MSDW Data Sources

1. Mount Sinai
Data Warehouse
DW130 – MSDW Data Source

2. Systems
•
•
•
•
•
•
•
•
•
•
Cerner
IDX Flowcast
EPIC
SCC
IDXRAD
Powerpath / Tamtron
HSM
Cardiac Cath
EKG (Muse)
CompuRecord
•
•
•
•
•
•
•
•
•
•
Canopy
TSI
Eagle
SoftMed
CareFusion
TDS
IBEX
Signout
MAR
QS
External Data Sets
•
•
National Death Index
Press Ganey Satisfaction Score
2
2

3. CERNER
Cerner Access Management System (CAMS) commonly known as Cerner is Mount Sinai’s primary access management and
medical record application. It went live on July 1st, 2002, however MSDW took the cutoff as Jan 1st 2003. Access management
refers to a set of core administrative services that focus upon managing information about patients and visits. These services
include scheduling outpatient clinic or ambulatory surgery appointments, registering Emergency Department visits and tracking
inpatient hospitalizations. Access Management Systems are also referred to as ADT (Admissions, Discharges, and Transfers) or
Registration systems.
Cerner is the primary system of record for maintaining patient demographic information; this includes details about the patient’s
next of kin, emergency contacts, payment guarantor, subscriber and insurance coverage. During the course of an inpatient
hospitalization, the application tracks patient location details such as the nursing unit, room/bed assignment. The Cerner
application also records relevant information specific to a patient’s encounter/visit such as provider information, reason for visit,
billing information etc. Cerner is the “gold standard” for generating Medical Record Number (MRN) which is an unique patient
identifier and this number is used by all applications in Mount Sinai for patient data.
As the core system of record for tracking patient visits, Cerner broadcasts new or updated patient visit (scheduling or
registration) information to a variety of secondary systems throughout the care delivery organization; integrating and
synchronizing these various applications is important to ensuring stable, manageable and accurately coordinated workflow
across the organization.
IDX Flowcast is an application parallel to Cerner which is used exclusively in the FPA clinics. A MPI project was implemented in
Mount Sinai to enable handshake between Cerner and Flowcast, allowing them to share MRN and related patient demographics.
The purpose of the project was to eliminate duplicate patient registrations and provide a controlled MRN generation.
Cerner is integrated to MSDW via HL7 messages. MSDW receives all the ADT messages and process them on nightly basis. ADT
message may include admit messages (like A01, A04), discharge messages (A03), transfer message (A02, A06, A07) and other
visit related messages.
Cerner data mostly populates the Person and Encounter dimension of the MSDW. It also loads Facility and Organization
dimension which are referenced by other application data as well.
3
3

4. Cerner Transactions
•
Patient Information:
–
–
–
–
–
–
–
–
–
–
–
–
–
•
•
Medical Record Number (MRN)
Name
Date of birth
Address and Telephone
Gender
Ethnicity and Ethnic Group
Language and Interpreter Need
Marital Status
Date of death
Citizenship
Religion
Social Security Number
Driver License, Donor ID etc.
Encounter Facts:
–
Admission
–
–
–
–
–
–
–
–
–
–
–
–
Encounter Visit ID
Visit Type
Admit date
Discharge date
VIP Indicator
Discharge disposition
Means of arrival
Estimated Length of Stay (ELOS)
Specialty Unit
Next of Kin information
–
–
–
Transfer Date Time
Facility transferred to
Transferring Caregiver
Transfer Reason
Discharge
Encounter Information:
–
–
–
–
–
–
–
–
–
–
Discharge Date Time
Discharge Disposition
Discharging Caregiver
Discharging Facility
Discharging Service
–
–
–
–
–
Admit Date Time
Associated Caregivers
Insurance
Admitting Facility
Admitting Service
Admitting Diagnosis
Admit Reason
Transfer
Cancel Discharge
Pre-admit
–
•
Expected arrival date
Merge and Unmerge
–
–
–
Merge two MRNs
Unmerge two MRNs
Move encounter from one MRN to another
4
4

5. IDX Flowcast
IDX Flowcast is primary access management application for Mount Sinai Faculty Practice Associates. MSDW plans to have data
from it starting Jan 1st 2003. Access management refers to a set of core administrative services that focus upon managing
information about patients and visits. These services include scheduling FPA clinic appointments and for the services rendered
during the visit.
IDX Flowcast along with Cerner are the primary systems of record for maintaining patient demographic information; this includes
details about the patient’s next of kin, emergency contacts, payment guarantor, subscriber and insurance coverage.
A MPI project was implemented in Mount Sinai to enable handshake between Cerner and Flowcast, allowing them to share MRN
and related patient demographics. The purpose of the project was to eliminate duplicate patient registrations and provide a
controlled MRN generation. For several key fields Flowcast and Cerner sync their data sets on each of the patient’s visit. Now
Flowcast uses Cerner generated MRNs only; the visit ids are internal to it.
Billing data from Flowcast is available at Account level as well as at Invoice Level. CPT-4 codes for all the services rendered during
the visits are also provided.
Flowcast is integrated to MSDW via HL7 messages. MSDW receives all the ADT and SIU messages and process them on nightly
basis. Billing data is delivered as flat file on nightly basis and is loaded to MSDW.
5
5

