Savvy cardiology departments tap into CVIS to engineer cost-savings, streamline workflow and better patient care.
Cardiology departments across the United States are positioned at a precipice, staring at an array of challenges: an aging population, epidemics of obesity and diabetes, increased competition and a constant crunch for qualified staff. The situation translates into the need for a new model that enables caregivers to meet the needs of a higher volume of patients in an efficient, cost-effective manner. Yet many departments function in a paper-based silo mode that fails to provide anytime/anywhere access to patient data.
Some cardiology departments have found a solution. Next-generation cardiovascular information systems (CVIS) serve as the cornerstone of a massive re-engineering program characterized by streamlined access to patient images and information. The results include improved patient care, better cost control and the ability to use data to inform decisions about every facet of departmental operations. This month, Health Imaging & IT visits several leading-edge sites to learn more about how CVIS is boosting patient care as well as making economic sense.
The hospital within a hospital approach
Over the last 20 years, South Shore Hospital in Weymouth, Mass., has grown from a relatively small community hospital into a regional medical center and provider of acute-care services. While it’s only 15 miles south of the medical-mecca of Boston, South Shore has been able to entice patients to stay local because the hospital is high-tech as well as high-touch—and very easy to access for patients of all ages. As hospital leaders surveyed the demographics of its large catchment area, they realized the hospital needed to overhaul its cardiovascular department. The hospital built a new center based on the “hospital-within-a-hospital” approach. All cardiovascular services, from EKG to cardiac ultrasound, cardiac catheterization and rehabilitation, and all providers are located in the one-stop center—which is just steps from the front door of the hospital for easy access.
The cardiovascular center further streamlines the patient experience by directing each patient to a multi-purpose room. Instead of subjecting the patient to multiple visits or inter-departmental appointments, all providers see the patient in one room.
The new center offered the opportunity to rebuild operations. “We wanted a single-vendor [cardiovascular information system] solution rather than [multi-vendor] departmental systems,” says Bill Burke, director of cardiovascular medicine. That’s because disparate departmental systems don’t communicate as effectively with each other, requiring duplicative data entry that can lead to quality and patient safety problems. “Many medical errors stem from how healthcare shares data,” notes Burke. Using GE Healthcare Centricity Cardiology as its one true source of data, South Shore Hospital overcomes the challenge. The approach is quite simple. After the patient registers, all cardiovascular equipment absorbs the patient data.
The CVIS allowed the center to implement other key improvements. For example, Centricity Cardiology serves as a single database that tracks data across multiple systems, eliminating the need for multiple databases using different methods. “With one click, we can grab and slice and dice data like volume by procedure, physician or time of day. This allows us to make amazing practice management decisions. We know where to put resources [such as staff and equipment] to use them optimally,” says Burke. In addition, clinicians and referring physicians can access all clinical data and images from a single user interface. Plus, clinicians can share images instantly via email, keeping referring physicians and caregivers informed.
With CVIS, South Shore Hospital automated other critical functions including scheduling and patient tracking, billing and supply management. “The lack of efficient processes for these functions can cripple any department,” warns Burke. Centricity serves as a dynamic digital dry-erase board. Every patient, procedure, physician and room can be seen on an Outlook-type calendar. The system constantly refreshes itself as the schedule changes to prevent unnecessary, inefficient over-communication, says Burke.
CVIS also simplifies coding and billing. In a traditional department, technologists and nurses share partial responsibility for coding, checking off CPT codes on a paper-based system before sending the data to the billing department. Centricity merges documentation and coding workflows, extracting coding data from nursing documentation. For example, if nursing notes indicate right and left cardiac coronary angiograms, the system adds relevant CPT codes, and a coding assistant completes the billing process. The results are impressive. Since deploying Centricity in 2007 and implementing processes to analyze inappropriate billing, South Shore Hospital Cardiovascular Center has realized a $45,000 net increase in monthly charges because bills are more accurate than under the previous system.
One of the final pieces of the puzzle is inventory management. The system digitally tracks supplies, alerting staff when inventory reaches pre-determined parameters. The center saves money because it doesn’t run short under the automated system, and it avoids unnecessary equipment surpluses. For example, reports track unused products, allowing the center to return them to the vendor prior to the expiration date. “We use less space, yet have more supplies at the same time,” reports Burke, “because inventory is tightly controlled to meet our needs.”
