About Community Outreach Using Health System Informatics (COHSI)

COHSI integrates outpatient, inpatient, and administrative databases, as well as an infrastructure of programmers and analysts with expertise accessing health system data.

COHSI includes all data collected in the Eclipsys Sunrise Clinical Manager (SCM) inpatient electronic health record (EHR), including encounter specific data on all orders, medication administration, lab results, and select provider notes. Eclipsys is a health information technology company providing services to more than 1,500 clients, including integrated delivery networks, academic medical centers, and community hospitals. The Eclipsys SCM system is an inpatient EHR with advanced clinical decision support capability that has been operational across Penn Medicine since 2006. More than one million orders are entered monthly into SCM, including those for pharmacy, radiology, laboratory, respiratory, and other services. Eclipsys is also interoperable with other Penn Medicine EHRs, including the ambulatory EHR and TheraDoc.

TheraDoc is an electronic infection surveillance technology that detects and monitors infections. The system surveys all available electronic data from multiple sources, including pathology and laboratory medicine, pharmacy, radiology, and admissions databases. The Infection Control Assistant module provides continuous infection surveillance, confirmation of healthcare-associated infections, easily programmed alerts, and analysis of monitored infections. TheraDoc was implemented across Penn Medicine from 2007 to 2008.

COHSI also includes the Pennsylvania Integrated Clinical and Administrative Research Database (PICARD). Developed by COHSI Co-Director Mark Weiner, MD, PICARD is a longitudinal database integrating clinical and administrative data from multiple information systems, including the health system's ambulatory care EHR (Epic Corporation), the laboratory results reporting system, and billing. The database captures patient demographics, participating physicians, diagnoses assigned during outpatient encounters, and charges and reimbursements for all procedures performed. Additional data include discrete details about outpatient medication prescribing, problem lists, and vital signs. PICARD has been operational since 1997 and its value as a data resource has been demonstrated in numerous published studies.

Horizon Performance Manger (HPM) is a vital component of Penn Medicine information systems, and COHSI. HPM is the health system's administrative database purchased from the McKesson Corporation. The system was implemented in 2001 and contains data from the hospital billing systems as well as the specialty and primary care physician billing system. HPM includes codes identifying patient, physician, diagnoses, procedures, adverse events, and other relevant clinical and administrative information. The data are consolidated into a common format available to end users throughout the health system. The system also includes data from complementary systems including: medical records; admission, transfer and discharge; general ledger; expected payment; and transfer center data. Cost is applied to all services (except specialty physicians.) The system is used extensively by administration and researchers across the health system.

COHSI analysts have access to data included in the Eclipsys inpatient EHR, HPM, and the PICARD database. As a whole, data available from these sources include hospital and ambulatory patient descriptors, diagnoses, procedure codes, medications, tests, admission and discharge dates, 30 day readmissions to Penn Medicine hospitals, and other relevant clinical and administrative information. Clinical data can also be extracted from TheraDoc, which centralizes data on infectious diseases, including diagnoses, medications, labs, antibiotic resistance information, and unit specific data that is valuable for infection control, such as number of urinary catheter and central line days. Treatment costs can be collected from HPM.

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