6. IDX Flowcast Transactions
•
Patient Information:
–
–
–
–
–
–
–
–
–
–
–
–
–
–
•
Medical Record Number (MRN)
Name
Date of birth
Address and Telephone
Gender
Ethnicity and Ethnic Group
Language
Marital Status
Deceased Indicator
Religion
Social Security Number
Primary Care Physician (PCP)
Employment Status
NOPP Status and Signed Date
Encounter Information:
–
–
–
–
–
–
–
–
–
Encounter Visit ID
Visit Type
Appointment Date
Visit Class
Financial Class
VIP Indicator
Discharge disposition
Next of Kin information
Guarantor Information
•
Encounter Facts:
–
Appointment
–
–
–
–
–
–
–
Scheduling
–
–
–
–
•
Appointment Date Time
Associated Caregivers
Insurance
Attending Facility
Attending Service
Reason for visit
Appointment Date
Scheduling Date
Appointment Status
Reschedule / No-show
Billing
–
–
Invoice Level
CPT-4 codes for services rendered
6
6

7. EPIC
Epic Care is Mount Sinai’s EMR application which captures all clinical information during the patient’s visit. It was initially rolled
out in ambulatory care (2006-12) and later implemented in Inpatient and Emergency (May 1st 2011). EPIC replaced TDS and IBEX
application in IP and ED. A variety of vital patient information was abstracted from the retiring applications in to EPIC to maintain
the patient history.
Epic Care is built on Caché Database and uses Clarity for its reporting purposes. Epic functionality includes: documentation,
results review, order entry, secure messaging, clinical decision support, prescription writing, and support for scanned documents.
The documentation module supports all clinical charting including progress notes, discharge summaries and letters. Results
review provides integration of clinical data from multiple sources including lab, radiology, and pathology. Computerized order
entry (CPOE) is used to order medications, medical supplies, testing, and referrals. Secure messaging facilitates communication
between providers by attaching relevant clinical information including the chart to messages. Finally, Epic provides shared
viewable clinical data among all clinical providers in a secure role based system.
Every patient visit is scheduled in Epic through Cerner or IDX Flowcast. For Epic to start documentation and ordering it requires
not only a schedule for every patient but also the patient needs to check-in into the Outpatient Clinic i.e. “arrived”. When a
scheduled patient arrives at a clinic, a case is opened for the patient. Assessments like Allergy, Vital Sign, and Pain, etc are
registered. . During the patient arrival process, medical history documentation is also completed. Physician’s diagnosis and
prescriptions are endorsed in the system. Associated caregivers complete other case related documentation. Orders that need to
be sent to other applications are out-bounded. Necessary review and approvals as part of workflow management is also
triggered by the application.
Clarity functions as reporting environment for EPIC. It is built on Oracle database. Data in Clarity is organized by Epic Care
functional subject matter area. A subject matter area is a group of data elements of interest to a particular subject. Eg:
Medications may contain details like medicine name, frequency, dosage, route etc. Data across all Epic implementation in Mount
Sinai is collected in Clarity. For extraction into the Data Warehouse various data elements have been identified in EPIC and a
customized routine has been written to populate extract tables. These tables serve as primary source of EPIC data for MSDW.
7
7

8. EPIC Transactions
•
Patient History
–
–
–
–
–
Medical history
Surgical history
Employment history
Family history
Social history
•
•
•
•
•
•
•
•
Patient Medication:
–
–
–
–
–
Alcohol
Tobacco
Illicit Drug
Sexual Habit
Education
Narratives
Following are key fields captured for all above
transactions:
–
–
–
–
–
–
–
–
Encounter Information:
–
–
–
–
–
–
–
–
Admission date
Discharge date
Transfer date
Caregiver associated
Discharge disposition
Means of arrival
ED acuity level (severity index)
Labor Status
Medication Order
Medication Administration (MAR)
Prescription
Immunization
Medication History
•
Medication Name
SIG
Unit
Dose
Route
Start Date
End Date
Refills
Clinical Documentation
–
–
–
–
–
Progress Notes
Discharge Summary
Patient Instructions
Operative Reports (WIP)
Physician Documentation (WIP)
Continued …
8
8

