The Epic electronic medical records system holds information on about 5 million Johns Hopkins patients, making it an indispensable resource for all kinds of clinical research. But many researchers do not know all the ways Epic can be used to collect and then extract the data they need for their studies. The key, experts say, is to create an optimal data collection system at the start of the study, so that the information is easy to use later.
Many tools and resources are available to help Johns Hopkins researchers use Epic efficiently, while protecting patient information. The Research Home Dashboard contains research-specific information, such as training content, Epic upgrade news and links to research websites. Researchers can save any Epic report as a favorite for quick access from the dashboard. Research coordinators automatically see this dashboard as their default view when they log into Epic.
Research clinicians can add it to their Favorite Dashboards.
Additional information about the study, such as the principal investigator and study team members, is also available here. Participating patients must be registered with the Clinical Research Management System CRMSa web-based tool that holds information about Johns Hopkins studies and their participants.
To further communicate research information across Epic, clinical research orders and research-related visits should be linked to the research study. This creates a blue flask icon next to the order or encounter within Chart Review and serves as a visual guide to quickly locate the orders and visits.
Epic also provides a variety of notifications to the study team, showing, for example, when a study participant is seen in the ED or as an inpatient admission.
These alerts can be turned off if desired. There are multiple ways to get de-identified research data from Epic. Epic SlicerDicer lets physicians conduct self-service searches on large patient populations to get rough patient counts to investigate a hunch, and then adjust their searches quickly to better understand their patient populations.
However, it does not access all the information in Epic and is rarely appropriate as the sole source of data for a study, says Gumas. Among other things, it can help develop preliminary anonymous data, provide natural language processing to find relevant information in patient notes, and assist with de-identifying data. Precision Medicine Analytics Platform PMAP : A secure network of software and services that collects and interprets vast amounts of data about individual patients and diseases.
PMAP has been in a pilot phase for two years, used for projects in urology, multiple sclerosis and other research areas selected as Precision Medicine Centers of Excellence.
Reconciling Problems and Medications with Epic (Clinical Reconciliation)
It will be available to all researchers starting May The fee-for-service program begins with a consultation to determine the scope and likely cost of the project.
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Apply for Admission M. Getting Started The Research Home Dashboard contains research-specific information, such as training content, Epic upgrade news and links to research websites.Account administrators can also export all patient records simultaneously within the Reports section of the EHR using the Exported batch CCD files report.
Follow the steps below to learn how to create and export individual CCD clinical documents:. Click the Actions button in the top-right corner of the patient chart and select Create clinical document.
Review the sections of the patient chart that will be included in the clinical document, and if applicable, un-check the boxes next to sections you do not wish to include in the document. For more details on the data that will be included in the clinical document for each section, see FAQ 2 at the bottom of this article. Alternatively, click the Actions menu and select View exported patient records. Select Preview to review the exported record. What kind of clinical document can I create and export using Practice Fusion?
Practice Fusion currently offers the ability to create and export Continuity of Care documents that utilize the CCDA clinical document framework. The table below outlines the different sections contained in each exported CCD, including information on the data elements contained in each section. Providers who want to customize the type of data included in exported records can use the checkboxes available within the clinical document generator to include or remove certain sections of data.
CCD section name. Data elements included in section. Social history. Problem list. Medications with a start date assigned. Drug allergies food and environmental allergies not included. Administered and historical immunizations.
Results Labs. Signed lab tests that have been entered in the patient chart. Vital signs. Only vital signs from signed encounters will be included. All referrals sent using the Practice Fusion referral workflow, including recipient name, contact information and reason for referral.
Care team. Care team members as entered in the Profile section of the patient chart name only. List of all encounters for the patient, including date of service, facility location, and any diagnoses recorded and attached to the encounter note. Medical equipment. Functional status. Functional status as entered in the Observations section of any signed encounter. Mental Cognitive status.
Cognitive status as entered in the Observations section of any signed encounter. All active goals. Health concerns. Information Description. Follow the steps below to learn how to create and export individual CCD clinical documents: 1. FAQs 1. URL Name.Many electronic health record vendors claim their technologies are interoperable with other healthcare information systems. And these claims can be true — or true to a point.
The first basic type of interoperability is health system to health system, to coordinate care for a patient across organizations, said Dave Fuhrmann, vice president of interoperability at Epic Systems.
Tag - ccda
Epic also offers its Happy Together feature, which allows patients and providers to see data from multiple sources in a single, merged portal view, and Working Together, which allows health systems to take actions like duplicate lab order checking, retrieving reference-quality images, scheduling, messaging, and searching across health systems, working as one.
