Examining how the use of integrated information management technology has improved reporting timeliness, information accessibility and workflow at the University of Washington Medical Center’s Cardiac Catheterization Laboratory
The UW Medicine Regional Heart Center is part of the University of Washington Medical Center in Seattle. Ranked in 2003 as one of the top 10 hospitals in the country by US News and World Report, the UW Medical Center is one of two major teaching hospitals for the University of Washington School of Medicine.
The Cardiac Catheterization Laboratory at the UW Medicine Regional Heart Center is a leader in interventional cardiology, with a depth and breadth of experience that sets it apart in the Pacific Northwest. The cath lab performs the full range of diagnostic and interventional procedures in three cath lab suites. The average annual case volume is approximately 2,200 procedures and 450 interventions. Three full-time interventional cardiologists, seven cardiovascular technologists and three RN FTEs staff the lab.
Optimizing workflow with information technology
To help us achieve greater workflow efficiencies in the cath lab, we installed the Vericis® image management and reporting system and the Vericis PhysioLog hemodynamic monitoring system from Camtronics Medical Systems in 2001 (Hartland, WI). Since the installation of these systems, we have experienced multiple workflow improvements, including:
Immediate network access to angiographic studies from anywhere in the medical center and its affiliated hospitals and clinics;
Paperless physician reporting and quicker availability of final results;
Streamlined, remote consultations with off-site diagnostic cath labs;
More efficient inventory management and supply billing;
Automated exchange of ADT, orders and results with UWMC information and electronic medical record systems.
Quicker availability of final reports
According to Larry S. Dean, MD, Director of the UW Medicine Regional Heart Center, integration and data exchange between systems has enabled a move from the conventional paper-based, dictation-driven procedure reporting to a computer-based, electronic reporting methodology.
Data is pulled from several different sources into the Vericis reporting application, including demographics from our ADT system and the data we’ve determined we want from the cath log. This data pre-populates the catheterization report to the point where the physician only needs to add his interpretation of the angiographic data and authenticate the report.
There are many benefits to this method of reporting, not the least of which is more efficient access to patient information. Once the report is authenticated and confirmed, it is immediately available on the network to any authorized practitioner who needs the information, notes Dr. Dean. We don’t have to send out a paper report, so there’s no longer all the FTE effort and time that was required in the past to generate copies and route paper to medical records and referring physicians.
We’ve also experienced a significant improvement in the turnaround of reports. Eliminating the dictation and transcription steps is key. With this system, in the 15 minutes between procedures, you can actually generate a finished cath report, says Dr. Dean. I can sit down at one of the dual screen review stations and all the information is right there the demographics, images, hemodynamic data. I can look at the images on one screen, add my interpretation on the other and confirm the final report on the spot. The system even abstracts key pieces of information out of the report and formats a referral letter.
In addition, we are using the auto-fax capability of the system to fax cath reports and referral letters as soon as they are available, which has significantly improved communication with our referral sources.
The consistency and accuracy of reports have also improved. If you look at reports that were done in the past with dictation, the amount of content varied widely from physician to physician, notes Dr. Dean. Now we are producing stylized reports that have a consistent structure and a certain set amount of information on each patient. Furthermore, the system prompts you to put in certain items that are necessary for a complete, billable report indications for example. If indications were not in the report, someone on your staff or in billing would have to go back and look at the medical record to ascertain why the procedure was performed in the manner reported. With this system, if you go through the report outline as it is presented, you will generate a report that is consistent, complete and ultimately more accurate.
The Vericis review stations display a study status indicator that serves as a reminder to physicians and fellows on cases that have not yet been reported, which further enhances reporting timeliness. Completed reports and the associated images are immediately available on the Vericis Web Server to authorized clinicians. The reports are then automatically transferred to the UWMC ADT and electronic medical record systems in the appropriate messaging format for those systems.
Despite these benefits, Dr. Dean notes that some physicians insist that dictation is a more efficient means of producing clinical reports. He believes that view is shortsighted. Certainly one can dictate a report very quickly, but there’s an important difference that’s often overlooked. The report I create on Vericis is the final report. It doesn’t have to be transcribed, reviewed or touched again by me in any way. You spend a little more time upstream, but you eliminate all the downstream steps.
In the end, we’re trying to improve patient care by making results available more quickly and widely to everyone who needs them, Dr. Dean summarizes. This system allows us to do that.
Streamlined communication with diagnostic labs
The UW Medicine Regional Heart Center also provides consulting services to the diagnostic cath lab at Harborview Medical Center, UWMC’s sister institution several miles across town. The Vericis system essentially links our two labs so that studies generated at each site can be easily viewed from either location.
In the past, when Harborview needed one of the Heart Center’s cardiologists to consult on a case, the CD or film had to be brought over by taxi cab, notes Dr. Dean. Now we can access and view the images immediately, and you don’t even need to be in the cath lab. I can pull up the images on any web-enabled PC with a reasonable amount of memory and processing speed and make my recommendations.
Hemodynamic system simplifies various routine tasks
Use of Camtronics’ PhysioLog hemodynamic monitoring system has had several positive implications for our lab. One of the most significant is in the area of supply billing. In the past, billing supplies from the previous day was a very time consuming, tedious task requiring 2-3 hours of technologist time. Today, that process takes minutes.
PhysioLog provides integrated inventory management capabilities, which allows the technologist to barcode scan inventory items as they are used during the procedure. We have loaded our hospital’s specific numeric billing identifiers for each of the thousands of items that we use during procedures into the PhysioLog database. When an item is scanned during the procedure, it is included in the cath log along with the associated billing identifier. At the end of the procedure, a charge sheet is printed out with all the supply items and the appropriate billing identifiers. In less than five minutes, this information can be entered into our billing system a significant time savings over our past practice.
The accuracy and consistency of our procedural documentation has also improved. Our previous monitoring system relied on free text data entry. Depending on how comfortable the technologist was with a keyboard, the procedure log tended to be minimal or verbose.
PhysioLog uses customizable templates and pick lists that allow you to drag, drop and fill in the blanks. There is very little typing required. In addition to the primary record/monitoring stations, each of our labs has a slave system in the lab that allows our nurses to chart medications directly into the log when they are given, rather than calling them out to someone in the control room. Consequently, we get a more accurate view of what actually occurred during the procedure, as do those on the nursing floor if there are any questions.
Another area we are beginning to take more advantage of is PhysioLog’s ability to help us evaluate and monitor certain quality measures. All the data charted during procedures goes into the system’s database. Using PhysioLog’s statistical reporting tools, I’ve created reports that look at measures such as percent penetration of DES vs. bare metal stents, stents per patient and stents per physician per patient, contrast and fluoro usage, and length of procedure. Obtaining this information in the past would have required extensive chart pulls and manual collation of data rather than the few minutes it takes today.
A good example of the benefits of PhysioLog’s reporting capabilities occurred just recently. Our pharmacy department wanted to make sure they had completed their billing cycle for all the patients who had received Angiomax® (The Medicines Company, Parsippany, NJ) and had asked me to provide them with a list of patients who received the drug in our lab. If we were still relying on paper charts, it would have been impractical from a time standpoint to help them with this request. However, because all of this information is in the PhysioLog database, I was able to easily generate a custom report for the pharmacy that provided them with exactly the information they required.
We have successfully employed integrated information technology in the cath lab to help us meet our goals in the areas of efficiency, productivity and communication. The result is a higher level of care for our patients, which is, in the end, our true mission.
* All photos are courtesy of the University of Washington Medical Center News and Community Relations