Mount Sinai Data Warehouse Data Sources Data Sources

Mount Sinai Data Warehouse Data Sources

Data Sources Cerner SCC Care. Fusion Eagle IDX Flowcast Blood Bank HSM TSI Epic IDXrad Soft. Med MAR Weblog TDS Tamtron Power. Path Compu. Record SIGNOUT EDR EKG MUSE QS BISLR Prism Ibex Cardiac Cath Canopy SSDI Mount Sinai / Presentation Name / Date 2

Cerner General Purpose: Patient Registration MSDW Data - Start / End Dates: January 1 st, 2003 – Present Description: Cerner Access Management System (CAMS) is Mount Sinai Health System's patient registration system. (But note that Mount Sinai Doctors Faculty Practice uses IDX Flowcast as their outpatient registration system. ) Cerner went live on July 1, 2002. The MSDW contains its data back to January 1, 2003. Cerner is the "source of truth" for generating medical record numbers (MRNs). As part of a Master Patient Index (MPI) project, Mount Sinai built an interface between Cerner and IDX Flowcast to ensure Cerner controls the generation of new MRNs. Mount Sinai / Presentation Name / Date Cerner Data Home 3

Cerner contents loaded to MSDW Patient registration information: • Patient demographics • Insurance coverage • Registration for inpatient hospitalizations, ED visits, ambulatory surgeries Patient unit, room, and bed locations throughout each inpatient hospitalization. Admission, Discharge, and Transfer (ADT) notifications via HL 7 message to other systems: • Admit messages (A 01, A 04) • Discharge messages (A 03) • Transfer message (A 02, A 06, A 07) • Other visit-related messages Mount Sinai / Presentation Name / Date Home 4

IDX Flowcast General Purpose: Physician Practice Management MSDW Data - Start / End Dates: xx - Present Description: IDX Flowcast is a patient scheduling, registration, and billing system for Mount Sinai Doctors Faculty Practice (formerly called Faculty Practice Associates). Its underlying database is Inter. Systems Cache, just like Epic. GE Healthcare acquired IDX in 2006 and renamed Flowcast to Centricity Business. GE later sold many IDX applications to private equity firm Veritas Capital in 2018, which combined them with Athenahealth in 2019. Mount Sinai / Presentation Name / Date IDX Flowcast Data Home 5

IDX Flowcast contents loaded to MSDW Patient registration information: • Patient demographics coverage • Registration and scheduling for outpatient office visits • Insurance Admission, Discharge, and Transfer (ADT) notifications via HL 7 message to other systems. Mount Sinai / Presentation Name / Date Home 6

Epic General Purpose: Electronic Health Record MSDW Data - Start / End Dates: May 1 st, 2011 - Present Description: Epic is Mount Sinai Health System's electronic health record (EHR), encompassing all clinical documentation and computerized provider order entry (CPOE). It sends orders and receives results from many ancillary systems (lab, radiology, and so on) via HL 7 message interfaces. Epic went live for ambulatory clinics in December 2006. Epic went live for Mount Sinai Hospital inpatient and emergency department on May 1, 2011. With this rollout, Epic replaced TDS (inpatient) and IBEX (emergency department). Subsequent Epic implementations by facility: • Mount Sinai Queens (MSQ) – 2013 • Mount Sinai West (Roosevelt) and Mount Sinai Morningside (St. Luke's) – March, 2018 • Mount Sinai Brooklyn (MSB) – September 8, 2019 • Mount Sinai Beth Israel (BI) – scheduled for 2020 Epic's application database Chronicles is Inter. Systems Cache, which is hierarchical rather than relational. Epic extracts data from Chronicles daily to its Clarity reporting database, which Mount Sinai has implemented on an Oracle database. Clarity then extracts a subset of its data daily to a dimensionally structured data warehouse downstream called Caboodle, which is on a Microsoft SQL Server database. Mount Sinai / Presentation Name / Date Epic Data Home 7