At Cerner, its EHR has built-in interoperability capabilities to access and exchange patient information across healthcare IT systems, said Kashif Rathore, the company's vice president of interoperability. Cerner, like other health IT vendors, has for years contributed to standards development organizations and initiatives that help drive adoption, so the industry can get to a common language that allows free and secure exchange of health data.
Our focus around interoperability is to place the person at the center so their information digitally follows them.
Regardless of where the person's health journey takes them, their information should be accessible, he added. Interoperability is a moving target, and its scope has expanded over the years as the technology, and appropriate data sets, have evolved, said Girish Navani, CEO and co-founder of eClinicalWorks.
Standards such as HL7, CDA or FHIR APIs are "enablers to meaningful information exchange between varied stakeholders like other care providers, payers, public health agencies and patients themselves, and we have real-world examples of data exchange with each of these stakeholders," he said.
DrChrono is committed to a culture of innovation; its mission is to enable an open platform where developers, customers, patients, educational institutions and researchers can get their data, plug an app into DrChrono or work with another vendor, said Daniel Kivatinos, co-founder and COO. We also have an App Directory where if a developer chooses to do so can be listed as an official partner. DrChrono empowers a developer to very quickly start to code on top of the EHR platform, he added.
When healthcare CIOs approach EHR vendors when considering a purchase, among the various topics they should be looking into is interoperability.
Navani of eClinicalWorks said one of the questions CIOs should ask is: Does the vendor have support for nationwide data sharing initiatives and trust frameworks depending on the purpose of use?
The CDA mechanism is far from perfect, but it is an iterative approach. Vendors yet to invest in interoperability are at a disadvantage in the creation of an overarching image of an individual's health record. The approach eases the implementation process, as opposed to a vendor-specific proprietary API approach, which is unscalable when dealing with multiple platforms.
And yet another question from Navani is: What does the vendor have to show for real-world data exchange capabilities and does it have integration with a Trusted Exchange Framework at no additional cost? CCDA is part of meaningful use and enables a quick export of a medical record in a standard format that is able to be taken in by another vendor from a patient or provider.
Always look for the latest certifications as well; it is a bad sign if a vendor isn't up to date on their certification. Outside data needs to interact with the native information to provide insights, such as clinical decision support. Another key question provider organizations should ask, said Rathore, is: "Does the EHR support innovation and integration?
We use standards-based APIs to drive meaningful interoperability and enable external applications to be embedded in EHR workflows.
Rathore added that healthcare CIOs also should ask, "What is my providers' ability to consume and meaningfully use patient health data?
Continuity of Care Document
Josh Green.I thought this an appropriate time to reflect on just how much your developers are going to need to learn to interoperate tomorrow.
I hope this post demonstrates the cognitive dissonance ONC has with their interoperability pledge. Epic is no harder to interoperate with any other vendor — they all use the same specs! Both of those networks point back to HealthIT. For example, your developers will revel in such classics as:. I put a question mark here because this may or may not be very challenging. Most of the specs you just read were published during the second Bush administration.
That means that Node. Part of our mission at Redox is to democratize this mess so you only need to worry about inputs and outputs, not the long ugly path in between. Assuming you have enough grasp of the documentation, you can start developing.Epic Lessons: Mayo Clinic Radio
Every good developer needs something to test with. Sadly, the options are lacking and not provided by vendors directly. Did you think that pile of specs was all you needed to read? Not even close — that just gets you an XML document that you need a whole other set of specs to deciper. Check out my Interoperability Primer to start making sense of that.
All of the work I outlined to interoperate really only has two inputs: a patient ID and some way of authenticating yourself. The output is an arcane XML document. The specs I outlined above suggest that the ONC has too many architects and not enough do-ers. Redox is all about doing — come talk to us to start getting data! Sure the big conference was canceled, but the show must go on, right? On Tuesday, March 10th we….
HL7 encompasses the complete life cycle of a standards specification including the development, adoption, market recognition, utilization, and adherence. Please refer to our IP Policy for more information about how members and non-members can use the standards.
Prior to this time the term "Draft Standards for Trial Use" was in effect. Aimed at facilitating the integration of applications at the point of use, CCOW Context Management Specification is a standard for both internal applications programming and runtime environment infrastructure that complements Health Level CCD fosters interoperability of clinical data by allowing physicians to send electronic medical information to other providers without loss of meani The Consult Note may contain both narrative and coded data.
For t It is intended to specify only A Decision Support Service facilitates the implementation of clinical decis A Diagnostic Imaging Repo At a minimum, this profile provi Through the creation of functional profiles, this model provides a standard descr The History and Physical Note may contain both narra These allow healthcare facilities and providers a standard way to communicate reports in an in This has become a widely adopted appro Data structure enables clinical decision suppo The RPS standard provides a common means of exchange of do It specifies functional electronic prescribing commu The primary use case around which the PHMR This imple The purp The message provides the ability to desc The DAM is balloted as an informative document and used as a reference in subs Clinical Statement is intended to facilitate the consistent design of communications that convey clinical information to meet specific use c This product provides a set of global representations for data used in the presentation and communication of healthcare information.
