HSSC is leading an effort to create a statewide health information technology system that will include all HSSC members and other South Carolina health care providers.
The IT infrastructure is critical to HSSC’s success. It will promote and accelerate research, facilitate data collection and analysis, attract clinical trials, and allow HSSC and its partners to more successfully compete for external funding from sources such as the National Institutes of Health. The IT system will also improve health care in South Carolina by connecting providers, transforming patient care, improving quality, and streamlining health care administration.
HSSC is working with corporate partners that include IBM, Siemens, Sun Microsystems, and Recombinant Data Corporation on both its strategy and implementation to ensure world-class systems and operation.
HSSC's IT infrastructure largely in place; members working toward data collaboration agreement
As HSSC expands its focus to include a more implementation-centered approach to improve patient care and population health (see “HSSC new strategic plan” [left]), the organization is making tremendous progress in establishing a complex and powerful biomedical informatics infrastructure that will be used by health researchers throughout the state. This infrastructure underpins HSSC’s efforts to improve healthcare through the use of data-driven, evidence-based research.
A central aspect of this infrastructure is the clinical data warehouse (CDW). The CDW comprises a range of components, each of which will play a crucial role in managing, organizing, and providing useful access to the patient data that is generated by HSSC’s collaborating hospitals.
In early 2010, HSSC’s hospitals signed a memorandum of understanding agreeing to provide their data into the CDW, but the parties are still working out precisely how researchers and other health professionals will be allowed to make use of that data, which for now is simply being stored, but not accessed. [ more ]
The following are the components of the IT infrastructure:
Electronic Medical Records
HSSC is using a $5.6 million grant from the U.S. Department of Health and Human Services to help implement electronic medical record (EMR) systems in doctor’s offices across the state.
With the grant funding, HSSC established a regional extension center program called CITIA-SC (short for the Center for Information Technology Implementation Assistance in South Carolina). CITIA-SC is helping the state’s primary care practices select certified EMR products, implement the systems, and train staff so that each practice and its patients get the maximum benefit in terms of improved care, safety, and efficiency.
CITIA-SC has completed the initial recruitment phase by registering 1,000 primary care providers in South Carolina (approximately 21% of all primary care providers in the state). There are 62 such programs across the United States, and South Carolina was the second in the nation to achieve this initial benchmark.
Clinical Trials Management System
The clinical trials management system (CTMS) will help manage the large amounts of data that are generated by a clinical trial as well as help researchers keep track of deadlines and milestones for reporting purposes.
Clinical Data Warehouse
A central piece of HSSC’s IT infrastructure, the clinical data warehouse (CDW) aggregates real-time clinical data from across HSSC’s collaborative hospitals.
The CDW is a unique resource for health care researchers and providers in South Carolina. It will allow researchers to access large amounts of patient data (with personal identifiers removed) that will contribute to easier execution of cohort analysis and power studies. Meanwhile, it will allow providers to have instant access to a full range of clinical data about their patients, such as lab tests, medication lists, diagnoses, and discharge summaries.
CDW will ultimately be connected to a statewide tissue biorepository, opening up further research opportunities, as researchers will be able to access a database of tissue specimens categorized by their appropriate phenotypic and genotypic characteristics. These tissue specimens will be linked with the appropriate clinical data in the CDW.
Ultimately, the CDW and related infrastructure (including the biorepository and a specialized system to collect permissions from patients who allow their tissue to be used for research) will combine with advances in genomics research to support the greater personalization of medicine across South Carolina. Health care providers will be able to make care recommendations based on a person’s phenotype and genotype, which will be available to the provider at the point of care.
Enterprise Master Patient Index
The enterprise master patient index (EPMI) will be situated at the “gateway” of the clinical data warehouse to resolve hospital and demographic identifiers into a unique enterprise identifier for all patients across the HSSC collaborative.
This gateway manages streams of health care data sent to the clinical data warehouse in real time from all HSSC collaborative hospitals.
Research Permissions Management System
The Research Permissions Management System (RPMS) is a novel and comprehensive mechanism for electronically capturing and managing informed consents, research authorizations and patient permissions in both clinical care and research settings. RPMS addresses the challenge of patient trust and research participant recruitment by replacing current paper-based methods and simplifying the collection and management of informed consents and research permissions that accrue to an individual through their direct and indirect interactions with the research enterprise.
The RPMS project was supported by a “Grand Opportunity” grant (#RC2LM010796) from the National Library of Medicine at the National Institute of Health to HSSC. A Grand Opportunity grant funds the research development of ideas that will have high-impact on the research community and which may also create new area of scientific investigation.
Electronic Institutional Review Board System
HSSC’s electronic institutional review board (eIRB) system is now operational at all six HSSC supporting organizations.
The eIRB system allows researchers to complete critical paperwork for clinical trials online, making the administrative aspects of research faster and easier and supporting collaborative research among HSSC member organizations. South Carolina is among the first states in the nation to implement such a system.
Traditionally, a review board will use paperwork submissions to evaluate the efficacy and safety of clinical trials involving human subjects. The eIRB system is a paperless way for the health research community to submit, track, and review required scientific, regulatory, and compliance information and to share information about amendments, protocol events, and continuing reviews. The eIRB system is efficient, secure, and “green,” and it makes HSSC and South Carolina more competitive in attracting research funding and commercial clinical trials.