It seems now more than ever that Information Technology (IT) is at the forefront of healthcare discussions. Information that documents the patient experience is essential to the understanding of clinical quality and cost outcomes. Information related to patient registration, pre-admission testing, recording a history and physical, the timely scheduling of diagnostic or surgical procedures, clinical documentation, patient follow-up, quality reporting, and billing/reimbursement are all essential elements of a full patient information profile. The prospect of information technology systems reaching beyond the wall of the acute care hospital and extending out into the physician office and ambulatory settings of care can be quite daunting for some organizations.
A complex set of variables must be managed across a broader patient care experience as we begin to layer on recently defined regulatory requirements for Electronic Health Records (EHR) and incentives that have been put in place for hospitals and doctors to achieve “meaningful use” objectives. The Health Information Technology for Economic and Clinical Health (HITECH) Act is driving this IT development with the intent to improve healthcare quality, safety, and efficiency through the development of the EHR and electronic health information exchanges.
Two recent regulations have been creating a lot of buzz in the industry as the Centers for Medicare and Medicaid (CMS) is working to define “meaningful use” requirements that providers must meet in order to qualify for bonus payments. The CMS final rule related to the minimum requirements for an EHR to qualify for additional payments can be found at http://www.cms.gov/ehrincentiveprograms/.
Corazon’s message is that the need for IT systems and solutions is everywhere, and it is never more evident than within the areas of information-rich cardiac, vascular, and neuroscience services. Unless your organization has fully embraced some component of IT, or has begun to vision how your departmental-based IT systems integrate with your overall enterprise-wide IT strategic plan, you may quickly be left behind. Hospitals and physicians are beginning to feel the pressure to implement seamless IT systems and infrastructure to remain competitive from a cost and quality perspective.
At a programmatic level, as software solution companies compete for your business and continue to refine their products, it is important for the service line administrator, physician specialist as well as the direct patient care clinician to understand the value and benefit of embracing one, if not both, a cardiovascular information system (CVIS), a picture archiving system (PACS), or more specifically, a cardiology picture archiving system (CPACS).
A program’s ability — be it Electrophysiology (EP) and/or Cardiovascular — to capitalize on these IT solutions will no doubt separate “best practice” programs from the rest of the pack.
Oftentimes, Corazon finds programs utilizing the same imaging equipment for both cardiac and EP studies. Beyond sharing the imaging equipment or “cath lab,” how can a program utilize its CVIS and PACS systems beyond hemodynamic management, clinical evaluation, or documentation of the patient and the procedure? Before we can answer this question, let’s first consider recognizing the need for a CVIS and PACS system and some of the challenges programs face as they bring this level of “best practice” to fruition.
Recognizing the Need for Information Technology
Programs recognizing the need to employ either a CVIS system or PACS, CPACS integration have already taken the first step to become a “best practice” program. These programs will be most equipped to appropriately utilize all data from documentation, inventory and cost management, and image storage and retrieval, as well as have the ability to internally and externally benchmark quality outcomes.
As simple as this may seem, it takes great planning and diligent execution to fully capture the benefits of the capital and “sweat equity” investment necessary to operationalize the IT vision. First and foremost, a program must assess what it is they intend to accomplish by either employing a CVIS solution and/or a PACS solution.
For those service line administrators wanting to move forward with a CVIS or PACS solution, Corazon recommends a careful assessment of their program needs as well as the fiscal and manpower resources needed to operationalize these systems. Figure 1 depicts the five stages that Corazon believes must be considered and recognized through a solid work plan before a CVIS system can become fully operational.
Once a program plan has been documented, the selection of a vendor or vendors must be seriously considered. Given the financial investment, these vendor decisions are extremely important as they have long-term implications for overall connectivity and the ability to achieve a seamless portal for the view and query of patient-related data. For implementation, the “devil is always in the detail.” Corazon recommends that end-users be involved early in the planning and development process to assure their concerns and needs are understood and addressed. Also, dedicated resources must be assigned to assure that the implementation process does not languish, and that end-user issues are addressed. This can be critical to a successful and timely implementation, and for user acceptance.
As these systems are selected and designed, the end product — whether that be clinical, financial, or management reporting — must be top of mind. Our experience is that many programs across the country spend significant dollars and energy in collecting information, but lack the systems and processes to analyze the information and improve cost and quality outcomes. Rigorous review of information that translates to actionable performance improvement recommendations must be the end goal for those programs that want to achieve “best practice” status.
The Quality Benefits of the CVIS Solution
Hospitals across the country offering some level of diagnostic or advanced cardiac catheterization or EP services are often faced with the decision of which CVIS system is best suited for their program. After all, not every hospital offers a “full-service” open-heart or complex EP program. With that said, it is important for these programs to clearly understand what it is they want to accomplish through implementing a CVIS or PACS solution.
