As the U.S. population gets increasingly older (the number of Americans over 65 is expected to increase a little more than 12 percent now to almost 20 percent by 2030), the demands on the nation’s health system—particularly in the area of cardiology—will continue to multiply. Cardiology departments and facilities are looking for ways to keep up with those demands, but in an environment in which adding resources is problematic—and expensive. With the use of cardiovascular information systems (CVIS), these facilities are looking to achieve greater financial and staff efficiencies and gain a positive return on their investment, all the while improving the quality of patient care.

When the Western Maryland Health System decided to take its two primary hospitals—Braddock Hospital and Memorial Hospital and Medical Center of Cumberland—and combine their services in one new, modern facility, the time seemed propitious for the deployment of a new cardiovascular digital archiving and data reporting system.

According to Karen Stair, director of cardiovascular services at WMHS, the topic had actually been under discussion for several years since each facility, neither of which used these systems, struggled with serious data management and storage challenges. So, with a team made up of representatives from the cath lab and non-invasive cardiology unit, as well as IT personnel, WMHS started to sound out vendors about their cardiovascular information systems.

Several factors were involved in vendor selection, one of which was the issue of the new system’s compatibility with a pre-existing information system. The old system is used for internal documentation, orders and registration, says Stair.

“The system that we purchased had to be compatible [with the existing system] in order to meet our record storage requirements,” Stair says. WMIS went with Agfa’s Impax Cardiovascular, which was first installed in both hospitals to let physicians familiarize themselves with the system before the new 275-bed Western Maryland Regional Medical Center opened in November.

The results have been impressive, says Ken Hamilton, operations specialist in the interventional cath lab. “We’ve been able to do away with having to store CDs and tapes from our echos,” he says. “We’ve been able to go paperless with our EKG tracings, physicians are able to access studies from home so it has increased the speed of the interpretation of studies, and its decreased door-to-balloon times because the EKG is downloaded into the system right from the emergency room.” Hamilton also notes that digital reporting in echocardiography has improved departmental efficiency and reduced transcription costs.

Efficiencies gained

For the longest time, the Heart & Vascular Center in the Cape Fear Valley Health System in Fayetteville, N.C., had clinical departments that just couldn’t talk to each other. “Our facility functioned in silos,” says System Coordinator Emily Thorne, so that, for example, the echo and cardiac cath labs had their own image and data management systems. Integration of those systems through the implementation of syngo Dynamics and the Sensis hemodynamic recording system, both Siemens Healthcare products, was a breakthrough regarding efficiency.

The biggest change was found in the cath lab, according to Thorne, where a paper-based data-management system, along with chronic cases of procrastination among physicians, had created a situation in which reports that were supposed to be dictated within 24 hours were taking days, and even weeks, to be completed. “Today, 95 percent of our physicians get their reports done within that 24-hour timeline,” she says.

For Derek Woods, manager, cardiovascular and diagnostic neurology information systems at Wake Forest University Baptist Medical Center in Winston-Salem, N.C., the concept of cardiac data management has been in place for quite a while, since 1992 to be exact, he says.

Even so, a switch in vendors to Lumedx was technically challenging, particularly, Woods says, the process of transferring data from one system to another while trying to deal with a vendor “that was on the way out.”

“It was not a painless process,” he says. “But it was one that reaped a lot of rewards going forward.”

These rewards could range from the front end of patient management more closely tracking data like capturing comorbidities accurately in a patient’s medical history or, at the back end—after a procedure has been completed or a patient discharged—being able to do a better job of tracking complications. “These are instances where we are doing a lot of data analysis to improve the quality of care,” says Woods. “As we collect data at the point of care, we are able to produce a patient’s procedural report in a timely manner. So not only do we have a printed report, but an electronic report going instantaneously into our hospital medical record that’s immediately available.”

Quality improvement

Marin General Hospital in Marin Country, Calif. (part of the Sutter Health network in Northern California) was the first Marin County-certified STEMI (ST-segment elevation myocardial infarction) receiving and treatment center. Yet, when it started facing challenges from competing hospitals to its preferred position as a STEMI receiving center, it analyzed CVIS data to better document and improve response times.

According to Al Tanabe, Sutter Health’s senior systems analyst, CVIS, Marin General Hospital’s CVIS is supporting the hospital’s “30-30-30” goal for STEMI patients—30 minutes for the first responder contact to emergency department handoff, 30 minutes for the ED to stabilize and discharge the patient to the cath lab and 30 minutes from the cath lab door to reperfusion.

“These are very challenging goals for all concerned,” says Tanabe. Marin approached the challenge by using the CVIS to capture data at the most granular and detailed level—all the way from dispatch times down to the serial number of the ambulance used to respond to a call. In addition, CVIS reporting tools were refined in such a way that emergency medical personnel were provided with real-time performance measurements and feedback that could be used to alter processes.

It’s not that STEMI response times were poor prior to the implementation of the “30-30-30” goal—they weren’t, according to Marin General Hospital. For example, its door-to-dilatation times had already decreased from 80.1 minutes in 2005 to 49.4 minutes in 2008. When it comes to STEMI services, what the CVIS offers, says Tanabe, “is continuous quality improvement.”

ROI

Ideally, the deployment of any new technology should help an organization streamline workflow, decrease costs and increase revenue. Certainly, that’s supposed to be one of the benefits of cardiovascular information systems.

Yet, according to a survey of cardiac cath lab directors conducted last year by Wolters Kluwer Health, 31 percent reported “no quantitative improvements” in revenues since implementing a CVIS. Respondents put much of the blame for this on physicians who continue to rely on dictation, despite the fact that clinical procedure documentation is considered to be a key feature of CVIS. In fact, 69 percent of cardiac cath lab directors said their physicians were still continuing to dictate.

Cape Fear’s Thorne says that despite her facility’s improvement in report turnaround time, it didn’t happen overnight. “You still have to get physician buy-in, even if the technology is there,” she says. “And you still have to get physicians to break their habits of dictation and procrastination.”

Breaking the transcription habit could have a significant impact on return on investment. According to the Wolters Kluwer survey, 40 percent of the cath lab directors believe that documentation issues could have at least a “moderate” impact on revenues, while 25 percent said they thought they could save up to $100,000 or more by eliminating costs related to transcription and dictation.

Wake Forest University Baptist Medical Center has realized a substantial reduction in transcription expenses—as much as $90,000 annually in some cardiology departments, according to Woods. The implications for ROI go beyond reducing those transcription costs, Woods says, since report turnaround times and compressing the transcription report cycle “represent everything you need to [speed up] the billing process.”

At Cape Fear, Thorne says it’s clear that the implementation of the CVIS directly impacted a rise in procedure volume.  The facility completes about 9,600 echocardiograms a year, a number that has doubled in the last four years, Thorne says. And as for cath lab procedures, Thorne says she has been working at Cape Fear long enough to remember when the facility performed one a day. By the time they added syngo Dynamics and Sensis that had increased to 12 a day, and now is up to 15 to 20 a day—an increase Thorne “absolutely” credits to the implementation of the integrated CVIS.

Woods also points out that it is possible that the ROI from a CVIS can manifest itself in less tangible ways than can be demonstrated on a balance sheet. For example, at an academic institution like Wake Forest, data collected through the CVIS will be used as the basis for many a statistical sample or research study performed by a Wake Forest physician, says Woods. “And that helps to build the reputation of our physicians, as well as that of the hospital.”