9. EPIC Transactions (contd.)
•
Clinical Assessments
–
Diagnosis (ICD-9 and IMO codes)
•
•
•
–
Noted Date
Resolved Date
Comments
Allergy Assessment
–
–
–
Allergen
Reaction
Severity
Height
Weight
Length (Peds)
Blood Pressure
Temperature
Pain Score
Pulse
O2 Saturation
Respiration
Lab Order
Radiology Order
Pathology Order
Admit Service Order
Discharge Service Order
EKG Order
Encounter (misc.) Order
–
–
–
–
–
–
–
–
–
–
Vital Signs
–
–
–
–
–
–
–
–
–
Clinical Orders
–
–
–
–
–
–
–
Reason for visit
Chief Complaint
Problem List
–
–
–
–
•
•
Nursing Order
Diet Order
Isolation Order
Dialysis Order
Referral Order
Rehab Order
Therapy Order
DME Order
Consult Order
All possible orders from EPIC Order Entry
workflow
Encounter Information:
–
–
–
–
–
–
–
–
Admission date
Discharge date
Transfer date
Caregiver associated
Discharge disposition
Means of arrival
ED acuity level (severity index)
Labor Status
9
9

10. SCC Lab
SCC Lab Information System (LIS) is lab management application at Mt. Sinai since 1999. MSDW is holding the data since 2003.
The application receives Lab Orders from various clinical order entry applications in MSMC like EPIC, TDS and IBEX. In return it
sends lab results back to the ordering application.
All the order and result communication happens through HL7 interface. SCC is also used to send result transactions to EDR. It
stopped doing so when the EDR application was archived in April 2011. The MSMC laboratory also functions as a reference
laboratory, providing services to community-based providers. The results for the referred patients are sent directly to the
ordering providers. Charges associated with each order are captured and sent to the MSMC Eagle Hospital Billing System for
hospital patients and to Sunrise Billing System for External Patients.
SCC maintains a lab code master which are ordering codes i.e. list of tests done at MSMC lab. MSDW sources these lab codes for
its Procedure Dimension. These codes are non-standard and local to MSMC. Future plan is to convert them to LOINC codes.
With Release 4 we have integrated the Bloodbank module of the SCC Lab. The bloodbank data will provide the order and
provision information between blood bank and EPIC.
10
10

11. SCC Transactions
•
Lab Order
–
•
Lab Initiated Order
–
–
–
–
–
–
Order Test Code
Order Date Time
Ordering caregiver
Ordering location
Order Status (new/cancel)
Specimen Collection
•
•
Lab Result
–
–
–
–
–
–
–
Result Value (could be numeric, string or
text report)
Unit of measure
Abnormal Flag
Reference Range
Research Indicator
Specimen Source
Comments
Specimen Collection Date Time
Specimen Received Date Time
11
11

12. IDXRAD (Radiology)
GE IDXRAD Radiology Information System (LIS) is the radiology management application at Mt. Sinai since 1992. MSDW is
holding the data since 2003. The application receives Radiology Orders from various clinical order entry applications in MSMC
like EPIC, TDS and IBEX. In return it sends radiology results back to the ordering application. The results are text reports which
contain clinical impression etc.
All the order and result communication happens through HL7 interface. IDXRAD is also used to send result transactions to EDR. It
stopped doing so when the EDR application was archived in April 2011. The MSMC radiology also takes in referral patients i.e.
orders not from MSMC’s clinics. The results for the referred patients are sent directly to the ordering providers. Charges
associated with each order are captured and sent to the MSMC Eagle Hospital Billing System for hospital patients and to Sunrise
Billing System for External Patients.
IDXRAD maintains a radiology code master which are ordering codes i.e. list of tests done at MSMC. MSDW sources these
radiology codes for its Procedure Dimension. These codes are non-standard and local to MSMC.
12
12

13. IDXRAD Transactions
•
Radiology Order
–
Radiology Initiated Order
–
–
–
–
–
Order Test Code
Order Date Time
Ordering caregiver
Ordering location
Order Status (new/cancel)
•
Radiology Report
–
–
–
–
–
–
–
–
–
–
–
–
–
Report Text
Clinical Info
Pregnancy Indicator
Reason For Study
Research Indicator
Planned Duration
Actual Exam Duration
Allergy Comments
Resource
Scheduled Date & Time
Stat Exam Indicator
Stat Exam Date & Time
Comments
13
13

14. PowerPath (Pathology)
The PowerPath Pathology Information System from IMPAC Medical Systems Inc. was installed at Mount Sinai in 2002 and MSDW
is holding the data since 2003. The application generates pathology orders for clinical order entry applications in MSMC like EPIC,
TDS and IBEX. It also sends the radiology results back to the clinical applications. The results are text reports.
All the order and result communication happens through HL7 interface. IDXRAD is also used to send result transactions to EDR. It
stopped doing so when the EDR application was archived in April 2011. The MSMC radiology also takes in referral patients i.e.
orders not from MSMC’s clinics. The system creates an "accession number”, a unique identifier for the case. A case is started
when a specimen arrives from the Operation Theatre (OR), other hospital area or from outside doctor or institution. The
specimen may be structured tissue (anatomic), fluid containing cells (cytology), Pap smear (gyn cytology), cadaver (autopsy) or
prepared slides (consult). Diagnostic information is usually entered via free text in Word. Cytology cases use a dictionary, which
is a pre-defined diagnostic information.
Charges associated with each Inpatient Order are captured, verified and sent to the MSMC Eagle Hospital Billing System. For
External Patients and Outpatients, Technical charges are sent to Eagle Hospital Billing System and Professional Charges to Per-Se
Billing System.
14
14

