UCSF Medical Center CTG – Apr 03, 2014

1. UCSF Medical Center UCSF Medical CenterCTG – Apr 03, 2014 Project: External Labs Integration- APeXto/from HistoTrac Department:Immunogenetics and Transplantation Laboratory (ITL)  Project Sponsor: Dr. Stephen Tomlanovich Project Champions: Dr. Ascher, Dr. Hamill, Dr. Roberts, Pediatric and Adult Hematopoietic Stem Cell Transplant Programs Primary Business Contact: Victor Corpuz & Rajalingam Raja, PhD., D(ABHI), ITL Director BCD Facilitator: Theresa Kirk

2. The presenter: • Dr. Stephen Tomlanovich, Professor of Medicine and Surgery Departments and Medical Director, Kidney Transplant Service The ask: At the end of this presentation, we will request this committee to prioritize this project. • Scope: Integrate APeX to/from HistoTrac • ADT (re-use) • Lab Orders (44 EAP records) outbound to HistoTrac (re-use SQ feed) • Discrete Lab Results (*) inbound to APeX (re-use SQ feed) • Include URL link to Final PDF Report stored on Surgery Center server in Medical Center Data Center • Include narrative text result filing to Chart Review • Charges inbound to APeX (re-use SQ feed), replacing weekly manual updates • Monthly Billing process will remain unchanged • Size (IT/CS):608 Hours • Total Cost (Vendor, Labor, …,): $109,334 • Labor Costs (IT/CS): $82,334 to be absorbed by the IT/CS Teams • Vendor Costs: $27,000 to be funded by the department • Funding (Vendor Costs): 75% FDP# 5019-148221-2001758; 25% FDP# 5019-148221-2005241 • Client & IT/CS negotiated timeline: April – June 2015 * Discrete Lab Results are required, in APeX, as a pre-requisition to going live on Phoenix. Including discrete lab results, within scope of this work, to avoid re-work later.

3. Context or Background: Diagnostic Testing, Research & Education • The Immunogenetics and Transplantation Laboratory (ITL) provides high complexity testing and services for allogeneic transplantation and conducts related research. • The laboratory provides support for blood, bone marrow, kidney, pancreas, liver, heart, lung and islet transplantation. • The ITL is a national reference laboratory, a referee laboratory for the ASHI proficiency testing program, a NMDP contract laboratory, a core laboratory for the NIH Immune Tolerance Network, and a participant in several national clinical trials. • The laboratory also conducts basic research and provides educational programs for health care professionals. • The laboratory is not-for-profit and is owned and operated by the University of California, San Francisco.

4. Existing Pain Points: • Patient safety risk • Due to manual processes and delay involved in viewing results in APeX • Time sensitive orders; 24 hour turn around • Orders for Immunogenetics and Transplantation Lab (ITL) are placed in APeX and flow to SunQuest(SQ) Lab System. • SQ sends paper order with specimen to ITL • SQ immediately sends a final result message back to APeX, even though order is not yet resulted. • Workflow creates unnecessary email, telephone calls and fax requests to obtain the result because it appears as if the order is resulted in APeX (due to the final message sent from SQ upon receipt). • Once the ITL team results the order, hard copy report is scanned into APeX per test – for up to 75 patients/day - If 5 tests are resulted on patient, scan 5 times same result report into APeX • On paper for charges • Patients are not billed directly by ITL for services related to solid organ pre-transplant • Per Medicare, as a free standing lab ITL is not allowed to bill patient • Tests performed as pre-workup for solid organ transplants cannot be charged to patient until service is performed/organ is transplanted. As many as 65 thousands labs being performed prior to a transplant. • Monthly process exists to bill Departments, via Journal Entry (JE) to Finance Center • Patients are billed for charges, via manual process, if tests are not part of a pre-transplant solid organ workup • File consists of labs related to pre Bone Marrow transplants and all post transplant tests • Weekly process exists to manually create a file from HistoTrac and then data enter, on average 100 charges/week, into APeX

5. Impact: • Affected Locations: • Transplant (Heart, Lung, Kidney) • Department of Rheumatology (Orthopedic Arthritis) • Peds/Adult Bone Marrow Transplant Program • Personnel Impacted: • Physicians   • Finance   • Lab • Training Required: • Who: Physicians, Nursing, Transplant Coordinators and Support Staff • Method:  TBD

6. Recap: We are requesting this committee to prioritize this project. • Scope: Integrate APeX to/from HistoTrac • ADT (re-use) • Lab Orders (44 EAP records) outbound to HistoTrac (re-use SQ feed) • Discrete Lab Results (*) inbound to APeX (re-use SQ feed) • Include URL link to Final PDF Report stored on Surgery Center server in Medical Center Data Center • Include narrative text result filing to Chart Review • Charges inbound to APeX (re-use SQ feed), replacing weekly manual updates • Monthly Billing process will remain unchanged • Size (IT/CS):  608 Hours • Total Cost (Vendor, Labor, …,): $109,334 • Labor Costs (IT/CS): $ 82,334 to be absorbed by the IT/CS Teams • Vendor Costs: $27,000 to be funded by the department • Funding (Vendor Costs): 75% FDP# 5019-148221-2001758; 25% FDP# 5019-148221-2005241 • Client & IT/CS negotiated timeline: April – June 2015 * Discrete Lab Results are required, in APeX, as a pre-requisition to going live on Phoenix. Including discrete lab results, within scope of this work, to avoid re-work later.

7. Appendix:

8. Funding/Costs in detail:

9. Integration