Innovation and Technology

UC San Diego Health System is nationally recognized for its information technology (IT) initiatives, as well as its advanced infrastructure that seamlessly integrates clinical systems — both have improved the quality and efficiency of health care delivery and positively impacted patient safety and outcomes.

Awards and Achievements

  • In 2011, UC San Diego Health System achieved Stage 7 of electronic medical record (EMR) adoption — a ranking devised by the Healthcare Information and Management Systems Society (HIMSS) Analytics group; achieved by only 1.1 percent of hospitals in the United States (see definition below)
  • Named one of the nation’s “Most Wired” hospitals for the seventh consecutive year in 2012 by Hospitals and Health Networks, a publication of the American Hospital Association
  • Named one of the top 25 “Most Wireless” hospitals four times by Hospitals and Health Networks

Initiatives

  • Received a $15.3 million Beacon Community Collaborative award in 2010 on behalf of a broad collaboration of San Diego health care partners — one of only 17 communities across the country selected for this award, designed to pilot the wide-scale use of health information technology and health information exchanges (HIE) to improve quality of care and efficiency throughout the San Diego area
  • Implemented Stroke Doc, which allows for an Internet consultation for stroke victims between UC San Diego Health System physicians and remote hospital emergency departments (ED)
  • Implemented ImpactED to connect UC San Diego Health System’s EDs to several local community clinics to allow real-time scheduling of patients and sharing of patient data
  • Implemented San Diego Safety Net HIE, a real-time scheduling and medical information exchange system linking UC San Diego Health System’s EDs and hospitals to the San Diego Family Care and Family Health Centers of San Diego community clinics

Infrastructure - Patient Care

  • Fiber-optic network systemwide; 10-gigabit ethernet
  • Ambulatory and inpatient EMR system (vendor: EPIC)
    • MyUCSDChart – a consumer-oriented patient portal linked to the EMR system that uses SSL encryption technology with no caching to allow secure Internet communication between patients and their physicians
    • CareEverywhere – provides a framework for interoperability so that wherever the patient goes in the U.S., a health care provider can access the information they need, regardless if that information resides in another EPIC system or a non-EPIC EMR that complies with industry standards
    • Meets all core and optional measures of “meaningful use” as set forth in the Health Information Technology for Economic and Clinical Health (HITECH) Act
  • Bi-directional computerized physician order entry (CPOE)
  • Beacon Oncology Module – an electronic CPOE for high-risk chemotherapy drugs and infusion services, within the infusion centers at UC San Diego Moores Cancer Center and UC San Diego Medical Center (vendor: EPIC)
  • e-Prescribing (vendor: Surescripts)
  • Laboratory information system (LIS)
  • Clinical data repository (CDR) (vendor: Claro Group)
  • Picture archiving and communications system (PACS) – more than 50 terabytes of storage capacity (vendor: AGFA)
  • Electronic Medical Information Exchange (eMIX) – electronic, cloud-based technology used to share radiology files between UC San Diego Health System and other, remote medical facilities; replaces images burned to a CD and sent via courier or a virtual private network (VPN)
  • Closed-loop electronic medication administration system (Willow Inpatient Pharmacy System) (vendor: EPIC) – reduces the potential for medication errors; all elements are linked electronically throughout the medication administration process to ensure accurate and safe dosing:
    • Automated dispensing system (PYXIS MedStation) (vendor: PYXIS) – medications are bar-coded so they can be tracked from the physician’s order, the pharmacy and the floor’s automated dispensing system, to the patient
    • Electronic medication administration record (eMAR) (vendor: EPIC) – bedside scanning and entry of medications; keeps track of patients’ medications
    • Radio frequency identification band (RFID) (vendor: Awarepoint) – patients are given bar-coded ID wristbands upon admission; staff IDs are also bar-coded
    • Smart infusion pumps (vendor: CareFusion) – an IV medication safety system that protects all types of infusions and all infusion modalities, including large volume, patient-controlled analgesia and syringe; includes a bar-coding module and integrated respiratory monitoring
  • Server-based voice recognition software (DRAGON) (vendor: Nuance) – allows physicians to use voice recognition at any computer, including laptops; will ultimately eliminate the need for transcription services

Infrastructure - Clinical Trials and Research

  • Clinical Data Warehouse for Research (CDWR) – a repository for clinical data that enables faculty investigators and physician-scientists to access de-identified Institutional Review Board (IRB) approved clinical data for research purposes
  • Velos – a robust clinical trials management and research system that is able to receive relevant information from our Clinical Data Warehouse, eliminating the need for redundant data entry
  • REDCap – a web-based data capture system for use in research studies; provides an alternative for investigators who use desktop databases, such as Excel and Access and facilitates secure data storage, transfer and analysis