15. PowerPath Transactions
•
Pathology Initiated Order
–
Pathology Initiated Order
–
–
–
–
–
Order Test Code
Order Date Time
Ordering caregiver
Ordering location
Order Status (new/cancel)
•
Pathology Report
–
–
–
–
–
–
Report Text
Specimen Source
Unit Charged
Rate Charged
Rate Charge for Single Unit
Pathology Diagnosis
15
15

16. HSM (Surgical Management)
At MSMC, two McKesson products are used for surgical management: Pathways Healthcare Scheduling (PHS) for scheduling the
cases and Horizon Surgical Manager (HSM) for post-surgery documentation. MSDW has data from HSM starting August 2005.
PHS was not integrated with MSDW as it contains only scheduling information which any way HSM provides.
HSM is used by the Sterile Processing Department (SPD) and Perioperative Nurses to prepare, allocate, and keep track of OR
supplies, and by Journalers, post case perioperative documentation data entry ; to review and process charges.
HSM provides valuable information from peri-op. For each surgery we are able to capture various charge levels, supplies used,
caregiver involved (and in what role), event timestamps and discharge disposition.
Charges are processed and it generates the surgical case charges which are transmitted to Eagle via HL7 for billing. Nonchargeable supplies are also noted in the surgical case, such as, gloves, gowns, etc.
16
16

17. HSM Transactions
•
Surgical Case
•
Type of case
–
–
–
•
Anesthesia type
Anesthesia charge level
Class Name
Delay Reason
OR Charge Level
PACU Charge Level
Procedure Duration
Wound Class
Practitioner Reserved Time
Scheduled
Emergency
Add-on
Event Timers
–
–
–
–
–
–
–
–
–
Patient In Time
Patient Out Time
Caregiver In Time
Caregiver Out Time
Procedure Start Time
Procedure End Time
Scheduled Date and Time
PACU In Time
PACU Out Time
Caregivers Associated
–
–
–
–
–
–
–
–
Case Profile
–
–
–
–
–
–
–
–
–
•
•
•
Principal Surgeon
Attending Provider
Ordering Provider
Referring Provider
Anesthesiologist
Residents
Nurse staff
Other caregivers documented
Material Consumed
–
–
–
–
–
–
–
–
–
–
Chargeable (Y/N)
Expiration Date
Item Cost
Lot Number
Manufacturer
Total Quantity
Quantity Wasted
Waste Reason
Serial Number
Site Implanted
17
17

18. Cardiac Cath
The Cardiac Cath provides the full range of diagnostic and intervention procedures in cardiac catheterization and
electrophysiology. It is one of the six laboratories of Cardio Vascular Institute, MSMC. The Cardiac Cath Clinical Reporting System
(Cardiac Cath) from Soft link International was installed at Cardiovascular Institute (CVI), MSMC in August 2003.
The major functions of the systems are results entry, report access, distribution and bill generation. The system captures data,
from the time patient enters the procedure room till the report is sent to ordering provider. Once the report is signed by
attending cardiologists, the reports are also available online in PDF format for ordering providers to view. Every report is
assigned a unique report number.
The Professional charges and Equipment summary are the major components of a Trip Ticket. The Professional Charges billing is
done through IDX system. The technical facility charges with materials and equipment used are billed in Eagle system for
Hospital Referrals and in IDX for External Referrals.
18
18

19. Cardiac Cath Transactions
•
–
–
–
–
–
–
–
–
–
–
–
–
–
–
–
–
–
–
–
–
–
–
–
–
–
–
–
–
–
–
–
–
–
–
Admission Type
Body Surface Area
Study Protocol Follow-up
Cath Tray
Catheter Pathway
Complications
Coronary Anatomy Conclusion
Disposition
Doppler Findings
FFR Findings
Heart Transplant Conclusion
Height
Hemodynamic Conclusion
IABP Conclusion
Intervention Conclusion
IVUS Findings
LV Function / Aorta Conclusion
Medical History
Other Indication
Peripheral Indication
Procedure Cost
PTVA Conclusion
Pulmonary Indication
Pulmonary Medical History
Recommendations
Recovery Room
Report Modification Reason
Report Signed Indicator
Valves Conclusion
Valvuloplasty Conclusion Aortic
•
•
Valvuloplasty Conclusion Mitral
Valvuloplasty Conclusion Pulmonic
Valvuloplasty Conclusion Tricuspid
Weight
–
–
–
Cath Report
Cath Indication
Peripheral Indication
Pulmonary Indication
Diagnosis
Events Recorded
–
–
–
–
–
–
–
–
–
Biopsy Signed date time
Cath Report Signed date time
Diagnostic Start / End
Report deletion date time
Intervention Start / End
Interventional Signed date time
Peripheral Cath Signed date time
Peripheral Interventional Signed
Room Start / End
19
19

