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 could not quickly adapt to it. The more time that elapses while trying to make the decision, the longer an EMR implementation will take. “Even if the group makes a decision today to move forward, the selection, preparation, implementation, and optimization will mean that it will not reap the benefits of EMR maturation until 2011 or later,” he says.
Sobal believes that ultimately their referral base will drive the decision. Most primary-care physicians have said that their lives are easier when the specialists they refer to are on the hospital system, he says.
Center of Excellence
In its quest to become a Center of Excellence, Hoag Memorial Hospital Presbyterian in Newport Beach, Calif., has many issues to address, particularly with respect to the disparate technology and information systems. The most important aspect when undergoing change of this magnitude is to have all stakeholders—in the front-end and the back-end—understand the need to have integrated data flow, understand the plan and have total buy-in from everyone, according to Tom Lonergan, executive director of Hoag Heart and Vascular Institute.
Lonergan says they planned the digital connectivity of the Heart and Vascular Institute for a year. They came up with a team-based approach and a design that made sense to everybody. For the design to make sense, the CVIS had to not only incorporate procedural data, but many other kinds of information including regulatory, inventory, scheduling, interdepartmental and more.
The institute is at the five-year mark of a 10-year plan. In the beginning, it had many disparate pieces of technology, but as each piece came due for replacement, it gave Lonergan and colleagues an opportunity to install technology that fit with the integrated design plan. “We knew every component was being added as part of the strategic design,” Lonergan says.
Now the institute is bringing all the technology together with a CVIS that includes connections to physicians’ offices that tie their EMR with the institute’s EMR. In the cath lab, for example, all information is input in real time into an electronic report using drop-down boxes and custom designed structured reporting. The CVIS sends the report—either in its entirety or in part—to the EMR, medical records, referring physician, billing or regulatory agencies.
Typically what most hospitals and groups have is a PACS (picture archiving and communication system), but a PACS is only one piece of a CVIS, says Lonergan. The CVIS has to go beyond handling clinical data and include scheduling, billing, regulatory reporting, EMR interfacing, patient registration—everything that has data. “You want instant access to all data at all times and you can only get that if all systems are integrated into one system.”
Having the right CVIS frees up management and decision-makers from having to find, collect and process information. Rather, their time can be better spent analyzing the data and devising ways to improve operations. “In my 30-plus years, I spent so much time chasing information. My job is to provide solutions and a competitive advantage. I’m less effective if I have to do the leg work,” Lonergan says.