When it comes to exchanging patient data with other healthcare providers under the Stages 2 and 3 meaningful use criteria, the University of Pittsburgh Medical Center (UPMC) will be able to create a unified and connected patient record.

UPMC has been offering multiple ways for affiliated physicians - no matter their level of health IT capability - to connect to the integrated delivery network. An important next stage of its affiliated integration, as well as its own internal electronic medical record, is to enable a Continuity of Care Document (CCD) exchange with physicians who move their patients in and out of the system, according to Lisa Khorey, vice president of enterprise systems and data management.
 
As primary care physicians (PCPs) refer their patients to UPMC employed specialists, the CCD from the physicians' EMR should come with the patient or with the consult, she said. As patients move through UPMC's program - whether it be transplant, cancer care, pediatric emergency department visit, or other area - the CCD should accompany the patient directly to the next provider of care as part of the transition. "That's an important part of connecting the affiliate community for us," Khorey said.
 
When UPMC commissioned the Software Engineering Institute at Carnegie Mellon to conduct a study on EMRs to help it define its strategy, one of the themes the study delivered in 2005 was that information exchange is the real power of electronic records, she said.
 
The recommendations propelled UPMC to eschew a single-vendor solution and instead pursue a best-of-breed approach to EMRs to accommodate the different workflows and serve the different departments. With dbMotion providing the interoperability platform, UPMC has the flexibility to move hospitals in and out of its system. "The more electronic you become, the more flexible you have to become," she said.
 
One of the other recommendations out of Carnegie Mellon was the need to work through vocabulary issues in order to exchange information, which UPMC succeeded in doing. The evolution of national standards, however, came after UPMC implemented its various hospital information systems. While acknowledging the challenge of having to revisit standards, Khorey pointed out that the semantic mapping capability of UPMC's interoperability platform relieves the pressing need to have to transition to the new standards right away.
 
The interoperability platform currently connects UPMC to the Pennsylvania State Department of Immunization for its state immunization registry, allowing query and response integration and information distribution. The platform also positions UPMC to be able to connect with health information exchanges, the statewide HIE when it becomes operational and other collaborative efforts. "It's not a stretch to say dbMotion aligns us with federal, state, regional and local health IT initiatives," she said.
 
Clinician feedback of UPMC's EMR has been positive, with adoption and access trending upward, Khorey said. In November, 15,000 unique patient charts were opened and part of the patient care workflow, primarily at transition of care.
 
"That's where we see data exchange and unified patient record playing its most important role - when patients are moving from one provider to another, from one environment of care to another," Khorey said. "The whole record, or the aggregated patient record, becomes really important.