20. EKG (Muse)
EKG Muse application capture EKG results that are generated at Mount Sinai. It stores the scan copy of the output as well as the
discrete measures that were used during the test.
EKG orders can be placed in EPIC application and is transmitted to Muse via HL7 message. The result, which carries discrete
measures and a web-link to the EKG scan is sent back to EPIC. EPIC users can access the EKG scan in Muse database through this
web-link.
Data Warehouse is collecting data from Muse (both order and result) since 2009 and through a separate process the historical
data is being extracted going backwards.
20
20

21. EKG (Muse) Transactions
•
EKG Test
–
–
–
–
–
–
–
–
–
–
–
–
–
–
–
–
–
–
Result Status
Report URL
Ventricular Rate
Atrial Rate
P-R Interval
QRS Interval
QT
QTc
P Axis
R Axis
T Axis
Report Text
Test Date Time
Point of service
Order Number
Order Date Time
Ordering Provider
Procedure Code Description
21
21

22. CompuRecord
CompuRecord system is an anesthesia information system that provides decision support and data management throughout the
perioperative process. The CompuRecord application has been installed at Mount Sinai since 1999. There is a separate database
for data from February 1999 through July 2002. The format is almost identical to the current database, but the old version used
8 character Medical Record Numbers (with a parity position) and do not tie to Cerner generated MRN.
Physiologic data from a wide range of patient monitors, anesthesia machines and other devices is automatically integrated with
the application for fast, thorough charting.
CompuRecord receives ADT information from Cerner, along with surgical scheduling data from PHS application.
22
22

23. CompuRecord Transactions
•
Anesthesia
•
Timers
–
–
–
–
•
Fluid Drug Detail
–
–
–
•
ASA Status
Emergency Indicator
Procedure Name
Prophylaxis
Fluid I/O
–
Fluid Input
–
–
–
Blood fluid given
Non blood fluid given
Fluid Output
–
•
Drug Name
Route
Antibiotic
Procedure Detail
–
–
–
–
•
Anesthesia Start Date Time
Anesthesia End Date Time
Procedure Start Date Time
Procedure End Date Time
Fluid Output Collected
Medication Administration
–
–
Bolus Drug given
Infusion Drug given
23
23

24. Canopy (Case Management)
Canopy Case Management, a product of Allscripts, is used by Case Managers at MSMC to support a variety of case management
activities like clinical review, planning discharges, tracking denials and avoidable days, initiating appeals, obtaining authorizations
and tracking notes. One of the most critical functionality is the process of obtaining approvals from payors for admissions and
extended stays.
Canopy has been in use at MSMC since 2003 and is an Oracle/Java application based on n-tier client server architecture. Out of
all available modules in the product, MSMC has Utilization Management and Case Management implemented. Admission and
discharge data is transmitted to Canopy from Cerner application via HL7 message.
Case Management is a particularly important function that directly affects revenue cycle and return-on-investment. Case
Managers affect MSMC’s bottom line by optimizing length of stay (LOS), reducing denials and avoidable days. Canopy is the first
step in the authorization, denials, and appeals of inpatient stays; the data generated is of great analytical value when combined
with data from other systems including Eagle and TSI.
24
24

25. Canopy Transactions
•
–
–
–
–
–
Utilization Management
•
Authorization
–
–
–
–
•
•
•
Care Co-ordination Level
Close Episode Reason
Episode Status
Resource Referral
–
–
–
–
–
•
Start / Locked / Discontinued
Finding and Group Description
Problem Description, Onset Date
Problem Selected for POC
Episode Description
–
–
–
Discharge Screening
Intensity of service
Overall criteria (and others)
Severity of illness
Admission / Sent to Payor
Denial Reason, Number, Status & Type
Level of Care
Responsible Party (and Others)
Pre Appeal and Outcome reimbursement level of care
Assessment
–
–
–
–
Count of days
Responsible Party (and others)
Reason
Start / End / Discontinued
Notes
Review Call
–
–
–
–
•
•
Denial
–
–
–
–
•
Discharge Planning
Clinical Review
–
–
–
–
–
•
•
Avoidable Days
–
–
–
–
–
•
Start / End / Discontinued
Authorization Number
Days certified
Pre-Certification Number
Discharge Disposition (ADT version)
Discharge Disposition (CC version)
Encounter Type
GMLOS for Expected DRG
UM Level
Resource Authorization Number
Resource Expected End Date
Resource Frequency
Service Type
Resource Referral Notes
Diagnosis Dimension
•
Canopy DRG codes
Correspondence
Intensity of service
Review Outcome
Severity of illness
Encounter Summary
–
Admit Reason
25
25

