This is a tale of making cardiac care better. Better for patients, better for the caregivers providing it, and better for a hospital morphing and migrating to thrive in the new world of accountable care. The key ingredients? A new cardiovascular information system, detailed internal project planning and workflow evaluation, structured reporting, seamless and standards-based integration among devices and IT systems, and ample staff training, so says the tight-knit clinical and IT team at North Kansas City Hospital in Missouri.
North Kansas City Hospital is a larger hospital among a plethora of healthcare providers in greater Kansas City. With 451-beds and 600 physicians in 49 medical specialties, the facility has one of the busiest emergency departments in Kansas City. This facility, serving a large cachement area north of the Missouri River, is an accredited Chest Pain Center that blends high touch with high tech.
A new strategy for cardiovascular image management sought to improve cardiac care and strengthen the economics at North Kansas City Hospital. The results prove the success with savings in physician and staff time and quicker hospital discharges. Transcription was replaced by electronic notes and structured reporting, including searchable, quantitative data.
More physicians now have direct and quick access to the results they need, says cardiologist Jim Mitchell, MD. “We see this as a time saver, ultimately, for physicians and a way to save money for the facility today and going forward as the management of care changes,” he says. “[Physicians] can fill in any needed information on a pre-populated structured reporting template, draw in the diagram, and use voice recognition dictation instead of typing. Reporting to the registries is easier and we are sure, when it comes to reimbursement, that our structured reports include the language we need to secure payment.”
Mitchell’s cardiology colleague Steve Gimple, MD, agrees. “Having the essential elements of reports structured offers an advantage to care, accreditation and payment,” he says. “I can sign the report, and within two minutes, it is in the EHR for other physicians to access. That positively impacts patient care and even speeds up discharges; for example, in the case of nuclear studies when we provide results quickly and the patients can leave the hospital sooner.”
Looking back about three years, North Kansas City Hospital had five technology-rich cardiac cath labs and a variety of nuclear medicine systems, echo carts and IT systems to read, create and manage reports. But, they needed a cardiovascular information system (CVIS) that integrated them all, allowed physicians more access points to report efficiently, facilitated greater access to images and reports, and interfaced with their EMR. They wanted a system that would bridge the gap with internal reporting and remote access, and had a standardized plan for end-user devices. Other musts were easy business and clinical reporting, including seamless reporting with ACC registries including Cath PCI, ICD, STS and Action, and accrediting bodies such as the Intersocietal Commission for the Accreditation of Echocardiography Laboratories (ICAEL) and the Intersocietal Commission for the Accreditation of Nuclear Medicine Laboratories (ICANL). Another goal was greater confidence in charge capture.
A broad search of seven CVIS vendors narrowed down to three. A rigid and comprehensive RFP process helped make the purchase decision, with the final nod to implement Siemens syngo Dynamics coming from both the clinicians and physicians on the selection board.
“Previously we had an excessive amount of human intervention to get systems to talk to each other,” says Manager, IT Applications Joe Singleton. “That didn’t work for us; there were too many inefficiencies in getting cases done and reports out quickly.
Physician reporting was limited to specific places in the hospital and that needed to be expanded," he notes. "That’s why this time we chose a system that would allow us to accomplish our ‘dream workflow.’”
That dream workflow—for both non-invasive and invasive cardiology—was created by a team of clinicians and IT specialists who took the time to learn each other’s languages. The team took to planning from the clinical and IT perspectives—enabling true collaboration to develop among the team in understanding one another’s needs and goals. It also extended to hospital and physician coders