Building a Better Cath Lab Report

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 - Khaldoon Alaswad, MD
Khaldoon Alaswad, MD, Co-medical Director of the Cardiac Cath Lab, ThedaCare, Appleton, Wis.

Creating the best cardiac cath lab procedure report is the first step to bettering patient care and maximizing reimbursement in this competitive and complex zone. State-of-the-art reporting today is all about uniting key patient data, anatomical diagrams and essential elements for quality improvement, coding and payment. If you haven’t already, it’s time to take a closer look at structured cath lab reporting.

ThedaCare, a community-owned health system based in Appleton, Wis., has done a lot of things right. They were early on the EMR adoption curve, implementing four years ago across the five-hospital system that includes Appleton Medical Center, Theda Clark Medical Center, New London Family Medical Center, Shawano Medical Center, and Riverside Medical Center. A solid IT infrastructure is coupled with leading edge cath labs, imaging equipment, hemodynamic monitoring and fully integrated cardiology PACS. “The rapidly changing healthcare environment requires a strong electronic infrastructure,” says Dean Gruner, MD, ThedaCare president and CEO.

But ThedaCare’s cath labs were missing an important piece: structured reporting and coding. “The physicians were struggling with paperwork,” recalls Keith Ende, director, Cardiac Diagnostics and Invasive Services. “They were trying to live in both an electronic world with reporting and a paper world in drawing important coronary tree diagrams that then had to be scanned. Sometimes people couldn’t find them. And we also didn’t have all we needed for coding and insurance to be sure we were paid. We were forgetting this or that in the report. It just didn’t work.”

Neither did the week-long turnaround on dictated reports, often full of errors, and incompleteness of patient data and essential billing codes, says Khaldoon Alaswad, MD, co-medical director of the cardiac cath lab. “We were not in control of the report. We had to wait for someone to transcribe it, often with errors inserted from misheard terms. Several days later it was hard to remember the case exactly to be sure no errors were present. We had to double-back to approve reports. It was just inefficient medicine.”

So the health system embarked on a search, taking an extensive look at technologies and vendor options. A team initiated and lead by physicians also included nurses, cardiology administrators, IT leadership and radiology technologists. They focused on systems that united both physician reporting and coding and would work well with their Philips hemodynamic monitoring and Epic EMR. The vendor of choice needed to be differentiated by robustness of technology, practical integration know-how among EMR and hemodynamic systems and quality physician training.

“Interventional cardiologists are very visual, they need to be able to easily create diagrams of unusual anatomy to communicate that with other physicians,” Ende says. “Electronic reporting takes that up a notch in personalization and detail. It allows physicians to draw what they saw which helps interventionalists, surgeons and the like.” As Alaswad says, “the picture is worth a thousand words.”

ProVation MD, a structured reporting and coding solution that provides clinically relevant, intuitive software that can ensure hyper-accurate documentation, emerged as the clear choice. “It was the horse we wanted to ride,” Ende says. “It gave us the best documentation for cardiac anatomy. It was nimble and met our needs.”

The system includes a medical content database, updated biannually, that includes comprehensive peripheral vascular and coronary content. The DocuDiagram feature makes coronary tree documentation more efficient by allowing physicians to modify unusual anatomy, quickly document findings and interventions and navigate easily through complex cases. While the cardiologist is filling in the DocuDiagram, the medical content database is completing the procedure note in the background. The powerful coding engine then applies the appropriate reimbursement codes based on what is documented.  ProVation MD’s reimbursement codes are updated quarterly and ICD-10 ready. Discrete data capture allows for easy sharing of quality data and streamlines American College of Cardiology registry submission.

From both the IT and clinical sides, ProVation MD was a good match for the health system, says Mike Rodman, manager, Cardiac Diagnostics and Invasive Services. “We were very pleased with the way it worked together with the systems we had in place. We knew we’d have to troubleshoot certain areas of integration but we were ready for that.”

At ThedaCare, the EMR is the backbone. “Per our CIO, Epic has to be the backbone, not the imaging system” Rodman says. “That is a change of tack here as well as other facilities.”

So once the commitment to purchase was made, ThedaCare and ProVation jumped into planning and implementation mode. Project managers from both organizations paired up to begin the careful integration of systems. ThedaCare had recently upgraded their Philips  hemodynamic system which ProVation interfaced with seamlessly. A ThedaCare IT project manager worked with an Epic interface person to make sure all the patient information and data were linked back to the EMR which then recognizes the results and sends the cath lab report to the physicians who need it. Three months prior to the go-live, IT staffers from ThedaCare and ProVation fine-tuned workflow and made sure data were properly populating reports.

Staff began training in a test environment a month before go-live, including two super-users per site. Physicians were trained at go-live, but no worries—“this is where ProVation really excelled for us,” Ende says. “We had two people at the elbow of the physicians guiding them through it.”
Start to finish, the project took nine months, ending with the go-live in September 2013.

“Very smooth” is how Ende and Rodman describe the go-live, with the only revision being adding some power to their PCs to boost performance. “We couldn’t have anticipated that prior to going live but we were able to upgrade quickly and not lose time,” Ende adds.

Physician reaction is all positive, too. “The report is almost instantaneous,” says Alaswad. “There is less chance for error and care is clearly faster for the patient and care teams. We create the report, we sign it and all the information is available right away in the EMR. Doctors are notified and they can make decisions as to what step is next for the patient. This saves myself and my partners’ time because we don’t have physicians paging us and then needing to call them back with information that we may recall or not if too much time has elapsed and we don’t have information right in front of us.”

With complete reports ready so quickly, physicians can review images as they advise patients and family. “You can’t beat this technology in terms of patient education,” Ende says.

Physicians also appreciate no longer being haunted by coders seeking the information-rich sheets physicians had to fill out and turn in for billing. “We have a 100 percent capture rate for procedures to code. That is the only way to be in 2014,” Ende says.

Structured reporting also adds another layer of depth: data mining for evidence-based medicine. “There are many examples,” Alaswad says, “such as easily tracking all of the patients with a particular stent so we can contact them if a recommendation has been published—such as the use or omission of a drug—that could improve their care or health. Tracking reports, with the push of a button, also gets rid of humans needing to look through records in the case of managing device recalls. Long term, this provides better care.”

Looking back, Ende says it was the physicians who drove the system purchase but all around it has been a good fit. “The physicians were very engaged. We had their buy in and made it a success.” That success is shared among great IT support internal to ThedaCare as well as from ProVation Medical and key cath lab equipment vendors. “We followed ProVation’s lead in how to manage this project. That was invaluable. It really works for us.”