U.S. EMR Adoption ModelSM Trends

Understanding the level of electronic medical record (EMR) capabilities in hospitals is a challenge in the US healthcare IT market today. HIMSS AnalyticsTM has created an EMR Adoption Model that identifies the levels of EMR capabilities ranging from limited ancillary department systems through a paperless EMR environment. HIMSS Analytics has developed a methodology and algorithms to automatically score more than 4,000 hospitals in our database relative to their IT enabled clinical transformation status, to provide peer comparisons for hospital organizations as they strategize their path to a complete EMR and participation in an electronic health record (EHR). The stages of the model are as follows:

Stage 0: The organization has not installed all of the key ancillary department systems (e.g., laboratory, pharmacy, radiology).

Stage 1: Major ancillary clinical systems are installed (i.e., pharmacy, laboratory, radiology).

Stage 2: Major ancillary clinical systems feed data to a clinical data repository (CDR) that provides physician access for retrieving and reviewing results. The CDR contains a controlled medical vocabulary, and the clinical decision support/rules engine (CDS) for rudimentary conflict checking. Information from document imaging systems may be linked to the CDR at this stage. The hospital is health information exchange (HIE) capable at this stage and can share whatever information it has in the CDR with other patient care stakeholders.

Stage 3: Nursing/clinical documentation (e.g., vital signs, flow sheets) is required; nursing notes, care plan charting, and/or the electronic medication administration record (eMAR) system are scored with extra points, and are implemented and integrated with the CDR for at least one service in the hospital. The first level of clinical decision support is implemented to conduct error checking with order entry (i.e., drug/drug, drug/food, drug/lab conflict checking normally found in the pharmacy). Some level of medical image access from picture archive and communication systems (PACS) is available for access by physicians outside the Radiology department via the organization’s intranet.

Stage 4: Computerized Practitioner Order Entry (CPOE) for use by any clinician is added to the nursing and CDR environment along with the second level of clinical decision support capabilities related to evidence based medicine protocols. If one patient service area has implemented CPOE with physicians entering orders and completed the previous stages, then this stage has been achieved.

Stage 5: The closed loop medication administration environment is fully implemented. The eMAR and bar coding or other auto identification technology, such as radio frequency identification (RFID), are implemented and integrated with CPOE and pharmacy to maximize point of care patient safety processes for medication administration.

Stage 6: Full physician documentation/charting (structured templates) is implemented for at least one patient care service area. Level three of clinical decision support provides guidance for all clinician activities related to protocols and outcomes in the form of variance and compliance alerts. A full complement of PACS systems provides medical images to physicians via an intranet and displaces all film-based images.

Stage 7: The hospital no longer uses paper charts to deliver and manage patient care and has a mixture of discrete data, document images, and medical images within its EMR environment. Clinical data warehouses are being used to analyze patterns of clinical data to improve quality of care and patient safety. Clinical information can be readily shared via standardized electronic transactions (i.e., CCD) with all entities who are authorized to treat the patient, or a health information exchange (i.e., other nonassociated hospitals, ambulatory clinics, sub-acute environments, employers, payers and patients in a data sharing environment). The hospital demonstrates summary data continuity for all hospital services (e.g., inpatient, outpatient, ED, and with any owned or managed ambulatory clinics).

Stage

Cumulative Capabilities

2011 Q1

2011 Q2

7

Complete EMR; CCD transactions to share data; Data Warehousing; Data continuity with ED, ambulatory, OP

1.0%

1.1%

6

Physician documentation (structured templates), full CDSS (variance & compliance), full R-PACS

3.5%

4.0%

5

Closed loop medication administration

5.9%

6.1%

4

CPOE, Clinical Decision Support (clinical protocols)

10.7%

12.3%

3

Nursing/clinical documentation (flow sheets), CDSS (error checking), PACS available outside Radiology

48.4%

46.3%

2

CDR, Controlled Medical Vocabulary, CDS, may have Document Imaging, HIE capable

14.1%

13.7%

1

Ancillaries - Lab, Rad, Pharmacy - All installed

6.7%

6.6%

0

All Three Ancillaries Not Installed

9.6%

10.0%

Data from HIMSS AnalyticsTM Database© 2011
N = 5,275 N = 5,310

Source: himssanalytics.org/hc_providers/emr_adoption.asp