The ability of the cardiac catheterization or EP lab to capture data beyond the basic hemodynamic recording and clinical documentation is essential. Cardiac catheterization and EP laboratories now have the ability to report beyond the standard indicators that are typically measured, such as procedural times, contrast or even catheter utilization. CVIS systems today are capable of drilling down beyond these indicators. In fact, given the increased scrutiny around program and physician quality, CCL managers are now capable of monitoring, reporting, and in most cases utilizing this data to drive performance improvement within their program and report physician-specific outcomes. This is especially relevant with the recent position statement released in March 2011 by the Society for Cardiovascular Angiography and Interventions (SCAI) regarding cardiac interventional programs and their PI and CQI processes.2
In today’s competitive cardiac and EP market, performance improvement is not the only driver for programs demonstrating top performer status. Costs are often directly related to quality, and the goal for top performing programs is to drive quality up and costs down. In fact, if you are considered a level 1 EP program in which the scope of the program provides the ability to implant permanent pacemakers and/or standard automated internal cardiac defibrillators (AICDs), the ability to track clinical quality and cost parameters is particularly important. An EP program implanting these devices must adhere to CMS criteria and guidelines, and the program must submit to the NCDR® ICD Registry™ in order to be reimbursed for these procedures.
Even beyond EP, if you offer percutaneous coronary intervention (PCI) within your CCL, then it is strongly encouraged that you participate and submit to the NCDR® CathPCI Registry® allowing you to benchmark your program nationally with other PCI programs. In each of these cases, programs have the data and information readily available at their fingertips to share and report not only with the national registries, but with those physician specialists participating within the organization. Systems must be in place to assure information use is not retrospective and available for action only when the report is issued. Top performing hospitals are scrutinizing and taking action on individual patient and program outcomes on a real-time basis to maximize their ability to implement timely positive changes.
Many of the CVIS solutions on the market offer inventory management software that assist programs in managing their supply inventory and track the utilization of a specific vendor or use patterns of individual physicians. The inventory management solution and associated standardization processes can raise an awareness of just how much inventory is consigned versus purchased, and the analysis of the costs associated with both options. Programs may find they may have four to five different vendors on the shelf, and through report generation may find that they are only utilizing two. The information from the inventory system should not only be used for setting par levels and just-in-time ordering, but can provide information to achieve consensus from medical staff operators. The goal should be to use the inventory system information to standardize product and processes to provide state-of-the-art care with an eye to cost containment.
The expectation of physicians at many advanced EP and cardiac programs is ready access to additional diagnostic test(s) reports or images. The utility of integrating CT, MRI, or SPECT study information, even as the patient is in the lab and on the table, has become even more important as we have multi-modality physicians working in hybrid settings of care. Programs that have successfully accomplished the integration of not only radiology PACS, but perhaps the CPACS solution, are capable of providing the patient with a more comprehensive care experience and the physician the ability to become more efficient and precise in their decision making and treatment options for that patient.
For example, a patient having a complex atrial fibrillation ablation may have undergone a three-dimensional CT or MRI study in order to more clearly define their cardiac structural anatomy. In addition, the same patient may have undergone additional diagnostic testing such as a Holter monitor, EKG, or even an echo test. All of these diagnostic tests assist in the most appropriate diagnosis and treatment plan for the patient. Providing the EP staff and the physician “real time” access to these reports and/or images is considered a “best practice” approach to care for many reasons. Their ability to retrieve this information during the time of the procedure allows for a shorter procedure or lab time for the patient, which can be directly related to a lower complication rate. In other words, there are no phone calls to other departments to send the reports or films to the EP lab, meaning no increased procedure time or inefficiency. Capitalizing on these efficiencies allows for a higher volume of procedures being scheduled and performed, thus increasing program revenue and decreasing labor or overtime costs.
Additional efficiencies that can be accrued through an integrated PACS or CPACS solution is making other diagnostic tests that a physician would otherwise have to leave the department to review, read, and/or dictate available for remote view and/or interpretation. Providing the physician this capability can provide for more patient decision making, allow for a more efficient utilization of the lab, provide capacity for increased procedural volume, and result in a more proficient and efficient physician.
Through this very high-level look at a few benefits of CVIS or PACS, CPACS solution integration, it is Corazon’s hope that cardiac and EP programs across the United States will begin to recognize that their ability to remain competitive will no doubt require initial and ongoing IT investments. There are many unanswered questions about the regulatory climate and how the “meaningful use” criteria will evolve and impact the course of our IT journey. For those programs that have stepped outside their “comfort zone” and have developed and integrated their information systems to achieve best practice, we salute you and will tap you for lessons learned.
Corazon welcomes the opportunity to speak to those programs who feel that they have successfully managed this “art of integration.” Please feel free to submit your feedback to the e-mail address provided below.
Amy J. Newell is a Director at Corazon, Inc., a national leader in the full continuum of services in the heart, vascular, and neuro specialties, including consulting, recruitment, and interim management.
To learn more, visit www.corazoninc.com, or call 412-364-8200. To reach Amy, email email@example.com.
- Gail Prochaska. “Cardiology PACS Adoption Maturing, while Integration with CVIS and/or PACS is a Work in Progress.” IMV. 26 January 2011. <http://www.imvinfo.com/user/documents/content_documents/def_dis/2011_01_25_14_36_33_807_IMV_CVIIS_2010_Press_Release.pdf>.
- Klein LW, Uretsky BF, Chambers C, et al. Quality assessment and improvement in interventional cardiology: A position statement of the Society of Cardiovascular Angiography and Interventions, part 1: Standards for quality assessment and improvement in interventional cardiology. Catheter Cardiovasc Interv 2011 Mar 2. doi: 10.1002/ccd.22982. (Epub ahead of print).