server 4.0 Data Sources Patient Demographics Clinical Notes Radiology Reports Surgical Notes Pathology Reports 10/14/01 18 #7313: Kaleidoscope 6

7 Initial Kaleidoscope Budget Hardware (ten 300 MHz Personal Computers $40,000 Testing Lab (Five 300 MHz Personal Computers) 20,000 Software 10,000 Programming 130,000 Total $200,000 10/14/01 19 #7313: Kaleidoscope KScope - Phase 2 KScope - June 1999 Technologies DCOM replaced by Microsoft MSMQ Microsoft SQL Server v7.0 Data Sources ECHO 10/14/01 20 #7313: Kaleidoscope KScope - Phase 3 KScope - November 2000 Technologies Microsoft s Dynamic Data Exchange (DDE) IMNET s Object Broker application Data Sources Scanned documents from IMNET / HBOC document-imaging system Other A hardware upgrade was required Amount of active storage increased from 45 days to 3 years of images Clients increased from 115 to /14/01 21 #7313: Kaleidoscope 7

8 KScope - Phase 4 KScope - December 2001 Technologies Upgrade all hardware to Server Class Machines Pool database connections between users Limit the amount of data retrieved, but allow up to 5 years of data Cause run-a-way clients to time-out & cancel outstanding Reduce the network traffic by making all public message queue into private ones Pusher load balancing. This is the server that allocates work to the database agents Faster client-side COM component for Lab & Clinical Notes Data Sources Lab Results 10/14/01 22 #7313: Kaleidoscope Problems Issues Instability of the application Local crashes when the local client workstation would crash and have to be rebooted Global crashes when one of the servers (pushers or other servers) would crash and have to be rebooted One episode of Kaleidoscope downtime every two months with the average duration lasting three hours Often related to the unavailability of the source systems Resolution: Weekly reboots of the Microsoft NT servers 10/14/01 23 #7313: Kaleidoscope Problems Issues Deployment problems Client-server architecture required direct access to every workstation for each fix or software upgrade Resolution: Design modified to be web-based This effort took about 8 months to design, test and implement, and was activated in fall 1999 Time waiting for data Some queries took seconds to complete Resolution: Time period parameter added to search 10/14/01 24 #7313: Kaleidoscope 8

9 Problems Issues No Remote Access High network traffic caused by the application design causes application time-outs Resolution: Design modified to be web-based 10/14/01 25 #7313: Kaleidoscope KScope Review Application reviewed by a major consulting firm Findings KScope could not be scaled to meet the ongoing needs of the organization Recommended to redesign Kaleidoscope as a purely web-enabled application based on Microsoft s Distributed InterNet Application Architecture (DNA) Code named Apollo 10/14/01 26 #7313: Kaleidoscope Apollo Architecture 10/14/01 27 #7313: Kaleidoscope 9

10 Apollo Web-enabled Federated Database is the primary system data store Isolates MCS from two common problems The unavailability of the MCR systems due to an unplanned outage Poor response time when a large amount of data is requested 10/14/01 28 #7313: Kaleidoscope Apollo Federated Database 10/14/01 29 #7313: Kaleidoscope Apollo One-time load Data Transformation Services (DTS) capabilities of Microsoft SQLServer 2000 will be used to keep the data base updated in a timely manner Architecture Microsoft s Distributed InterNet Application Architecture Windows 2000 Clustering and Load Balancing 10/14/01 30 #7313: Kaleidoscope 10

11 Apollo Storage needs Initial data storage requirements were 27 GB 30% annual growth rate Storage Projections 2002 (35GB); 2003 (46GB); 2004 (60 GB); 2005 (77GB); 2006 (100 GB) 10/14/01 31 #7313: Kaleidoscope Initial Apollo Budget Hardware (Production & Quality Assurance Environments) $120,000 Testing Lab 40,000 Software 20,000 Programming 330,000 Total $510,000 10/14/01 32 #7313: Kaleidoscope Current Status of the Project KScope is the de facto EMR for MCS & MCH In daily use by 1,700 users with excellence acceptance From a temporary solution to a major production system Accesses all Clinical data except patient demographics & scheduling information 10/14/01 33 #7313: Kaleidoscope 11

12 Kaleidoscope Usage Statistics Kaleidoscope Usage Statistics January through September, 2001 Document Type Weekdays (including Holidays) Weekends (including Holidays ) Total Requests Clinical Notes 659,374 25, ,771 Radiology 619,947 24, ,407 ECG 327,717 13, ,196 ECHO 108,824 5, ,134 Op Notes 345,196 14, ,512 Pathology 405,930 15, ,933 Total Requests 2,466,988 97,965 2,564,953 Average (per day) 2, ,627 High 5, ,417 Low Note: a request is equivalent to a single inquiry for one or more documents. 10/14/01 34 #7313: Kaleidoscope Application Strategy KScope to be a backup to Apollo IDX scheduled to release Document Manager in 2003 IDX will be the primary EMR Viewer, with Apollo as a backup Users will favor one over another Inherent synchronization issue in the maintenance of these dual environments 10/14/01 35 #7313: Kaleidoscope Lessons Learned Explore the Vendor Product Life-Cycle Move Sooner to a Browser-Based User Interface Reduce the complexity Fast Track Development Can Work 10/14/01 36 #7313: Kaleidoscope 12

13 Questions? 10/14/01 37 #7313: Kaleidoscope Kaleidoscope: The Use of Wraparound Technology to Form the EMR ( Ken Bobis, PhD John Camoriano, MD Mayo Clinic Scottsdale HIMSS-2002 January 29, 2002 Atlanta, GA #7313: Kaleidoscope 10/14/