One goal of hospital administrators and executives is that all of their various patient information systems work well in concert. A concomitant concern of private practice cardiology groups is that they find the available patient data from the hospital systems valuable and effective on a day-to-day basis. The two endpoints don’t always meet up.
Cardiologists are increasingly conducting more imaging tests in their offices. Along with imaging study results, they also want to know other patient data that possibly originated in the hospital such as ejection fraction, lab values, ECGs or previous cardiac conditions. Some hospitals don’t capture the necessary data digitally, making it available to the cardiology group as a text document only. This becomes problematic if physicians want to track specific outcomes over time via the electronic medical record (EMR).
Without the digital capture of data that enables information to be tracked and mined via the EMR, practices have several choices. They can continue to track information from text documents or they can have staff enter specific pieces of data into the office-based systems. Both options are becoming increasingly unpalatable in the 21st century.
“Many vendors are making efforts to create the clinical documentation at the point of care,” says Michael J. Mytych, president of Health Information Consulting, Milwaukee, Wis. “If those data are inside the cath lab or inside the nuclear diagnostic area, the clinical documentation that occurs in those locations can actually acquire the data digitally. Then it’s a matter of making sure that the information systems have the ability to export the data via an HL7-type message to any other clinical system that has a need to know.”
The challenge for hospitals is they have multitudes of physician groups representing all kinds of specialties that need information. Hospitals are not necessarily in a position where they have built their data export technologies out far enough that they can move information virtually seamlessly to the physician practices, Mytych says.
Cardiology groups need to understand each facility’s particular workflow process: what data can be transferred back and forth today and what advances can they expect in the future. In addition, cardiologists need to work closely with hospitals so that the hospitals are aware of the discreet data the physicians will find valuable and ensure that the cardiovascular information systems (CVIS) can import and export those data to and from the private practice EMR, Mytych says.
Years of decision-making
Larry Sobal, CEO of Appleton Cardiology Associates in Appleton, Wis., has been refereeing the choosing of an EMR for four years. The 17-member independent cardiology group cannot find consensus regarding the matter. One of the problems is that the group can purchase the system used by their major hospital partner and reap the benefits of a federally-mandated discounted price, but they would suffer certain functionality limitations the hospital system doesn’t offer specialists. In addition, with the hospital system the group would enjoy connectivity to a large number of primary-care physicians employed by the hospital. This group represents nearly 70 percent of the cardiologists’ referral base.
“The decision has divided our group,” Sobal says. “Some people are willing to make the trade-off of less functionality, cost advantage and more connectivity to the primary-care physicians. Others are willing to pay more to get a system designed for the specific needs of cardiologists. And still others say both options are unacceptable. They’d rather wait to see if the hospital system improves its functionality or if something else comes along.”
Nevertheless, the group’s board appointed an IT task force to study the issue and make a recommendation regarding when and how the group should implement an EMR. Most everyone associated with the group agrees an EMR is inevitable. Those who support immediate action point to the efficiencies gained from consistent and easy access to information. It is evident that the current system will not be able to handle the changeover in 2011 to the new ICD-10 codes, of which there are nearly eight times more than the outgoing ICD-9 codes.
Sobal says the pace of change in healthcare would put them at a disadvantage if they