26. TSI (Decision Support System)
TSI, Transitions System Inc., is a comprehensive financial and clinical decision support, contract management and clinical
resource management system. It combines both the financial and clinical information captured in Eagle and clinical systems, and
integrates them into a powerful tool for both clinical and financial decision making. The following is the functionality provided
by TSI:
Financial
Cost Accounting
Flexible Budgeting
Product Line Management
Modeling and Forecasting
Profitability Analysis
Contract Analysis
Clinical
Care pattern analysis for specific populations
Utilization analysis
Phase of Care/Episode of Care Analysis
Outcomes Measurements
Clinical Pathways
Length of Stay Analysis
TSI data goes back till 2003 and it cover both inpatient and outpatient encounters. It accepts data from several applications
including ADT data from Cerner, billing data from Eagle, clinical data from EMR (Epic) etc.
TSI users can create reports using CCM or KIT report writers based on the complexity of the report. It also creates data that is
loaded in to Information Builders, which is later used for Dashboard. Dashboard supports several canned reports and provides
functionality to generate user-defined reports as well.
26
26

27. TSI Transactions
•
Encounter Summary
•
Diagnosis documented
–
–
–
–
–
–
–
APRDRG
APRMDC
Federal DRG
NYDRG
MSDRG
Principal Diagnosis
Secondary Diagnosis
27
27

28. Eagle (Inpatient Billing)
The Eagle Hospital Billing System has been in use for managing billing and remittances at Mount Sinai since 1992 for inpatient
accounts and since 1996 for outpatient accounts. MSDW however holds data since 2003. For outpatient, the data is available for
hospital clinics only; the FPA clinic data is available through IDX Flowcast.
Each patient registration in the Cerner ADT system creates an account to be created in Eagle. The 3M encoder system sends
diagnosis, procedure, and attending physician information to Eagle. Charges captured by ancillary systems (e.g., SCC, IDXRad,
Tamtron, SCC, et al) are forwarded to Eagle for consolidation.
Eagle application produces bills/charges for the encounter related charges. It also generates allowance (or adjustment).
Electronic and manual payments are posted in the application.
28
28

29. Eagle Transactions
•
Account Receivables
•
–
–
–
–
–
–
–
–
–
–
–
•
Allowance
Charges
Late Stay
On/Account Applied
Room and Board
Transfer (deductible)
Allowance
Cancellations
Descriptions, zero value item
Available fields are: credit amount, debit
amount, indicator, denial reason, description,
entry amount
Data available for Inpatient & Outpatient
Cash
–
–
–
–
–
–
–
•
•
Billing
Adjustment
Allowance
Denial
Payment
Transfer
Available fields are: credit amount, debit
amount, indicator, denial reason, description,
entry amount
Data available for Inpatient & Outpatient
Restored Accounts (Outpatients)
–
Credit amount, debit amount, indicator, denial
reason, description, entry amount
Status Change (Inpatient)
–
–
–
–
•
•
Admitting
Principal
Secondary
–
–
–
–
•
Credit amount, debit amount, indicator, denial
reason, description, entry amount
Begin Date Time
Encounter Type
Encounter Visit ID
Medical Record Number
Diagnosis
Encounter
Hospital Charge
–
–
–
–
•
Posting Date
Rate Charged for multiple unit
Rate Charged for single unit
Units Charged
Medical Profile
–
–
–
–
–
–
–
Admitting Diagnosis
Caregiver
Encounter Summary
Principal Diagnosis
Principal Procedure
Secondary Diagnosis
Secondary Procedure
29
29

30. SoftMed
The SoftMed from 3M Systems Inc. is installed at MSMC for managing discharge summaries and operative reports. SoftMed
application stores transcribed and electronically signed Discharge Summaries, Inpatient and Ambulatory Operative Reports. It is
used by HIM operations, chart completion clerks and physicians to receive operative reports and discharge summaries. The
application supports chart location tracking, deficiency tracking and makes physician dictated and transcribed d/c summaries and
operative reports available for online editing and electronic signature.
The SoftMed application interfaces with other systems through ChatLinc. It provides a variety of services like data download,
upload and querying. It can send transcribed results from SoftMed to the other systems for electronic distribution, printing or
storage. Discharge summaries and operative reports are automatically sent to physicians once they are signed electronically.
After the implementation of physician documentation in EPIC, all the operative reports and most of the discharge summaries are
formulated in EPIC. SoftMed still sends out a few discharge summaries mostly the ones that get transcribed.
30
30

31. SoftMed Transactions
•
Discharge Summaries
–
–
–
–
–
–
–
–
–
•
Preliminary version
Final version
Addendum
Report Text
Transcribed Date
Authorized Date
Dictated By
Electronically Signed By
Signed Date Time
Operative Reports
–
–
–
–
–
–
–
–
–
Preliminary version
Final version
Addendum
Report Text
Transcribed Date
Authorized Date
Dictated By
Electronically Signed By
Signed Date Time
31
31