Epic contents loaded to MSDW • Encounters and associated diagnoses • Patient medical, surgical, social, family, and immunization histories • Patient assessments, including allergies, vital signs, problem list • Clinical orders: lab, radiology, pathology, medications, etc. • Medication administrations • Clinical documentation: progress notes, discharge summaries, etc. Mount Sinai / Presentation Name / Date Home 8

TDS General Purpose: Hospital information system MSDW Data - Start / End Dates: January 1 st, 2003 – April 30 th, 2011 (Retired) Description: Technicon Data Systems (TDS) was Mount Sinai's legacy mainframe-based hospital information system (HIS) implemented circa 1997. It was replaced by Epic in April 2011. Progress notes were documented on paper, but nursing assessments were documented in TDS. Mount Sinai built HL 7 interfaces between TDS and all other ancillary systems (registration, lab, radiology, pathology, cardiology, and so on) for sending orders and receiving results. To support analysis and reporting, data were extracted from TDS and loaded to EDR (see below). MSDW contains TDS data spanning the period January 2003 to April 2011. Mount Sinai / Presentation Name / Date TDS Data Home 9

TDS contents loaded to MSDW • Encounters and associated diagnoses • Patient assessments, including allergies, vital signs • Clinical orders: lab, radiology, pathology, medications, etc. • Medication administrations Mount Sinai / Presentation Name / Date Home 10

EDR General Purpose: Reporting database MSDW Data - Start / End Dates: January 1 st, 2003 – April 30 th, 2011 (Retired) Description: Electronic Data Repository (EDR) was a home-grown reporting database loaded with HL 7 messages being transmitted between systems, and with data extracted from TDS. EDR was decommissioned in April 2011 along with TDS. Mount Sinai / Presentation Name / Date EDR Data Home 11

EDR contents loaded to MSDW • All clinical information from TDS (see above) • HL 7 lab orders to SCC (see below) Mount Sinai / Presentation Name / Date Home 12

Ibex General Purpose: Emergency department MSDW Data - Start / End Dates: November 2002 – April 30 th, 2011 (Retired) Description: Ibex Pulse. Check is an emergency department (ED) information system, which Mount Sinai implemented in November 2002. It was replaced by Epic's ASAP module in April 2011. (Ibex Pulse. Check may still be used in the emergency department at Mount Sinai Queens. ) Ibex was a web-based application with a backend comprising Microsoft SQL Server and proprietary data files that could not be parsed or queried. Later, Mount Sinai implemented a "discrete data interface" that converted data from Ibex into HL 7 messages, which were then loaded to MSDW. Ibex was acquired by Picis in 2004. Mount Sinai / Presentation Name / Date Ibex Data Home 13

Ibex contents loaded to MSDW • Encounters and associated diagnoses • Patient assessments, including allergies, vital signs • Clinical orders: lab, radiology, pathology, medications, etc. • Medication administrations Mount Sinai / Presentation Name / Date Home 14

SCC General Purpose: Lab information system MSDW Data - Start / End Dates: January 1 st, 2003 - Present Description: SCC Soft. Lab is Mount Sinai's laboratory information system (LIS), implemented in 1999. MSDW contains its data from January 1, 2003. Mount Sinai's laboratory serves as a reference lab for community-based providers, so SCC also supports sending lab results directly to those providers. All lab orders and results communication is done via HL 7 messages between SCC and other systems. Charges for each lab test are sent to Eagle (inpatient) and Sunrise (external patient) billing systems. SCC is the "source of truth" for Mount Sinai's lab code master file, which are non-standard local codes. These codes need to be mapped to standard LOINC codes in the future. Mount Sinai / Presentation Name / Date SCC Data Home 15

SCC contents loaded to MSDW • Lab orders • Specimens received • Lab results Mount Sinai / Presentation Name / Date Home 16

