In this interview, we speak with Daniel R. Anderson, MD, PhD and Shane F. Tsai, MD about their use of the Geneva Platform (Geneva Health Solutions). University of Nebraska Medical Center (UNMC)/Nebraska Medicine in Omaha, Nebraska, was an early adopter of the Geneva Health Solutions technology platform. Dr. Anderson is the Director of Cardiac Electrophysiology at the University of Nebraska Medical Center and Nebraska Medicine, and Clinical Operations Advisor at Geneva Health Solutions. Dr. Tsai is an electrophysiologist with Nebraska Medicine.
Tell us about your EP program.
Tsai: We have 2 EP labs at Nebraska Medicine, and currently there are 5 electrophysiologists in our practice. We’re adding 2 more faculty this summer.
Anderson: There is a total of 5 cath/EP labs for cardiovascular procedures. We also have a hybrid lab where we do device extractions. As with most academic medical centers, we each spend part of our day focused on clinical workload, education, research, or administration. We have recently hired 2 more EPs, who will be primarily clinical based. Overall, we take care of our primary EP cardiology patients; however, we are also a referral center for many of the private cardiology and EP cardiology providers within the region.
How long have you used the Geneva Platform and service at your institution?
Anderson: We have been developing with Geneva for about 2-3 years — since pretty much its onset. The company initially developed the product to be a tool that the Emergency Department could use to evaluate a device’s battery, leads, and threshold. The University of Nebraska Medical Center partnered with Geneva early on, and have been involved in the development of the current product (including functionality, etc.).
Tsai: Geneva Health Solutions came into development approximately 6 years ago. They contracted with Nebraska Medicine over 2 years ago to help develop their web-based clinic application, as the next evolution of their existing Emergency Medicine platform. We began integrating it in our clinical workflow in July 2016, starting with remote monitoring. Over the last 6 months, we have fully integrated it into our practice, even while Geneva continues to develop their platform.
Tell us about the Geneva Platform and how it was customized to suit Nebraska Medicine’s specific practice operations.
Anderson: Before using the Geneva Platform, the University of Nebraska Medical Center was managing its own “deforestation project” with the amount of paper we were using to print reports for our daily remotes. Those reports would be sent to the doctors to read and annotate, then taken to the nurses for them to review, and finally scanned into a PDF and sent into the abyss of the Epic monitoring system. We needed to streamline and more effectively manage our remote monitoring, and the Geneva Platform offered us this ability right away. We’ve been involved in the kind of data elements we wanted, and have had flexibility in the program and the software platform. We wanted to be able to upload PDFs, and we wanted to be able to acquire the individual data elements (pacing thresholds or impedances) to utilize them within our notes and reporting system. The first step was to remove the paper trail and streamline that process. A flow sheet of the remote monitoring workflow we used to have compared to the workflow we have now demonstrates all the extra steps we used to take (Figures 1 and 2). With the Geneva Platform, patient remote downloads from Medtronic, Abbott, BIOTRONIK, and Boston Scientific go into the Geneva portal, where we can review, annotate, sign, and schedule follow-up, and it then becomes part of the medical record. We submit it and it gets translated back to Epic as a PDF, is annotated, and then our staff will see the remote. Billing and scheduling are done manually. Beyond developing the look of the interface, the next step will be to build the billing component and integrating this with Epic, so that when the EMR is signed, it will also be billed and scheduled. Becoming more automated will help us do all the essential components and also decrease the burden of time and overhead.
Tsai: It’s a work in progress, and we’ve spent the past year figuring out what this product does best, and then making that useful in our workflow. Geneva can be used for data management of both remote monitoring and in-person device checks in the clinic and hospital. This is a web-based platform that integrates and translates all the individual codes from the major pacing systems into one website, where we can review all the information on one platform. The basic premise of the initial platform was to make reviewing cardiac electronic devices as simplistic as possible; however, physicians have different levels of use. For instance, the purpose of the ED platform was to determine whether or not the device was functioning correctly. It didn’t measure trends or things like that, which is obviously something that a device clinic is much more interested in. The initial platform took the information from individual devices and put it into report format, and the current platform is being developed into something more robust. From my understanding, I believe their intent is to be able to quickly customize the website to the consumers’ request — that will be available over the next 6-24 months. In terms of customizing our needs, we wanted the platform to provide more in terms of programming and device information, and to translate the data from the device websites into the Geneva Platform. All the device companies use different programming languages; it is essentially like taking 4 different foreign languages and trying to interpret them into one common language that everyone can understand and use — anyone can appreciate how difficult that might be. Geneva’s efforts are to work with these companies to figure out how to translate their codes into one usable feature so it comes across one web-based platform.
