Rx for Medical Records
Charles Wang of the UCLA Health System isn’t a nurse or a physician, but he spends every day working to improve the care of patients.
As the organization’s director of architecture since 2002, Wang has integrated hundreds of medical applications and digitized millions of medical records to enable health care staffers to access patient information in one central place, a computerized health record. They can view the data from just about anywhere: their offices, health care clinics and even while making rounds at the system’s four Los Angeles area hospitals: Ronald Reagan UCLA Medical Center, Mattel Children’s Hospital UCLA, Santa Monica-UCLA Medical Center and Orthopaedic Hospital, and Resnick Neuropsychiatric Hospital at UCLA.
“The purpose is to provide clinicians with individual patient information at their fingertips,” Wang explains.
Like many health care providers nationwide, the UCLA Health System has raced to implement electronic medical records (EMRs) to improve patient care by providing doctors and nurses with timely access to patient information. The technology reduces medical errors and cuts costs by streamlining operations.
Wang deploys service-oriented architecture (SOA) to tie together the health system’s disparate applications and data. To accomplish this, the IT staff standardized on IBM software, including the DB2 9 database with pureXML capabilities, WebSphere Application Server and WebSphere MQ integration software. By using XML as the standard for medical data, UCLA can share data across its medical applications.
At the heart of UCLA’s EMR system is an electronic medical records repository, called Patient Oriented Document System (PODS). PODS holds more than 40 million patient documents, ranging from X-rays to doctors’ handwritten notes that have been scanned in. This repository stores 400 different file formats, including text, pictures, PDFs and binary files.
Wang and his staff have built a whole suite of Java APIs connecting the health system’s clinical applications with the data repository.
“We built around the database to capture all the data,” he says. “Through the APIs, we can do a download to extract the medical record out of PODS, and we can load new or amended medical records into PODS.”
For example, two years ago, Wang and his staff implemented Orion Health’s portal application to provide clinicians with a single computerized view of their patients’ medical records. Through integration work, the online portal application—which UCLA calls cView—pulls a patient’s medical history from PODS, along with more-recent data from other applications, such as lab results or radiology images, Wang explains.
The health care provider is taking a phased implementation approach. Currently, about one-quarter of its 10,000 clinicians are using the cView portal application.
Scanning Paper Documents
In addition, Wang’s team wrote its own document management and scanning application, called Image Capture Access and Management, which is used by every department to scan paper documents into the PODS repository. Despite attempts to go paperless, it’s impossible to completely eliminate paper, he says.
For example, a new patient getting checked into a hospital may have an advance directive or insurance information that needs to be scanned into the system. In addition, each hospital department is still digitizing old paper documents.
To improve the scanning process, Wang purchased high-speed Kodak i840 and i1860 scanners and is rewriting the scanning application so that it’s better optimized with the SOA architecture.
Wang continually fine-tunes and improves the system. Last fall, he installed another Orion Health application that allows physicians to write their patient notes directly onto the computer. The application, which UCLA calls “ClinDoc,” is integrated with the cView portal and replaces the organization’s homegrown note-taking application. Last year, Wang also replaced the health system’s aging 10-year-old Sun Solaris servers with new Intel Linux-based servers, resulting in a huge boost in performance.
The UCLA Health System has pieced together an EMR system through a variety of homegrown and third-party applications—and the system works. However, there could be improvements, Wang says. In fact, he will soon explore purchasing a full-fledged, commercial-grade EMR system that does even better data integration, improves access to real-time data and offers new services, such as computerized physician order entry.
“Right now, we have our homegrown EMR system and a good foundation for the future,” Wang says, “but it’s hard for the data to flow between all the systems. “It’s a natural transition for us to find one platform that simplifies the sharing of data and provides all the features we need.”