Seamless CV Data Integration into the EMR
The urgency to transition the U.S. healthcare system to a paperless system has increased as the government has offered incentives to “get connected” and penalties for those who lag behind. Advances in image and report IT capabilities allow cardiologists to now provide seamless access to all patient data across hospital departments and facilities.

Poudre Valley Health System

Almost three years ago, Poudre Valley Health System (PVHS), based in Fort Collins, Colo., but spanning three states, started working with Philips Healthcare to more tightly integrate all of its imaging data with their EMR (Epic). The goal was to bring radiology, cardiology and other specialty imaging systems together as part of the overall EMR plan to provide one-stop shopping from providers. The next stages of the project, which should be completed in the third quarter of 2010, will involve upgrading the current hospital information system (HIS) from Magic to Client/Server (Meditech).

One of the main goals of this project was to have all images available in one system, the PACS (iSite, Philips). To do that, Gretchen Gibbs Allman, ancillary applications manager at PVHS, and her team needed to have an order entry application (radiology information system, or RIS), which both cardiology and radiology could use, to generate an accession number—a DICOM study’s identifying number. This is a challenge for many health facilities, Allman says, as many RIS applications are designed for the radiology workflow, not multidiscipline HIS systems like the one at PVHS. MediTech provides a module, called ITS (Imaging & Therapeutic Service), that can bridge all ancillary departments. ITS was designed with a multidisciplinary appeal, thus it can be used for placing orders and generating an accession number for many different modalities.

Interactive EMR graphics allow fast documentation of multiple interventional, electrophysiology, and vascular tests and procedures results. Provided by NextGen.
“One of our HIS’s greatest strengths is the modular integration,” says Allman. For example, demographic, patient specific account and medical record number (MRN) entered into the Meditech admissions module are directly accessed by the ITS module without interfacing. This saves time and increases accuracy. “We also needed this order information from Meditech to flow into our Philips systems and have the results from the Philips systems flow back into Meditech. The solution was to use an interface between the Meditech system and the various Philips systems. The interface allows patient demographics, account number, MRN and accession number to populate the worklists for the image systems. This also saves time and increases accuracy and, thus, improves patient safety,” Allman says.

Advice for shoppers

For facilities or practices looking to purchase a system that helps them seamlessly connect cardiology data with the EMR, Allman suggests ensuring that the order entry system, on the EMR or HIS side, is flexible enough to handle the needs of various areas.

Another key element is to ensure that upper management is dedicated to the vision to see projects through to their completion. In the case of PVHS, senior management had to ensure that everybody wanted to have a single registration system in order to share information across facilities. Even though the cardiology clinics at PVHS have their own ordering system (ECIS), they have signed onto the single registration system as well. “They do a very short double entry. They register into their own system and they register in ours, so that we have a common patient identifier to allow for cross-facility integration of patient care records,” Allman says.

Connecting practices to hospitals

A few years ago, Cardiovascular Consultants, a 38-cardiologist practice in Kansas City, Mo., had an IT manager and an IT staff, but no director of IT. That changed with the arrival of Kelly Lolli, who was hired to help better integrate the practice with Saint Luke’s Mid America Heart Institute. “It was important that the practice have a voice in hospital IT project implementations,” Lolli says.

The practice, as well, needed to modernize its IT security and the strength of its infrastructure. The EMR (NextGen) had been in use for about five years. It had been purchased before NextGen had a specific cardiology package. Over the years, the IT team has added many applications to enhance their workflow. “We have 100 percent utilization. All physicians use the EMR, not only to view patient information, but also to enter patient data, orders, and they use the e-prescribing module,” Lolli says.

The interoperability with other systems is integral to utilization. From the EMR, cardiologists have access to outside system results including holter tracings, cath lab, nuclear, echo and electrophysiology reports. They can also view images from the EMR by clicking on an embedded link. Referring physicians have access to information such as lab results through the Health System’s Community Health Record.

Referring physicians only want a summary of what happened in the patient’s visit. They do not have the time to sift through a book of information, Lolli says. The hemodynamic reporting system (Mac-Lab; GE Healthcare) at the hospital, for example, generally contains more information than a referring physician actually wants or needs. Cardiologists review the hemodynamic data when they are in the cath lab, create a truncated report and send only the essential data to the referring physician or the next treating physician. Additionally, when the cardiologist confirms the report, it is automatically sent to the EMR at the practice.

For those shopping for EMRs, Lolli suggests asking as many questions as possible about all the potential scenarios. Just as important, be prepared to make changes along the way, she says. “Clinicians will figure out ways to simplify their workflow or organize data in a way that improves clinical outcomes,” she says.

William Daniel, MD, and John Spertus, MD, of Cardiovascular Consultants did just that. They presented two studies at the 2009 American College of Cardiology meeting showing that a home-grown clinical decision support (CDS) tool improved outcomes.

In one study, they programmed the CDS to identify patients at high risk of sudden cardiac death, according to the guidelines. The recognition rate of patients who would benefit from an implantable cardioverter-defibrillator (ICD) increased from 24 percent pre-CDS to 93 percent post-CDS, and the increase was sustained out to two years.

In the second study, the researchers addressed reports of lower rates of ICD implantation of among eligible women and African Americans. Using the CDS, they found that the gender and racial disparities which were present prior to implementation were no longer apparent afterwards.

One concern as the government moves toward IT standardization is the level of customization that IT teams often build into their systems. Lolli recommends having an EMR that is customizable, but she cautions that the impending regulations might hinder some of those personal touches.