32. CareFusion
CareFusion infusion devices and application at Mount Sinai help address its infusion needs and interoperability of the infusion
data to electronic medical record.
The application went live on Mar 19th, 2013 in limited number of inpatient units (see appendix for the list). An estimated 65% 70% of all units currently report on CareFusion system; rest 30% does not get documented in CareFusion. More so, not all the
products infused to patients, get documented in CareFusion.
The bedside infusion devices remotely transfer the infusion data to Blood Bank application, which in turn completes the
provision process and updates EPIC EMR. The data interchange mostly happens via HL7 feed, however for some units a batch
message file is sent to Blood Bank and subsequently to EPIC EMR.
32
32

33. CareFusion Transactions
•
Blood Product Infusion
–
–
–
–
–
–
–
–
–
–
–
–
–
Product/Blood Type
Product Code
Patient Blood Type
Product Volume
Comment
Stop Comment
Transfusion Date Time
Release Date Time
Start Date Time
End Date Time
Unit Number
EPIC Order Number
Administered By
33
33

34. TDS (decommissioned in April 2011)
TDS was Mount Sinai’s EMR application which captured all clinical information during an inpatient visit. The TDS system was
initially developed approximately 30 years ago, and was implemented at MSMC around 1997. It was a mainframe-based
application that employed a closed, proprietary architecture.
The system was used extensively throughout MSMC’s patient care units, and represented a source of information for a variety of
MSDW stakeholders interested in conducting analysis of clinical and patient care data. The TDS system provided functionality in
several key areas: patient administration, resource and appointment scheduling, ancillaries, pharmacy, medical staff, nursing,
laboratory and care management. Not all these functional areas were implemented at MSMC (e.g. Patient Administration,
Resource and Appointment Scheduling, et al were performed by other systems); the features of interest to the MSDW primarily
involved order entry, clinical results and documentation.
Nursing and physician documentation was partly paper based and partly entered in TDS. Progress notes remained on paper,
nursing admission assessments and shift assessments were mostly in TDS. Allergies, alerts, medication orders and
administration, vital sign were documented in TDS and out bounded to EDR.
The ancillary departments responsible for fulfilling clinical orders use specialized departmental systems to maintain information
about orders placed and the associated clinical results. These systems – laboratory (SCC), radiology (IDXrad), pathology
(Tamtron), and Cardiology – received orders electronically and communicated order status and clinical results back to TDS as
they become available. All orders and results were communicated via real-time HL7 interfaces. TDS had live HL7 interface with
Cerner to receive patient information along with admission and discharge information.
EDR (Electronic Data Repository) was an in-house developed application which interfaced with TDS and other systems and was
storing most of the clinical information from TDS. It provided a nice interface to access all the historical information for a patient
and was widely used in patient care.
TDS was replaced by EPIC Inpatient in April 2011. MSDW holds TDS data from Jan 2003 to Apr 2011.
34
34

35. TDS Transactions
•
Clinical Orders
–
–
–
–
Lab Order
Radiology Order
Pathology Order
Encounter (misc.) Order
–
–
–
–
–
•
•
Nursing Order
Diet Order
Isolation Order
Consult Order
All possible orders from TDS Order Entry
workflow
Patient Medication:
–
–
Medication Order
Medication Administration (MAR)
Clinical Assessments
–
–
Working Diagnosis
Allergy Assessment
–
–
–
Allergen
Reaction
Vital Signs
–
–
–
–
–
–
–
–
–
Height
Weight
Length (Peds)
Blood Pressure
Temperature
Pain Score
Pulse
O2 Saturation
Respiration
Following are key fields captured for all above
transactions:
–
–
–
–
–
–
Medication Name
Unit
Route
Status
Note
Repeat Pattern and Duration
35
35

36. IBEX (decommissioned in April 2011)
MSMC implemented IBEX ED PulseCheck solution as their clinical information system for Emergency Department (ED) in
November, 2002. The application was decommissioned in Apr 2011 and was replaced by EPIC ED solution named ASAP. IBEX is
still functional at Mount Sinai Hospital of Queens.
IBEX operated as ED Management System and had following functionalities: Patient tracking, Triage, Orders (Clinical &
Pharmacy), Clinical Documentations, Billing. It received ADT information from Cerner via HL7 feed, which created an episode in
IBEX to start the triage process. All the orders were sent through HL7 messages to the lab and radiology applications.
IBEX was a web-based application with a proprietary backend. Its backend was a combination of SQL Server tables and text files.
Most of the clinical data resided in the text file in proprietary format that made it impossible to be retrieved and reported. Later
a “Discrete Data Interface” was installed to pull clinical information in HL7 format and MSDW used it to source the data.
Clinical data was entered in the application using a template system i.e. each type of case could use a customized template that
would capture all relevant information on one screen and take less time from user to enter the clinical information.
36
36

