In the current era of healthcare reform, spawned by the funding made available in the HITECH Act of February’s stimulus package, there has been much discussion about producing transparent and quantifiable data on the performance of various departments. In addition, the Joint Commission as well as state and federal agencies has enacted measures to ensure quality care. These developments have placed new onus on hospital IT systems, such as cardiovascular information systems (CVIS), to produce actionable and quantifiable data that can drive quality process improvement.
Properly utilizing and disseminating data gathered from a CVIS requires a systematic approach that should extend throughout a healthcare network, says Mark Watts, imaging systems manager at Iasis Healthcare. The deployment of a widespread IT project needs complete administrative support, and should be bolstered and reviewed by a physician champion. He installed a CVIS at his previous employer, Provena Healthcare, a six-hospital system based in Illinois, and currently is undertaking a similar, but larger scale implementation with McKesson’s Horizon Cardiology CVIS at Iasis, a 15-hospital chain that spans six U.S. states.
Once deployed, hundreds of reports can be acquired via the CVIS, and certain providers are choosing to change processes based on these data, with the intention of improving quality measures and patient outcomes within their facility.
Methodist DeBakey Heart & Vascular Center in Houston was an early adapter of CVIS when in 2003 it implemented a Digisonics system, says director Marti L. McCulloch. The center has 10 operating rooms, eight cardiac catheterization labs, 154 acute-care beds, 48 ICU beds and 30 transplant beds.
Methodist tracks quality measures, such as study turnaround times and patient report turnaround times, which can be pulled from the database to assess physician performance. Then, the provider disseminates the data through a quality metrics dashboard, which includes report turnaround times and stat turnaround times, to ensure processes are completed within the provider’s mandated time frames. For instance, STAT EKGs need to be done within 15 minutes.
“Regardless of the superiority of the clinicians or their interpretation, if the report doesn’t get sent off to the referring physician in a timely manner, its relevance is lost,” explains McCullough.
In fact, when the CVIS was first installed, the facility discovered its vascular lab had an average turnaround time of 10+ days. Now average turnaround time is 24 hours.
“With CVIS, we are building transparency into our system to identify opportunities for improvement, not to admonish under- performers” Watts says.
McCullough concurs: “It’s important to have performance very transparent because physicians and their staffs tend to be competitive, and each team wants to perform the best.”
Barry Szakolczay, data specialist for the cardiovascular services at Scottsdale Healthcare, a three-hospital network with a total of about 850 beds in Scottsdale, Ariz.—which went live with its GE Healthcare’s Centricity DMS [Data Management System] in late 2006—says his institution generates between 70 and 90 reports per month from the CVIS.
Scottsdale Healthcare frequently monitors length of stay in both the cath lab and cardiac surgery. With those data, length of stay from admission to procedure, length of stay from procedure to discharge, and total length of stay can be reviewed by cardiologists and CV surgeons. Also, surgery data are entered into the Adult Cardiac Registry of the Society of Thoracic Surgery (STS), allowing STS to evaluate outcomes on a national level.
One of the key data elements the society tracks is patients with a hospital length of longer than 14 days. Data collected in the cath labs also is entered into an American College of Cardiology (ACC) registry, allowing the provider to compare outcomes with those on a national level.
“If a surgical patient had an extended stay of 14 days or beyond, our surgeons would review that case to assess why the patient stay was prolonged. But the only way we are able to track these factors on a frequent basis is through reports issued from the DMS,” Szakolczay says.
Also, the Joint Commission requires providers to track their critical results,