The ICSR messa The purpose of the ebXML message wrapper is to provide a secure, flexible transport for exchanging HL7 messages and other content, and potentially other message formats, between message handling interfaces or ebXML Message Service Handl If secur They are generally "consumed", or used by both the producing and other work groupExpand the access to health data to create a more comprehensive health record and improve the speed of care.
Care Everywhere is an HIE platform that is primarily a federated model that is controlled by the patient and can be used widely without the need for an intermediary. Push and pull exchanges are embedded within Epic applications used by providers and consumers:. As of October Care Everywhere is free to use for treatment and care coordination, regardless of the exchange partners technology platform. Care Everywhere facilitates automatic distribution of exchange-ready providers and healthcare organizations regardlesss of EHR system or network that user belongs to.
Care Everywhere uses a sophisticated probabilistic patient matching algorithm and there is no centralized MPI necessary. Care Everywhere exchanges information using industry standard transport protocols. Care Everywhere is natively integrated into the Epic EHR and does not require a separate implementation process.
Care Everywhere is also a Qualified Technology Solution with the Sequoia Project so groups can instantly go-live on Carequality or the eHealth Exchange to expand national connections to include the Veteran's Health Administration, the Social Security Administration and thousand of additional providers.
Federated Model: There is no centralized hub or data storage. No data flows through Epic servers involved in the exchange and Epic does not store any protected health information PHI or personally identifiable information PII.
Standard connectivity testing is conducted during the initial implementation. New sites are connected with no additional testing. Extend the content of documents exchanged to match the needs of specialists.
Each provider should find information relevant to their discipline and the patient's care being delivered.
In these scenarios, Epic is focusing not just on the information exchanged but also how it dovetails into a seamless workflow for staff who are providing care for the patient spanning across organizational boundaries.
Expand the network to support image exchange between organizations. The long-term vision is to support full DICOM exchange and integrate it natively into the provider's workflow. Care Everywhere is an implementer of the Carequality Framework.Sometime when transitioning to drchrono from another vendor you will need to export your data. There are a few ways that you can do this. One of the newer ways you can do this is by asking your other vendor to export the patients medical records via CCDA, you might even be able to do this on your own if it is an option in the EHR.
Once you get this data, let your implementation specialist know on the drchrono team and we would be happy to import this into drchrono. With CCDA, we can do point-to-point import of your patients data, sending critical and real-time patient data into drchrono.
You might be asking yourself what is CCDA? Let me define this for you. Primary function of the CCDA is to standardize the content and structure for clinical care summaries. It is being adopted by the United States through Meaningful Use efforts, and will make it incrementally easier to achieve international interoperability, and deliver on the promise of persistence, stewardship, potential authentication, context, wholeness and human readability, as originally promised by CDA in It is a single standard for communicating summary of care records, enabling the sharing of clinical care information in the most common care scenarios: inpatient-to-outpatient, primary care physician PCP -to-specialist, provider-to-patient and provider-to-ACO.
The idea of templates, which aides in human consumption, allows caregivers to know where to go for the information they are specifically looking for. The Clinical Document Architecture gives context by providing a clinical document that tells a specific story about the care provided to the patient for diagnosis and treatment of their problem.
The CDA supports human readability, for both patient and provider, and it supports video and audio interoperability between systems. CCDA accommodates more than just summaries and snapshot stories for patients. It provides a methodology for all types of medical documents. It is based on the HL7 Reference Information Model RIMbut is flexible enough to accommodate user-defined fields typical HL7and can store complete documents, binary data, and multimedia as well in its body.
CDA introduces the concept of incremental semantic interoperability, which allows tracking of relationships between elements of care. The minimal CDA is a small number of XML-encoded metadata fields such as provider name, document type, document identifier, and so on and a body which can be any commonly-used MIME type such as pdf or.
CCDA has two separate components:. CDA is in use world-wide. The most popular use is for inter-enterprise information exchange aka XDS. Mayo sees CDA as a strategic investment in information that will increase in value over time and which can be reused in multiple applications. It has all sorts of health data in it. CDA, which was until recently known as the Patient Record Architecture PRAprovides an exchange model for clinical documents such as discharge summaries and progress notes — and brings the healthcare industry closer to the realization of an electronic medical record.
Is this an answer to importing everything into drchrono? It is a great starting point since we support importing CCDA!
First time hearing about CCDA. With different formats, a universal sharable health format is the right way to go. Nice article Daniel.
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