37. IBEX Transactions
•
Clinical Orders
–
–
–
–
•
•
Lab Order
Radiology Order
Pathology Order
Bed Requests
–
–
Medication Order
Medication Administration (MAR)
–
–
–
Encounter Information
–
–
–
Admit From
Discharge Disposition
Transfer To
•
•
Allergen
Reaction
Vital Signs
–
–
–
–
–
–
–
–
–
Medication Name
Unit
Dose
Route
Note
SIG
Repeat Pattern and Duration
Last Dose
Dispense
Chief Complaint
Reported History
Final Diagnosis
Primary Diagnosis
Presenting Problem
History of Present Illness (HPI)
Allergy Assessment
–
–
Following are key fields captured for all above
transactions:
–
–
–
–
–
–
–
–
–
Diagnosis
–
–
–
–
–
–
Patient Medication:
–
–
•
Clinical Assessments
Height
Weight
Length (Peds)
Blood Pressure
Temperature
Pain Score
Pulse
O2 Saturation
Respiration
Isolation Indicator
Emergency Severity Index (ESI)
Procedures Performed
Event Timers from triage
37
37

38. Signout (decommissioned in April 2011)
The Signout and MAR (Medical Admitting Resident) Weblog were in-house applications at MSMC primarily used in the inpatient
care. Both these applications filled in the workflow gaps related to team assignment and discharge planning.
Signout for its main part handled the discharge summary related workflows. It was primarily used by residents to draft Discharge
Summary before it was sent to SoftMed for attending’s signoff. The tool was also used to record Communiqués after a consult
service. After years after its onset, the application added Meds Reconciliation module to register Admit and Discharge
medications accurately. Through its progress notes section, it also provided caregiver-to-caregiver communication during the
patient’s length of stay.
Signout application was launched on 12/4/2001 and ability to write discharge summaries in Signout was introduced on
07/11/2005. EPIC inpatient rollout replaced Signout’s functionalities and the application was decommissioned in April 2011.
38
38

39. Signout Transactions
•
Clinical Documentation
–
Discharge Summaries (discrete components)
–
–
–
–
–
–
–
–
–
–
–
–
–
–
–
–
–
–
Discharge Instructions
–
–
–
–
–
Patient Medication
–
Medication Reported (on admission)
–
–
–
–
–
–
–
–
–
–
Brand Name
Dose
Form
Last Dose
Quantity
Route
SIG
Continue (Y/N) (approved by physician)
Reviewed (Y/N)
Prescription (on discharge)
–
–
–
–
–
–
–
Brand Name
Dose
Form
Quantity
Route
SIG
Medication Reason
Follow up appointment (date, location, provider etc.)
Lab Prescription (test
name, instruction, reason, scheduled flag)
Procedure Prescription
Referral (instruction, reason and referral note)
Admission to service
–
–
Admit Diagnosis
Allergies
Code Status
Complications
Discharge Condition
Discharge Diagnosis
Discharge Plan
Report Header
Hospital Course
Medical History
Medications
Physical Exam
Primary MD
Problems
Procedures
Results
Report Text
•
Admit Reason
Communique
–
Report Text
39
39

40. Medical Admitting Resident (MAR) (decommissioned in July 2010)
The MAR (Medical Admitting Resident) Weblog was an in-house applications at MSMC primarily used in the inpatient care for
team assignment.
MAR Weblog portal was used at the at the start of any service during the patient’s stay. It handled caregiver team assignments to
the patient i.e. which caregiver team/group will be attending the patient for a given service. This tool also became an important
source for identifying “teaching” teams and their patients. It also registered all start and end timestamps of services during
length of stay which were not available from any other source.
MAR Weblog was launched in 2009 and was decommissioned in July 2010. The team assignment functionalities were moved to
AgileTrac.
40
40

41. MAR Transactions
•
Admission / Transfer
–
–
–
–
–
–
–
–
–
Team Name
Admit/Transfer From
Reason for admission
Admitting Physician
Attending Physician
Isolation Requirement
Service Name
Team Notified Date / Time
Comments
41
41

42. QS (decommissioned in May 2012)
The Centricity Perinatal Clinical Information System (formerly QS Perinatal), is perinatal clinical information system that captures
and stores the entire maternal/fetal care data. It also provides central station viewing of multiple fetal strips or a full-screen view
for diagnostic purposes.
Some of its functions include but not limited to displaying fetal strip waveform continuously for ease
monitoring, flexible, centralized alerts for fetal/maternal monitors, viewing patient's entire fetal strips, annotating and viewing at
the same time with split-screen capability.
It has archiving, retrieving capabilities and stores fetal strips and data permanently. The system allows one nurse to monitor
more than one patient at a time and runs twenty-four by seven.
The application was replaced by EPIC OBIX solution in June 2012.
42
42