Decision Support: Improving Data Quality, Improving Cardiology Decision-making

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mountain-state-tenn.jpg - CVIS - Mountain State Health, Tenn.

Providing excellent healthcare in our data-rich world comes down to having excellent data. The highest quality data today are assisted by decision support software and for structured reporting. Mountain States Health Alliance headquartered in Johnson City, Tenn., is one health system leading the charge and reaping the benefits of a more intelligent, decision support-enabled CVIS with a built-in quality control engine that ensures data entered into the report are consistent. It means the right information gets to the right person at the right time.

Mountain States Health Alliance is a not-for-profit healthcare organization operating a family of 13 hospitals serving a 29-county, four-state region in Northeast Tennessee, Southwest Virginia, Southeastern Kentucky and Western North Carolina. A “Most Wired” award winner, Mountain States includes a large tertiary hospital, a heart hospital, several community hospitals, two critical access hospitals, a children’s hospital, a behavioral health hospital and two long-term care facilities, among other services.

The cardiology department manages six cath labs at Johnson City Medical Center, one at Indian Path Medical Center and one at Johnston Memorial Hospital; together completing 6,000 procedures each year. Mountain States offers echocardiography at all facilities and two outpatient diagnostic locations, which adds up to about 30,000 exams each year. Some 30 cardiologists support the health system.

Digging deeper

One of Mountain States’s core values is to always pursue a higher standard. A decade ago that higher standard meant improving cardiovascular care with the installation of a Siemens syngo Dynamics CVIS. Last summer they raised the bar once again by adding decision support (DS) software to the CVIS. “The decision support tool is excellent for optimizing workflow, automating processes, and evaluating the quality of the data transferred to the report,” says William “Brent” Nottingham, cardiovascular and informatics manager. “It provides great consistency checks. It helps us on several levels: clinical, operational and financial. It has greatly improved efficiency in how quickly we can abstract cases for NCDR purposes because we know the source of the data, and we know the place to go to get those answers.”

Decision support adds a deeper layer of detail to structured reporting, to guarantee accurate, precise and complete data input to the EMR, care teams and/or separate clinical decision support systems. syngo Dynamics DS software helps the cardiovascular care team compile reports knowing the data input is from a trustworthy source.

Here’s how it works: syngo Dynamics CVIS now features an embedded user-configurable rules engine, with which the user can create policies or rule sets for different study types. The IT team at Mountain States can then define rules to automatically inspect study data such as measurements, observations, dates, times, Booleans and text to confirm that a study’s information achieves consistency and clinical relevance. For example, alerts can be generated if questions like these were not answered correctly: Is the qualitative interpretation of the systolic function consistent with the measured value of the ejection fraction? Or, is a 3D echo billing code supported by the physician report that mentions 3D echo was performed?

If there are missing or inconsistent data in the report, users such as sonographers or physicians can be alerted to provide additional information or correct the data. “It’s a great help to the techs doing the echocardiograms,” Nottingham says. “We automate some processes based on study time, some values and a collection of values. This allows us to analyze multiple observations and generate results off of them. For the physician's workflow, decision support is all about results out. It is truly driven by the question: Is the data collected reflected in the interpretation of the physician?"

Bits, bytes and benefits

The team at Mountain States spent a great deal of time evaluating their goals for decision support, how they were going to access the data, analyze the data, and who was going to be the responsible party. Parameters were defined based on evidence-based medicine and physician preference, with the team leaning heavily on the American Society of Echocardiography for the echocardiography and other American College of Cardiology guidelines for appropriate use criteria (AUC), ACC semantics, cath lab procedures and measurement