Deploying IT to build a seamless enterprise
Seven years ago, MedCentral-Mansfield Hospital, a 250-bed community hospital in Mansfield, Ohio, was a typical 20th century enterprise, characterized by departmental, paper-based silos of information that talked poorly to each other. “It was frustrating for physicians. We weren’t as efficient in delivering clinical care as we could be,” recalls Gregory Eaton, MD, director of cardiovascular medicine. Top cardiovascular programs, on the other hand, provide efficient care because data are readily available.
Eaton spearheaded a plan to create an integrated backbone of data. The task, says Eaton, is mission critical. “All hospitals need to use IT to its full potential to provide care in an efficient, cost-effective manner to improve patient outcomes.” The core of MedCentral’s strategy is Siemens Medical Solutions Soarian Suite, including Soarian Clinicals, Soarian Financials and syngo Dynamics.
The IT-based approach removed silos of data, allowing the hospital to increase efficiency, standardize patient care and review outcomes. A before/after snapshot illustrates improved processes. Before the hospital deployed Soarian and syngo, it was very difficult for physicians to obtain prior EKGs. In many cases, treatment started without key pieces of data. “Physicians were hampered without the old test. They couldn’t tell if the changes were old or new,” shares Eaton. Today, physicians access all data via Soarian. If the data show that changes are new, the patient can be directed to a more invasive [treatment] approach. On the other hand, patients with old changes can be treated more conservatively. “Ready access to old data improves safety, and we think it may improve outcomes,” states Eaton.
As MedCentral-Mansfield Hospital eyes the future, the hospital plans to continue to mine Soarian to drive improvements in care and efficiency. For example, it is difficult to extract data from the traditional dictated patient report. Soarian provides a structure for report generation, pushing physicians to add key elements that influence outcomes. Researchers can search the key elements or variables to connect the dots between variables and patient outcomes. “This isn’t possible with dictated reports,” Eaton says. Similarly, the hospital is collaborating with Siemens to tie drop-down menus in the structured report to billing and supply programs. The results include a more accurate bill and the ability to instantly order replenished supplies.
Seizing the competitive advantage
Northridge Hospital Medical Center in Los Angeles operates in an ultra-competitive medical neighborhood. The 450-bed hospital is shoehorned among six hospitals in an eight-mile radius. “We have to stay ahead of the curve,” asserts Ed Lopez, service line director for cardiovascular and respiratory services. Last fall, the hospital upgraded from a first-generation cardiology PACS to a fully integrated CVIS solution by deploying McKesson Corporation Horizon Cardiology. The goal was simple: to make it easier for physicians to come to Northridge and provide efficient patient care.
The three-phase project started with a cardiology PACS upgrade. Prior to Horizon Cardiology, cardiologists were tied to a single PACS workstation in the cath lab. Horizon Cardiology, a web-based system, provides access to cath lab and echo images in the cath lab, throughout the hospital, in physicians’ offices and at home. The hospital ensured speed by adding a separate 2 gigabyte (GB) network and new network drops in the cath lab, echo suite and in physician review areas.
Phase two centered on hemodynamic monitoring and nurse charting. “This is the age of quality. We wanted everything captured for American College of Cardiology (ACC) reporting,” explains Lopez. Horizon Cardiology captures essential data and populates the physician report with it, which ties to the final phase of the project: physician reporting. Documentation is more complete and consistent, he says. For example, consider the patient with a small myocardial infarction. Horizon Cardiology ensures that the physician documents the length of the lesion and stent.
One year after beginning the CVIS project, Northridge Hospital continues to refine its implementation. Cardiologists regularly use Horizon Cardiology to access images and complete reports from home. “They don’t have to come to the hospital as often to dictate or review images,” reports Lopez. In fact, with Horizon Cardiology, cardiologists can view images and consult with each other from home to make an informed patient care decision. In many cases, the hospital can begin treatment before the physician arrives to accelerate patient care.
When Atrium Medical Center, a new 250-bed hospital in Middletown, Ohio, opened its doors last year it started with straightforward goals for ScImage software. “We wanted to improve report turn-around time, provide enterprise access to images and enable serial comparisons,” says Lead Echocardiography Technologist Mike Perez. The software delivers, says Perez, and in addition to streamlining echo operations, the hospital gained a partner.
Prior to ScImage, echo report turn-around languished in the 24- to 48-hour range. ScImage CVIS eliminates the entire dictation/transcription loop. As soon as the physician interprets the echo exam, physicians can view the report. Clinical decision-making is accelerated, and the hospital has trimmed transcription costs.