Blood Bank General Purpose: Blood bank information system MSDW Data - Start / End Dates: xx - Present Description: Mount Sinai's blood bank uses the blood bank module of the SCC laboratory information system. SCC Blood Bank module was added as a new MSDW data source in late 2010 or early 2011. Mount Sinai / Presentation Name / Date Blood Bank Data Home 17

Blood Bank contents loaded to MSDW • Blood product orders • Blood type and cross tests Mount Sinai / Presentation Name / Date Home 18

IDXRad General Purpose: Radiology information system MSDW Data - Start / End Dates: January 1 st, 2003 - Present Description: IDXrad is Mount Sinai's radiology information system (RIS), implemented in 1992. MSDW contains its data from January 1, 2003. Just like Mount Sinai's laboratory, the department of radiology also fulfills orders from community-based providers. All radiology orders and results communication is done via HL 7 messages between IDXrad and other systems. Charges for each radiology procedure are sent to Eagle (inpatient) and Sunrise (external patient) billing systems. IDXrad is the "source of truth" for the radiology code master file, which are non-standard local codes. GE Healthcare acquired IDX in 2006 and renamed IDXrad to Imagecast and later to Centricity RIS-IC. Mount Sinai / Presentation Name / Date IDXRad Data Home 19

IDXRad contents loaded to MSDW • Radiology orders • Radiology reports Mount Sinai / Presentation Name / Date Home 20

Tamtron Power. Path General Purpose: Anatomical pathology information system MSDW Data - Start / End Dates: January 1 st, 2003 - Present Description: Tamtron Power. Path is Mount Sinai's anatomic pathology information system, implemented in 2002. MSDW contains its data from January 1, 2003. Power. Path was acquired by IMPATH Medical Systems in 2002, and was subsequently acquired by Sunquest Information Systems in 2011, who renamed it to Sunquest Power. Path. Mount Sinai / Presentation Name / Date Tamtron Power. Path Data Home 21

Tamtron Power. Path contents loaded to MSDW • Pathology orders • Pathology results • Captured charges Mount Sinai / Presentation Name / Date Home 22

EKG MUSE General Purpose: Cardiology information system MSDW Data - Start / End Dates: xx - Present Description: GE Healthcare's MUSE is a cardiology information system. EKG orders and results are transmitted between Epic and MUSE via HL 7 messages. The results messages include a weblink to the EKG strips stored in the MUSE application database. MSDW began loading these MUSE HL 7 messages in 2009. Mount Sinai / Presentation Name / Date EKG MUSE Data Home 23

EKG MUSE contents loaded to MSDW • EKG orders • EKG results Mount Sinai / Presentation Name / Date Home 24

Cardiac Cath General Purpose: Cath lab information system MSDW Data - Start / End Dates: August 2003 - Present Description: Mount Sinai's Cardiovascular Institute implemented Soft. Link International's Cardiac Cath Clinical Reporting System in August 2003. Professional charges are sent to IDX Flowcast and facility charges are sent to Eagle. Mount Sinai / Presentation Name / Date Cardiac Cath Data Home 25

Cardiac Cath contents loaded to MSDW • Cardiac cath procedure reports Mount Sinai / Presentation Name / Date Home 26

Care. Fusion General Purpose: Infusion therapy information system MSDW Data - Start / End Dates: March 19 th, 2013 - Present Description: Care. Fusion is a system for infusion therapy, including bedside infusion pumps, that Mount Sinai implemented on March 19, 2013 in a limited number of inpatient units. Later, use of the system was expanded to cover ~70% of all inpatient units. However, not all intravenous infusions are recorded by this system. There is an HL 7 message interface between Care. Fusion and Epic, and with the Blood Bank system (for blood products). MSDW includes infusion information for blood transfusions only. Care. Fusion was acquired by Becton Dickinson in 2015, who now markets these systems under the Alaris brand name. Mount Sinai / Presentation Name / Date Care. Fusion Data Home 27

