VITL Partners with UVMMC for CCD Project

The University of Vermont Medical Center(UVMMC) CCD query project was a combined effort between VITL and UVMMC staff, to create a new technical method for getting a patient's Continuity of Care Document (CCD) from the hospital's electronic health record (EHR) system into the Vermont Health Information Exchange (VHIE), by using Admit, Discharge and Transfer (ADT) messages. The ADT messages will be used as a trigger to query for CCDs in the EHR when a patient is admitted, transferred or discharged from the hospital.

The UVMMC CCD query surpassed a gap remediation goal of a State Innovation Model (SIM) grant from the Centers for Medicare and Medicaid Innovation program. The larger Gap Remediation project is addressing gaps in connectivity and clinical data quality of health care organizations sending data to the Vermont Health Information Exchange.

According to a 2015 report from the Vermont Health Care Innovation Project (VHCIP), Vermont is making strategic investments in clinical data systems for quality measurement, in order to reduce provider burden while ensuring accountability for health care quality, and to support real-time decision making for clinicians. The Health Data Infrastructure portion of the SIM grant will strengthen Vermont’s data warehousing infrastructure to support interoperability of claims, clinical data and predictive analytics. These investments have yielded significant improvements in the quality and quantity of data flowing from providers’ electronic medical records into the VHIE. Data gaps have also been identified for non-meaningful use providers to support strategic planning around data use for all providers across the continuum.

VITL staff who made the UVMMC CCD query project possible included:

  • Jennifer Starling, project manager
  • Mark Daly, programmer analyst
  • Regi Wahl, project manager
  • Kenan Nurkanovic, systems engineer

UVMMC staff working in partnership with VITL:

  • MaryAnne Sjoblom, programmer analyst
  • Ross Mohn, senior Epic/Caché database administrator

Recognition for their support during of the first phase of the project also goes to Epic, the UVMMC electronic health record vendor.

What is the gap that this project remediated? Epic, the electronic health record systems used by UVMMC, does not actively contribute CCDs to the VHIE. The health information stored in CCDs is necessary, in part, for OneCare Vermont, the accountable care organization (ACO) that UVMMC is part of, to perform a variety of data analyses.

VITL investigated querying and retrieving the CCDs from Epic using IHE Profiles for Cross Gateway Query and Retrieve. ADT messages were analyzed to determine the best indication that a patient was being discharged and a CCD would be forthcoming. It was determined that if a type of ADT message called an A03 (patient discharge message) from the Epic system was used, and retrieval was delayed at least 24 hours prior to querying, there was a likely chance the CCD would be available. This knowledge allowed VITL to build code for automatic retrieval of CCDs from UVMMC's Epic system after they were available.

VITL & UVMMC CCD project

Mary Anne Sjoblom at UVMMC elaborated on this new technical method for getting CCDs from UVMMC’s EHR to the VHIE: the method created a link between the UVMMC servers and VITL systems which is authenticated to keep data secure. Based on the ADT triggers, VITL will request data for patient discharges. If the request matches the patient in UVMMC system, a CCD is returned electronically to VITL.

The UVM CCD data is currently being stored in VITL's data warehouse. Phase two of the project will work toward displaying the CCDs in VITLAccess, the portal that allows providers to view health information in the VHIE. UVMMC is working to configure the ambulatory sites so that the trigger mechanism will work for these sites as well.

Regarding the UVMMC CCD project, David Raths, columnist for Healthcare Informatics, wrote, "In one year, VITL went from gathering only 17 percent of the data the ACOs need about beneficiaries to 64 percent, in large part by bringing in CCD interfaces from the largest hospital in Vermont, the University of Vermont Medical Center. “We have been connected to UVM Medical Center for quite a while, but we didn’t have CCD interfaces,” Robert Gibson, VITL vice president of marketing and business development said, “so while we were getting a lot of data from them, we weren’t getting the pieces that the ACO needs for their clinical measures.”

When asked about the greatest benefit to UVMMC's patients with the completion of this phase of the project, Sjoblom said, "The heart and science of medicine is supported by technology. With this project, the non-UVMMC providers will have access to patient information via the VITL portal. This data is only released with consent of the patient."

*Follow this link to read the 2016 VCHIP report to the Vermont Legislature about the progress of health data infrastructure projects: