Legacy Data Issues

Suzanne Spradley, MS, CLS (MT, ASCP) and Rita Barsoum, CLS (MT, ASCP)

Kaiser Permanente (KP) HealthConnect integrates a complete electronic medical record to deliver optimizations in care delivery and cost savings across the Kaiser Permanente organization. Kaiser Permanente provides healthcare to meet the needs of 8.5 million patient members employing 11,000 + physicians and 130,000 employees across 8 regions serving 9 states and D.C. Kaiser healthcare facilities include 29 hospitals and medical centers and 423+ medical office buildings. Kaiser Permanente HealthConnect Program is the program-wide strategic initiative to deploy an integrated set of clinical and administrative health care systems that will streamline internal processes and assist us in delivering healthcare. However, having access to clinical information alone is not sufficient. The foundation to these savings, efficiencies and positive clinical outcomes, lies in the standardization of this clinical data across all Kaiser Permanente regions. All data populates a single database, providing the source for sophisticated reporting, decision-support, best-practice and research tools.

Kaiser Permanente (KP) HealthConnect integrates a complete electronic medical record to deliver optimizations in care delivery and cost savings across the Kaiser Permanente organization. The 8 Kaiser regions across the U.S. translate regional Current Procedure Terminology (CPT) and result Logical Observation Identifier Names and Codes (LOINC) codes to a national codeset, maintained as the 'standard library' for use in KP HealthConnect (EHR). (See Figure 1) This project involves the standardization of this clinical data to national coding standards to allow the exchange and pooling of data elements, defining common data definitions, standardizing ancillary and EHR interface design and overcoming geographical and organizational cultural barriers. The objectives of CPT and LOINC are to create "universal, unambiguous (measurable entity) identifiers for use in data exchange standards, such as HL7, that send information as name-value pairs." (White & Hauan, 2002) SNOMED CT and laboratory LOINC are being used as the foundation for the standardization efforts, containing more than 357,000 unique meanings and formal logic-based definitions with comprehensive coverage of diseases, clinical findings, therapies, procedures and outcomes.

Kaiser Permanente comprises of 8 regions serving 9 states and D.C. Each of these regions has had autonomy when selecting information systems, continuing the use of legacy systems and interface development to these systems. When Kaiser selected a common EHR vendor, EPIC Systems®, an inventory of clinical ancillary systems was done to determine the scope of the data and interface standardization efforts. The challenge was to translate all clinical ancillary codes to a national standard codeset for statistical analysis and correlation and consistent Computerized Physician Order Entry (CPOE). The need for standardized data has long been recognized and the coordination and continuity of care typically necessitates that relevant information about a patient be integrated from several clinicians and settings.

References

White, Thomas M., and Michael J. Hauan. "Extending the LOINC Conceptual Schema to Support Standardized Assessment Instruments" J Am Med Inform Assoc. 2002 Nov–Dec; 9(6): 586–599.