Care. Fusion contents loaded to MSDW • Blood transfusions Mount Sinai / Presentation Name / Date Home 28

HSM General Purpose: Perioperative surgical management system MSDW Data - Start / End Dates: August 2005 - Present Description: Mc. Kesson's Horizon Surgical Manager (HSM) is a perioperative surgical management system. It is used for procedure scheduling, ordering and tracking surgical supplies, entering post-procedure documentation, and capturing charges. Charges are transmitted to Eagle via HL 7 messages. MSDW includes data from HSM starting from August 2005. Mount Sinai uses Mc. Kesson's Pathways Healthcare Scheduling (PHS) system for surgical procedure scheduling instead of HSM. But PHS is not used as a source for MSDW because the scheduling information is sent to HSM. Mount Sinai / Presentation Name / Date HSM Data Home 29

HSM contents loaded to MSDW • Surgical procedures, including case team assignments • Surgical supply charges Mount Sinai / Presentation Name / Date Home 30

Soft. Med General Purpose: Clinical documentation system MSDW Data - Start / End Dates: xx - Present Description: Soft. Med is clinical documentation software that provides templates, voice dictation, speech recognition, electronic signature, and document scanning. Prior to the Epic implementation in April 2011, Soft. Med was used extensively at Mount Sinai for transcribing, editing, and electronically signing operative reports and discharge summaries. It is still used for transcriptions of dictated notes and reports. For interfacing with other systems, Soft. Med required the use of an add-on utility called Chat. Linc. Soft. Med Systems was acquired by 3 M in 2006. Mount Sinai / Presentation Name / Date Soft. Med Data Home 31

Soft. Med contents loaded to MSDW • Discharge summaries • Operative reports Mount Sinai / Presentation Name / Date Home 32

Compu. Record General Purpose: Perioperative anesthesia information system MSDW Data - Start / End Dates: August 2005 - Present Description: Philip's Compu. Record is a perioperative anesthesia information and workflow management system. Mount Sinai first implemented it in February 1999. It was later upgraded in July 2002. The old version used 8 -digit MRNs that are not compatible with the current MRNs generated from Cerner. Compu. Record has HL 7 interfaces with other systems, such as with Cerner for ADT messages and with PHS for surgical case scheduling. Mount Sinai / Presentation Name / Date Compu. Record Data Home 33

Compu. Record contents loaded to MSDW • Surgical procedures • Anesthesia administration records Mount Sinai / Presentation Name / Date Home 34

QS General Purpose: Perinatal information system MSDW Data - Start / End Dates: xx – May 31 st, 2012 (Retired) Description: Quantitative Sentinel (QS) was renamed Centricity Perinatal by GE Healthcare in 2005. It is a perinatal information system. QS was decommissioned in May 2012 after it was replaced with Epic. QS was originally developed by Quantitative Medicine Inc (QMI), which was acquired by Marquette Medical Systems in 1995. GE acquired Marquette in 1998 to form GM Marquette Medical Systems. Mount Sinai / Presentation Name / Date QS Data Home 35

QS contents loaded to MSDW • Delivery procedures Mount Sinai / Presentation Name / Date Home 36

Canopy General Purpose: Case management system MSDW Data - Start / End Dates: 2003 - Present Description: Allscripts Canopy is a case and utilization management system, implemented at Mount Sinai in 2003. Canopy's backend is an Oracle database. Canopy is used for payor authorizations, utilization tracking, clinical reviews, and discharge planning. It has an HL 7 interface with Cerner for ADT messages. Canopy was developed by A 4 Health Systems, which was acquired by Allscripts in 2006. Mount Sinai / Presentation Name / Date Canopy Data Home 37

Canopy contents loaded to MSDW • Payor authorizations and denials • Clinical reviews • Tracking of avoidable days • Discharge planning assessments • Referrals Mount Sinai / Presentation Name / Date Home 38

