In healthcare today, climbing to the top or staying there requires keeping up with the latest advances in technology that improve not only patient care, but a facility as a whole. That whole is made up of many departments that operate best when connected to each other and throughout the enterprise. Until just a few years ago, electronic reporting and connectivity wasn’t readily available to cardiology departments. As a result, cardiology felt left behind while other departments connected. Those days are over as new and improved cardiovascular information systems (CVIS) make their way to the center of cardiac care.
On the 50-mile drive to one of Cincinnati Children’s Hospital’s outpatient clinics in Batesville, Ind., pediatric cardiologist William M. Gottliebson, MD, director, MRI Cardiology, explains what he does when he arrives prior to seeing his young cardiology patients. “The first thing I’ll do is fire up the PC,” he says. In doing so, he has immediate access to patient records and images through Emageon HeartSuite Vericis Web Access, a CVIS product. He has at his fingertips complete reports of all his patients, as well as his colleagues’ patients he needs to tend to.
Gottliebson began working with CVIS in 2003, a month before he joined the 475-bed Cincinnati Children’s Hospital in Ohio, where 12,400 children are treated annually for cardiac problems. He says he can’t imagine working without it. “Knowing all that information and being able to get it all with a mouse-click is incredibly important, particularly when you are at home or when you are on call,” says Gottliebson.
Accessing reports remotely is just one of CVIS’ most convenient and popular features, along with viewing images from PACS. The Emageon CVIS is tied to the radiology imaging studies at Cincinnati Children’s, which includes x-rays, CT, ultrasound, MRI, nuclear medicine and fluoroscopy scans.
There is a CVIS revolution in progress, though it’s not fast-paced, and it’s something cardiology departments have been wanting for a long time. As more digital images become available in PACS, as hospitals become more connected and as more information is required for reimbursement and national registries, the need for a comprehensive image and information system also grows.
CVIS—as the image and information solution for cardiac care—provides everything a cardiology department needs, digital image management, archiving, reporting and workflow management. It links cardiac ORs, echo labs and cath labs—their records, PACS and modalities—with other hospital departments. In a couple of words, it’s cardiac central.
“In radiology, basically the workflow is driven by the creation and managing of images; cardiology is quite the opposite—it’s all information-driven,” says John Alex, director of CVIS at the 613-bed Rush University Medical Center in Chicago.
“Data really drive the day for cardiologists. So the capture of discrete information, and more importantly, the creation of actionable types of reports from this data are what’s really important,” says Alex, who adds he’s seen a lot of changes since joining Rush in 1986. Rush relies on GE Healthcare’s Centricity to manage their cardiology patient information. Echo, stress, electrophysiology (EP) and electrocardiogram (ECG) are integrated into CVIS.
Around since the late 1990s, CVIS debuted with a few kinks. In the last few years, vendors have done some fine-tuning and the systems now meet the needs of cath and echo labs in approximately 30 percent of the 1,500 hospitals with cardiovascular departments.
“[CVIS] was not very stable in the beginning; it was very difficult to manage,” says Alex. “The system itself has become more stable over the years. They’ve opened up more and more modules for different areas within cardiology.”
Now that the system kinks have been worked out, the industry anticipates annual growth of 10 to 20 percent as more and more hospitals need to be connected. To install a system, they will pay from $250,000 to more than $1 million, depending on the size of the facility.
Cumbersome versus a cinch
What a cardiologist needs first and foremost is information—historic, accurate, complete and ready at a moment’s notice. In the “old days,” before the implementation of CVIS, getting that information together was cumbersome, or nearly impossible in some cases.
“A paper chart on a patient who is very complicated becomes massive—they become inches and inches thick and then what happens is they start a new chart,” says Gottliebson. “When you work in a big hospital, certainly one that deals with hundreds of thousands of charts, they miss some. Just trying to keep up with the information is really hard.”
Gottliebson says prior to HeartSuite, during emergency situations cardiologists often had to rely on family members to provide a patient’s history, which was sometimes incomplete. With CVIS, the physician can review the history with the caller in real-time, and fill in the gaps as needed.
Physicians can easily navigate patient reports via a PC, whether in the hospital emergency room or outpatient clinic. Such is the case when the cardiologist is on call. He or she can get a call about a colleague’s patient at home and access his or her records from a home computer via the web-based function.
