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