Eagle General Purpose: Billing and revenue cycle management system MSDW Data - Start / End Dates: January 1 st, 2003 - Present Description: Eagle is a hospital billing system used by Mount Sinai for inpatient accounts since 1992. It added facility-based outpatient accounts in 1996. (Professional billing is done in IDX Flowcast. ) Charges captured by all ancillary systems (lab, pathology, radiology, and so on) are transmitted to Eagle for billing. Eagle was originally developed by American Healthware Systems, which was acquired by Siemens in 1999. Cerner acquired all of Siemens healthcare IT applications in early 2015. Mount Sinai / Presentation Name / Date Eagle Data Home 39

Eagle contents loaded to MSDW • Inpatient and outpatient billing accounts • Billed charges, including coded procedures and diagnoses • Revenue cycle transactions, including payments and adjustments Mount Sinai / Presentation Name / Date Home 40

TSI General Purpose: Cost accounting and decision support system MSDW Data - Start / End Dates: 2003 – Present Description: Allscripts TSI is a cost accounting and financial decision support system. TSI was developed by Transition Systems, Inc. , which was acquired by Eclipsys in 1998. Eclipsys later merged with Allscripts in August 2010. Mount Sinai / Presentation Name / Date TSI Data Home 41

TSI contents loaded to MSDW • Encounters and associated coding for billing (procedures, diagnoses, DRGs) Mount Sinai / Presentation Name / Date Home 42

MAR Weblog General Purpose: Inpatient care team assignments MSDW Data - Start / End Dates: 2009 – July 2010 (Retired) Description: The Medical Admitting Resident (MAR) Weblog system was an in-house application developed in 2009 to manage care team assignments for all patients on each inpatient service, especially assignments of medical trainees and their attending supervisors. The start and end times of certain procedures performed during inpatient hospitalizations were also recorded in this system; at the time, this was the only electronic record of these timestamps. This system was replaced by GE Healthcare's Agile. Trac system in July 2010. Mount Sinai / Presentation Name / Date MAR Weblog Data Home 43

MAR Weblog contents loaded to MSDW • Inpatient care team assignments Mount Sinai / Presentation Name / Date Home 44

SIGNOUT General Purpose: Discharge summaries and med reconciliation MSDW Data - Start / End Dates: 2005 – April 30 th, 2011 (Retired) Description: Signout was an in-house application developed in 2001 for residents to draft their discharge summaries before they were transmitted to Soft. Med for their attending's signoff. It was enhanced to include additional functionality: drafting consult notes, provider-to-provider communication for inpatient hospitalizations, and medication reconciliation upon admission and discharge. This system was replaced by Epic in April 2011. Mount Sinai / Presentation Name / Date SIGNOUT Data Home 45

SIGNOUT contents loaded to MSDW • Discharge summaries instructions • Medications upon admission • Medications upon discharge • Provider communications • Discharge Mount Sinai / Presentation Name / Date Home 46

BISLR Prism General Purpose: MSDW Data - Start / End Dates: Future/TBD Description: PRISM (Patient Real-time Information Systems Management) is the name of the GE Centricity electronic health record used at the former Continuum Health Partners hospitals: • Beth Israel Medical Center • St. Luke's Hospital (now Mount Sinai Morningside) • Roosevelt Hospital (now Mount Sinai West) Mount Sinai / Presentation Name / Date BISLR Prism Data Home 47

BISLR Prism contents loaded to MSDW • Admissions, discharges and transfers, labs, medication, etc. Mount Sinai / Presentation Name / Date Home 48

SSDI General Purpose: Social Security Death Index MSDW Data - Start / End Dates: Future/TBD Description: Social Security Death Index (SSDI) is a database created from the Social Security Administration's Death Master File extract. It includes most people with a Social Security Number whose death was reported to SSA, although SSA stopped using state sources in November 2011, causing a 33% drop in reported deaths. Mount Sinai / Presentation Name / Date Home 49