EHIT Uses Data Synchronization to Improve Healthcare

Volume 17
May 2004

Like all healthcare providers today, Montefiore Medical Center is under enormous pressure to reduce costs while maintaining high standards of care. In response, Montefiore, working with its wholly owned subsidiary Emerging Health Information Technologies (EHIT), has implemented several IT systems that help contain or drive down costs by automating care, eliminating errors, and streamlining decision making. The focal point of this effort is the hospital's physician order entry/clinical information system (POE/CIS), built on an HP NonStop platform, with Enscribe databases and IDX Carecast™ software.

Initially deployed in 2001, Montefiore's POE/CIS is a powerful tool for optimizing clinical care because it collects information from sources all across the hospital--laboratory, pharmacy, admitting, treatment rooms, and so on--via standard networked PCs, computer terminals and, increasingly, handheld wireless devices. In this way the POE/CIS allows the hospital to create comprehensive lifetime patient records; automate workflow; and streamline clinical, financial, and administrative processes. Moreover, by centralizing all the important data that doctors and nurses need to make responsible clinical decisions, the POE/CIS helps Montefiore achieve clinical excellence through more accurate patient information, greater operational efficiencies, and improved patient safety.

TAPPING THE VALUE OF DATA
With the POE/CIS infrastructure in place, EHIT's and Montefiore's executives realized that the system's databases contained vast and growing amounts of valuable information on patients and clinical processes that could be further leveraged to provide insight into treatment practices and outcomes. To unlock the value of its data, EHIT and Montefiore designed and implemented a real-time data warehouse. This system uses GoldenGate data synchronization software to capture, transform, and deliver massive volumes of data at sub-second speed from the HP NonStop POE/CIS to a Sybase database. Using unobtrusive log-based change data capture technology, GoldenGate incrementally replicates database changes as they occur, an approach that eliminates the need to reload entire databases and minimizes impact on host systems. Powered by GoldenGate, this real-time data warehouse allows Montefiore to pull data from multiple sources across the hospital, perform transformations on the fly, and make the data available to the hospital's innovative outcomes analysis application: the Clinical Looking Glass (CLG).

Developed in-house using proprietary code and off-the-shelf elements, the CLG enables Montefiore department heads and clinical team leaders to perform decision support and outcomes analysis specific to patient care based on data from years past right up to the present day. For instance, the CLG lets hospital decision makers determine how dietary sugar has affected patients in study group A versus study group B, and examine the root causes of re-emergencies to the ER. It also provides the hospital's institutional review board (IRB) with reports based on extremely detailed information. More than just a tool for data slicing and dicing, the CLG has powerful, real-time evaluation capabilities that the hospital can use to proactively monitor the quality of care down to the individual level, and begin implementing targeted care improvement efforts that help contain costs, eliminate errors, and improve clinical decision making.

Dr. Eran Bellin, EHIT's Director of Medical Informatics, explains the clinical value of real-time data: "The reason GoldenGate is so important is that it allows us to move data between complementary environments, each optimized for its own task. IDX Carecast is a wonderful tool for supporting clinical care, rapidly accessing all the important data a good clinician would need to make responsible clinical decisions. Clinical Looking Glass, developed by EHIT, permits longitudinal evaluation of the quality of care and targeted care improvement efforts. GoldenGate allows us to synchronize the data between both systems allowing us to benefit from the best of both worlds. We manage care and analysis, GoldenGate manages the synchronization."

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