At Atrium Medical Center, the CVIS deployment resembles a collaborative process rather than a finite project. The hospital is working with ScImage to fine-tune the system in a number of ways including:
- Incorporating voice dictation into the software to provide a best-of-both-worlds reporting option for physicians reluctant to use report templates
- Expanding data mining capabilities to allow the hospital to further analyze procedures, physicians and operational efficiency
- Building an interface to provide access to reports and images via a link in the EMR
Laying the framework for success
CVIS is a multi-faceted project, requiring clear vision and purpose. Experienced insiders offer some tips for success.
- True improvement requires a dedicated cardiovascular IT person, not the IT person of the day, says Burke. Without a dedicated staffer, the program loses accountability and ownership.
- Remember the purpose of the project, says Lopez. Involve physicians, technologists, nurses and quality staff from the beginning to ensure a good fit between the product and end users. In addition, keeping key players involved at every step helps informs the design of structured reports and other mechanisms.
- Find a vendor committed not only to maintaining a smoothly functioning system but also to collaborating for ongoing process improvements.
- Training is significant; cath lab staff must be the physicians’ expert, says Lopez. Designate super-users and tap into them for ongoing training and oversight.
CVIS can serve as the framework for true departmental re-engineering. Sites that implement CVIS as the backbone of an integrated data access project realize critical advantages beginning with comprehensive access to patient images and data and including linkages between systems to reduce duplicative data entry, minimize errors, boost efficiency, cut costs and enhance quality control and patient safety. With CVIS-initiated improvements, the department is transformed into a provider of efficient, cost effective, data-driven, high-quality patient care.
|PACS Across the Enterprise: Meeting the Image Integration Challenge|
As PACS has matured, the reality of digital imaging has become clear. Images are not a departmental commodity. To provide truly efficient digital patient care, images must be available across and beyond the enterprise. Sites are tackling the challenge in several ways. Here are two organizations recognizing the benefits of an integrated approach.
The universal archive
Marshfield Clinic in Marshfield, Wis., is a large group practice, operating 50 clinics and employing 750 physicians across northern Wisconsin. After the clinic implemented departmental PACS nearly a decade ago, it tackled the EHR challenge. Today, it is moving toward a single repository for all DICOM and non-DICOM images. CIO Carl Christensen explains, “The core of our strategy is straightforward. Independent image silos are not sustainable. Silos are very difficult to manage from an IT standpoint, and they are very costly.”
On the other hand, a universal strategy addresses critical challenges in the multi-site enterprise. A sufficiently open repository provides vendor-independence or PACS-agnosticism. That is, images can be easily shared among diverse PACS. For example, a study stored on one vendor’s PACS can be sent to a second vendor’s workstation at another site with a consistent look. In addition, because the open system integrates with various PACS, it allows Marshfield Clinic to provide backend storage for other organizations.
At Marshfield Clinic, the common repository combines TeraMedica Evercore Clinical Enterprise Suite and internally-developed software for image management and smart DICOM routing. When Evercore receives a study, it applies routing and storage rules. That is, if a physician needs to review an image from PACS X on workstation Y, Evercore coerces a DICOM header that integrates into the disparate PACS workflow.
Independent imaging centers face a unique set of challenges and intense competition. Many sites are beginning to hear the same request from referring physician offices. Referrers want to view reports in the EHR, which represents a tremendous integration challenge for the practice faced with dozens of EHR systems. On the other hand, the request is a marketing opportunity as the practice that establishes itself as a leader gains a leg up on the competition.
Epic Imaging in Portland, Ore., has tackled the challenge, tapping into NeoTool NeoIntegrate interface engine to reduce the cost and improve the process of interface development. “It’s costly to develop a RIS interface for each provider’s EHR,” states John Griffith, operations director and CIO, who estimates the price tag per interface at $20,000 to $25,000. NeoIntegrate reduces the cost to about $5,000 per interface. The HL7 integration engine takes standard RIS feeds and builds outbound messages that conform to each EMR’s requirements.
“We improved service to the referring physician population and helped them provide better patient care,” shares Griffith. Reports are automatically placed in an electronic cue for physicians, eliminating the complications, inefficiencies and expense of faxes. The system also monitors each interface, alerting Epic Imaging if an interface goes down.
Enterprise integration delivers
Sites that tackle the enterprise image integration challenge realize critical benefits. They gain a competitive advantage, boost efficiency across the enterprise and facilitate patient care improvements. The upshot? Enterprise image integration will be a business essential.