Technology and Teamwork Take CVIS Up a NotchDiscover North Kansas City Hospital’s Recipe for Improved Cardiovascular Care

With cardiovascular information systems, physicians are able to make faster and more informed decisions.

December 03, 2014 | This is a tale of making cardiac care better – for patients, caregivers, and for a hospital morphing and migrating to thrive in the new world of accountable care. The clinical and IT team at North Kansas City Hospital, Missouri, USA, have the key ingredients.

 

Text: Mary C. Tierney

 

Cardiovascular information systems could improve workflow in hospitals and therefore improve quality patient care.
The cardiovascular information system significantly improved the hospital’s workflows.

North Kansas City Hospital is a larger hospital among a plethora of healthcare providers in greater Kansas City. With 451 beds and 600 physicians in 49 medical specialties, the facility has one of the busiest emergency departments in Kansas City. This facility, serving a large catchment area north of the Missouri River, is an accredited Chest Pain Center that blends high touch with high tech. 
A new strategy for cardiovascular image management sought to improve cardiac care and strengthen the economics at North Kansas City Hospital. The results prove the success with savings in physician and staff time, and quicker hospital discharges. Transcription was replaced by electronic notes and structured reporting, including searchable, quantitative data.

 

Integrating Cardiology
Looking back about three years, North Kansas City Hospital had five technology-rich cardiac cath labs and a variety of nuclear medicine systems, echo carts, and IT systems to read, create, and manage reports. But, they needed a cardiovascular information system (CVIS) that integrated them all, allowed physicians more access points to report efficiently, facilitated greater access to images and reports, and interfaced with their EMR.
A broad search of seven CVIS vendors was narrowed down to three. A rigid and comprehensive RFP process helped make the purchase decision, with the final nod to implement Siemens syngo® Dynamics coming from both the clinicians and physicians on the selection board. “Previously, we had an excessive amount of human intervention to get systems to talk to each other,” says manager of IT Applications Joe Singleton. “That didn’t work for us; there were too many inefficiencies in getting cases done and reports out quickly. Physician reporting was limited to specific places in the hospital and that needed to be expanded," he notes. "That’s why this time we chose a system that would allow us to accomplish our ‘dream workflow.’” That dream workflow - for both non-invasive and invasive cardiology - was created by a team of clinicians and IT specialists who took the time to learn each other’s languages. The team took to planning from the clinical and IT perspectives - enabling true collaboration to develop among the team in understanding one another’s needs and goals, says Cardiac Cath Lab clinical nurse educator, Vickie Rupard, RN, BSN, RCIS.

 

Cardiovascular information systems were able to improve workflow in hospitals and therefore deliver quality patient care.
Cardiology manager Cathy Sullivan

Mapping Out a Plan
Planning became a three-part process: Understanding clinical needs, integrating devices, and creating and refining reporting templates. On the clinical side, cardiology manager Cathy Sullivan was a key liaison communicating clinical needs, as were Rupard and Rhonda Taylor, supervisor of the non-invasive cardiology, neurology, and vascular lab. Drs. Mitchell and Gimple offered the cardiologist perspective. Stacey Holle, the senior business systems analyst, bridged clinical needs with IT, while hemodynamics/Sensis clinical IT specialist Amy Dewey and clinical IT specialist for CPACS/syngo Dynamics Mike Chastain worked with Singleton on the IT side to make it all work. The IT team translated the patient care processes into the information technology world in terms of all of the interfaces needed between devices and people, and access to data for the physicians. The third piece of the puzzle was the creation of structured reporting templates. The liaisons worked with physicians and one another to refine the templates with all of the features and fields needed for appropriate documentation, viewing, coding, and registry and accreditation reporting, along with physician requirements. 

 

Going Online
From beginning to end, planning took a year and syngo Dynamics went live in July 2011 with 100 percent physician participation in the non-invasive areas of echocardiography and nuclear medicine. Next were the cath labs, with a new lab coming on-line every two weeks. Hemodynamic and electrophysiology integrated recording via Siemens Sensis followed, including bidirectional connectivity with syngo Dynamics.

syngo Dynamics also interfaces with the health system EMR and ADT systems to send demographic data to populate order entry and modality worklists, thus improving patient safety and expediting billing. It also helps in inventory management. Once a physician verifies a report, syngo Dynamics populates results into the Cerner EMR for use by clinicians, and eventually to support statewide health information exchanges in Kansas and Missouri.

 

With cardiovascular information systems physicians, are able to make faster and more informed decisions.
IT Applications manager Joe Singleton

How it Works
So what are the benefits of electronic reporting? “We can see this will potentially speed up care for chest pain management, and have a positive impact on length of stay,” Mitchell says. “We are seeing greater physician efficiency for sure, in the hospital and in physician’s offices, with access to cath lab reports. There is a lot more availability of patient information. In critical care situations, this helps physicians make faster and more informed decisions. Workload balancing between physicians helps with our time management, as well.” By sharing the number of patient exams waiting to be read, for instance in echo, patients can be diagnosed, treated, and discharged more efficiently. Tighter inventory management via CVIS is trimming costs, too, and allowing for more informed supply acquisition. Cath lab staff query inventories and are narrowing the scope of wires and stents ordered to bring down par levels. Electronic data-tracking helps the facility track expired materials and order stents for overnight delivery rather than having to stock them. Savings thus far have topped USD 100,000. The cardiology department will soon add a PET/CT system. The new system will be integrated into the CVIS environment for easy viewing and reporting, as well.


Communicating 101
Pain points appeared in all steps of the change process. The best way to deal with the situation was conspicuously; being visible and showing value. Mitchell notes, “Reports used to be dictated, then typed, and we had to fill out a diagram by hand. This replaces all of that. It is quick, gets rid of variables in procedures, and doesn’t involve a lot of typing, which we as physicians don’t usually like.” Ultimately, it all comes down to better patient care. “Having a more readily accessible, complete picture of patient data allows us to take better care of patients,” Mitchell says. “It has paid off well for our patients, physicians, staff, and overall healthcare efficiency. We are just beginning to see the benefits. Asked if we’d do it again, I’d say, ‘yes.’”

 


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