In what ways has your workflow changed or improved with use of the Geneva Platform?
Anderson: It has dramatically streamlined workflow. I was recently talking with some local reps who used to help us sometimes in the clinic with device checks — they’d check the device, print out the report, and we’d annotate it. Now they are just uploading the report from the programmer, and it saves them time.
Tsai: It has redesigned workflow in our device clinic. We used to interrogate devices, print out reports, give them to the physician to review, and someone else would enter that as a report into the EMR system. There was a lot of handoff, a lot of paper involved, and a lot of people trying to read physician handwriting, which in itself can be quite a task. The new workflow is one streamlined system in which devices are interrogated and reports are put into electronic format, so the physician now reviews them online, signs the report, and that automatically transfers into the EMR system. There is more automation that occurs now. When you’re interrogating and reviewing 40-50 device reports per day, that used to mean printing out 10-20 report pages per device, which added up to a lot of paper in the clinic and hospital. Now all this information comes in PDF format, and it’s all online. I simply sign it electronically — no one has to read my handwriting or interpret what I wrote, and it is entered into the system.
How does use of the platform also translate into better patient care?
Tsai: Because everything is automated, it’s more accurate and there is less potential for human error. The website is also very accessible, which makes our job easier because we’re able to quickly facilitate patient care. Everything is on one website that can be accessed from anywhere, so I can read reports from my laptop. I think one of the biggest issues with our previous workflow was the amount of scanning that we were doing. Reports would come over as paper, and would have to be scanned and uploaded into the system. I don’t think that was happening as efficiently or accurately as we’d hoped. If you didn’t go back in to check if everything was uploaded, you wouldn’t know if reports were missed. Now everything is transmitted automatically, so once it is uploaded — as long as it is signed and has accurate identifying information — it goes automatically into the EMR, and there is a permanent record. Information is instantly available without having to log into different websites. This all improves patient care. We’ve expanded to where we’re now training our fellows how to use Geneva. After interrogating a device, they upload the interrogation into a PDF that gets uploaded into Geneva. When I log into Geneva, I can see a copy of that report and verify their interrogation results because it is part of the embedded data.
Has the Geneva Platform helped you reduce costs?
Anderson: Yes, it has significantly reduced our use of paper – we used to have stacks of papers everywhere. It has also improved efficiency along the line, including documentation, reporting, action items, billing, and collections. It will only get better as we automate this further. While we have been using Geneva for our remote monitoring, Dr. Tsai has been central to the integration of Geneva into our clinic, which has also had a positive impact on our clinic workflow.
Tsai: We began using this last July. We used it for evaluation of remote monitoring for about 3 months, and then added it into device clinic practice. We haven’t yet had a chance to go back and look at cost effectiveness. On the one hand, we’re saving money on paper, which translates into thousands of dollars. On the other hand, it has helped better automate our system, and if we are more efficient with remote monitoring, it should reduce costs associated with duplication of efforts. In terms of patient care, automation is helpful because alerts are more organized, resulting in fewer missed events and prompter clinical decision making, which should also improve overall patient care costs.
Has your caseload grown since utilization?
Anderson: Although our device numbers haven’t increased, we’re more effectively and appropriately managing remotes. So instead of having one staff member spend their day driving device workflow, we now have them making sure everyone is doing the remote monitoring that we know is medically important. Geneva offers that functionality, capacity, and flexibility.
Tsai: It’s been an interesting process working with this energetic and innovative group. We’re now using Geneva for about 90% of our device management workflow. Occasionally if there is a problem, we revert to printing things out, but it doesn’t frequently happen. Geneva Health Solutions does also offer a separate remote monitoring service. We have not yet engaged them for this particular resource, but it is an important option for cardiology groups which may have challenges supporting this aspect of device management. I’m excited — there is a lot of potential in the system, and I simply want to see it work for our institution.
Disclosures: The authors have no conflicts of interest to report regarding the content herein. Outside the submitted work, Dr. Tsai reports honoraria from Boston Scientific and Medtronic. Dr. Anderson is the Clinical Operations Advisor at Geneva Health Solutions.