While a cardiovascular information system (CVIS) can help practices achieve meaningful use and improve outcomes, due diligence is required to adopt one.
Ochsner Health System
The Ochsner Health System, an eight-hospital, 38-health center system located in southeast Louisiana, uses its homegrown CVIS, among other usages, to facilitate computer decision support (CDS) when admitting cardiac patients with acute MI or acute coronary syndrome. The CDS system utilizes clinical and laboratory data to derive risk scores (TIMI risk, bleeding risk) and suggests therapy or drug dosing based on quality-performance guidelines. In a study, Richard V. Milani, MD, vice-chairman of the department of cardiovascular diseases at Ochsner, and colleagues found that patients in a CDS-generated care group had half the 30-day mortality as the standard care group (2 vs. 4 percent).
The CVIS also creates reminders and provides suggestions of guideline-driven therapies that should best suit the patient, such as properly prescribing aspirin, ADP-antagonists, statins, beta-blockers and ACE inhibitors, Milani says.
Because the CVIS facilitates better documentation and cuts transcription costs, the homegrown technology has netted more than $1 million overall through better coding and billing practices. In fact, Milani says that cutting transcription costs has saved the facility $40,000 to $50,000 annually. Additionally, rather than using the previous e-bill solution that cost Ochsner $800,000 per year to run, the CVIS now performs the billing. The annualized cost to run the CVIS is $200,000 to $250,000 per year; however, the estimated $1.8 million in savings has outweighed the yearly expenses, Milani says.
Hoag Heart and Vascular Institute
For the 500-bed Hoag Heart and Vascular Institute in Newport Beach, Calif., the three main priorities for its CVIS (Philips Healthcare) are to decrease operational costs, improve quality of care and improve patient outcomes, according to Tom Lonergan, executive operations director at Hoag.
Lonergan says the CVIS can help in establishing protocols. In the case of electrophysiology, for example, standard protocols for operators do not yet exist. Hence, some operators use more supplies, some procedures take longer and some operators may use more radiation. Lonergan tracks these metrics with the CVIS in an effort to standardize protocols. Once operators perform procedures relatively uniformly, all parties should benefit. Patients and operators could be exposed to less radiation, utilization of supplies could be more balanced and outcomes should improve.
The cost to integrate a CVIS in a medium- to large-sized hospital is between $500,000 and $1.5 million. Therefore, it’s imperative to fully understand the diverse functionality of a CVIS, including that which leads to improved cath lab workflow, patient care and staff performance, among others, Lonergan says.
Information on Atlantic Health System
For the 1,000-bed, two-hospital Atlantic Health System in northern New Jersey, the 29-month CVIS implementation (McKesson) process was no easy feat. As a beta site, the facility's implementation process was prolonged because it tested newer modules as they became available. Jennifer Scatcherd, project manager at Atlantic Health, calls this “scope creep.”
“It is important to create a clear internal process to manage scope control, which might include members of the project management office and all the major stakeholders,” she says, adding that Atlantic Health had a CVIS steering committee that had oversight for the project’s scope control.
Often vendors will write software that has all the elements and functionality required for a first-rate product, but users of the application will still be frustrated at the interface, Scatcherd says. “One particular group that is vocal about this functional challenge is physicians, who rarely have time to deal with technological decision making. Physicians repeatedly report that anything more than ‘one click’ is unacceptable.”
Perception can sometimes interfere with reality and if physicians perceive the new CVIS to be cumbersome, their adoption enthusiasm will lag, potentially dragging others down with them. Be prepared for dissatisfaction and plan a strategy to counter it, Scatcherd says. “While a satisfactory solution to one-click syndrome may not be in the offing initially, building a strong relationship with your application vendor will give you more leverage when requesting a resolution of the issue.”