CVIS: Improving Departments from Within

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Data from the cath labs at Scottsdale Healthcare in Arizona are directly exported to the ACC registries from the CVIS.

Cardiology departments are learning that their cardiovascular information systems (CVIS) are the perfect conduit to produce actionable and quantifiable data that can drive quality process improvement and cost savings.

Quality measures

Properly utilizing and disseminating data gathered from a CVIS requires a systematic approach that should extend throughout a healthcare network, says Mark Watts, system imaging manager for Iasis Healthcare’s 16 hospitals in six U.S. states. The deployment of a widespread IT project needs complete administrative support, and should be bolstered and reviewed by a physician champion.

Watts installed a CVIS at his previous employer, Provena Healthcare, a six-hospital system in Illinois, and currently is undertaking a similar, larger scale implementation with Horizon Cardiology CVIS (McKesson) at Iasis’ facilities. Once deployed, hundreds of reports can be acquired via the CVIS, and these data can be mined to help improve myriad processes and quality initiatives.

Methodist DeBakey Heart & Vascular Center in Houston was an early adopter of CVIS when in 2003 it implemented a Digisonics system, says Director Marti L. McCulloch. The center has 10 operating rooms, eight cath labs, 154 acute-care beds, 48 ICU beds and 30 transplant beds.

Methodist tracks quality measures, such as study turnaround times and patient report turnaround times, which can be pulled from the database to assess physician performance. Then, the provider disseminates the data through a quality metrics dashboard. “Regardless of the superiority of the clinicians or their interpretation, if the report doesn’t get sent off to the referring physician in a timely manner, its relevance is lost,” says McCulloch.

When the CVIS was first installed, the facility discovered its vascular lab had an average report turnaround time of 10-plus days. The average turnaround time now is 24 hours.

Barry Szakolczay, data specialist for the cardiovascular services at Scottsdale Healthcare, a three-hospital network with about 850 beds in Scottsdale, Ariz., says the institution generates between 70 and 90 reports monthly from the CVIS. Scottsdale Healthcare went live with its Centricity DMS (GE Healthcare) in late 2006.

Scottsdale Healthcare frequently monitors length of stay for the cath lab and cardiac surgery. With those data, length of stay from admission to procedure, length of stay from procedure to discharge and total length of stay can be reviewed by cardiologists and cardiovascular surgeons. Surgery data are entered into the Adult Cardiac Registry of the Society of Thoracic Surgery (STS), allowing the society to evaluate outcomes on a national level. One of the key data elements the society tracks is patients with a hospital length of longer than 14 days. Data collected in the cath labs also are entered into an American College of Cardiology (ACC) registry, allowing the provider to compare outcomes nationally.

“If a surgical patient had an extended stay of 14 days or beyond, our surgeons would review that case to assess why the patient stay was prolonged. The only way we are able to track these factors on a frequent basis is through reports issued from the DMS,” Szakolczay says.

Patient outcomes

Scottsdale Healthcare’s CVIS has a statistical risk report which extracts data from an STS module, and examines the outcome/expected outcome ratio of patients for such events as mortality, renal failure, re-op, prolonged ventilation and deep sternal wound infection rate. Patient characteristics and co-morbidities also are available from the database. The STS module assigns a risk score to each patient for each of the categories, and that information is pulled onto a report from the CVIS. Biannually, Szakolczay and his colleagues meet with the surgeons to review expected outcomes, compared with actual outcomes.

Szakolczay says that the “surgeons rely on these data very heavily, and look forward to seeing the report and where they stand, as well as where they can make improvements.” 

Likewise, at Iaisis Healthcare, the CVIS produces “hard facts that allow managers to have serious, productive conversations with their physicians, who in turn, have tremendous clout within the community and within the organization,” Watts says. Within the cath lab, there has been a tremendous push to reduce door-to-balloon times. 

For the ACC/AHA databases on door-to-balloon times, figures can be captured in real-time via hemodynamic equipment and fed back into