“I just click on cath and it will show me all the old cath reports. Not only can I see the letter that was written about the catheterization, I can see the data,” says Gottliebson. He adds that he can now look through all the data to better understand the treatment and monitoring course, and thereby make better decisions about additional therapies.
“[CVIS] revolutionized things for us—almost like everyone having a PC and using email,” says Gottliebson.
The internal bridge
Internally, replacing the paper chart for the physician is just the beginning of CVIS. Its enterprise-offerings provide answers to workflow and administrative challenges that, in turn, save time and money. “It’s allowed us to manage our time more effectively,” says Alex.
From scheduling to procedure reporting to billing, it’s all tracked by CVIS. The system records everything, basically the five Ws—who, what, when, where and why. It ties in all of the functions to the appropriate fields and provides information dissected as needed.
In 2004, Memorial Hermann Healthcare System in Houston, Texas, installed the first phase of Agfa HealthCare Heartlab Encompass. Eight of the system’s hospitals currently have Encompass with echo imaging and echo reporting; six hospitals also have cath imaging; and one hospital has American College of Cardiology (ACC) data collection capabilities.
“For the healthcare system, the key benefit to using Heartlab was around cath reporting. In fact, we started looking at this system from the cath procedures reimbursement perspective,” says Donna Snover, manager, multidisciplinary solutions team, Memorial Hermann Healthcare System. “Prior to Heartlab, there was no way to track any additional procedures the physician would perform while in the cath lab because everything was on dictation.”
Snover also recounts the benefits of hemodynamic monitoring, one of the functions available on CVIS. She says “Our Southwest Heart & Vascular Institute was able to automate pulling off the [data] from the hemodynamics system into Heartlab, where before they had an FTE who was manually typing it. Now it comes over from hemo, goes into Heartlab, and then she can import the data and export it to ACC. So that’s a big time savings and the quality of the data is there.”
Hemodynamic monitoring is tied to CVIS clinical reports, notes Alex. “The physiologic recording systems pass information pertaining to demographics, wave form data and measurement, logging of events, medication and supply usage, as well as ongoing vital signs. It is important to have this data entered once, in one place, and flow into the report,” he says.
“We have seen that we have been able to move on things quickly and if we have a problem, we have not just our gut feeling about what’s going on. We have real numbers and real information to tackle these issues,” says Kelly Neal, RN, MSN, MBA, director of cardiovascular services at The Washington Hospital in Washington, Penn. The 239-bed hospital with 17 cardiologists has three cath labs and five echo labs. They installed McKesson Horizon Cardiology in 2005, one of about 100 in use nationwide.
Before CVIS, “we needed to have inventory; we had no idea what we were spending on our cost per case,” says Neal. With the automation, that detailed information is available at anytime.
Data that counts
As technology advances, so does the quest to acquire and analyze data. What might have taken years to do using paper charts, or not be accomplished at all, can now be done with a few keystrokes on CVIS. One of the most important reporting features relates to collecting data for the ACC national registries. Collecting data for cath lab certification, comparison to other facilities, reimbursement, pay-for-performance and insurers is becoming more necessary. Participation in the National Cardiovascular Data Registry, a quality measurement program for cardiac and vascular facilities, provides them with access to research and data—two essential tools to keep moving forward. To participate, facilities must use an ACC-certified CVIS.
“I will tell you that the ACC [data collection] was one of the things we were most pleased with because what comes out of our reports maps directly to the ACC and those mandatory seals are 80 percent complete,” says Neal.
The ACC information also is critical to Memorial Hermann Healthcare. An organization on the move with three newly constructed hospitals and another on the way, they consider being named an Academic Center of Excellence a necessity on two fronts: reputation and reimbursement.
The ACC data also can be used for research purposes which is critical to the Memorial Hermann System—an organization on the move with 14 hospitals which include three hospitals in the Texas Medical Center (a level 1 trauma center, a hospital for children and a rehabilitation hospital), as well as three heart and vascular institute locations and eight suburban hospitals.
“Being named an Academic Center of Excellence is an advantage for many reasons, including enhanced reputation and reimbursement level,” commented Snover. “But, most importantly, it lets our community know that we are committed to a higher quality of care.”
Far reaching results
CVIS does more than eliminate thick charts, save time, streamline operations and more effectively monitor billing. As the center of cardiac care, it is the primary connection within a facility that links cardiologists, patients and administrators inside and out.
This article first appeared in the August 2007 issue of Health Imaging & IT.