A full year has gone by since 425-bed Northridge Hospital Medical Center in Los Angeles went live with a new enterprise-wide EMR solution from Cerner. The hospital likes what it’s seeing, but as capable as the system is for most departments, its cardiovascular reporting modules have not shown to be as versatile nor as precise as those in the McKesson CVIS Northridge’s CardioVascular Center has been using since 2006.
Combined with the other components in the McKesson cardiology suite—CPACS, hemodynamic monitoring and supplies tracking among them—the 9-year-old CVIS has proven itself an indispensable workhorse.
Updated and now EMR-integrated as well, the cardio IT suite has allowed the department to increase its efficiency, expand its services and grow its business.
“When we first got McKesson, we had two cath labs and an open heart room,” recalls Ed Lopez, cardiovascular service line director. “Since then we have added an electrophysiology lab and a hybrid room. McKesson is in all of them, and our physicians are happy with it.”
Northridge, part of the 17-state Dignity Health system, is a Level II trauma center as well as a designated STEMI center. The CardioVascular Center averages 4,500 cardiac echoes, 800 diagnostic caths, 400 PCIs and 125 CABGs per year. (The latter number has dropped markedly as PCIs have risen.)
“We have cardiologists, cardiac surgeons, interventional radiologists, vascular surgeons and electrophysiologists all using our cath labs and our hybrid room,” says Lopez, adding that the only service they don’t offer is heart transplantation.
Amid all the streamlined workflows, the center has lately been busy creating a virtual valve clinic. “We have a system where, using McKesson, we capture criteria from echoes,” explains Lopez. “Then a cardiologist or cardiac surgeon follows up with the patient’s primary care physician in case the patient might be a candidate for a heart valve.”
Northridge is the only hospital in the San Fernando Valley offering PCI and stenting in high-risk patients using the Impella® Platform, a temporary ventricular-assist device manufactured by Abiomed. It’s widely considered a breakthrough technology. “We also want to be the first to offer TAVR,” says Lopez. “Hopefully that will happen over the next year.”
Growing the service line was very much part of the plan back in 2006, when, as Lopez recounts, the department had to work with one vendor’s standalone system for hemodynamics and another’s for CPACS. The overarching goal was to go paperless and, in the process, give physicians and staff a common workstation solution for all recording, reporting and image viewing.
“McKesson was of very few vendors that had a true CVIS,” he adds. “We went with them because they had everything we needed, including a way to abstract clinical data and send it right into the heartbase™ repository, which we use to submit the necessary quality data to the registries” maintained by the American College of Cardiology, the Society of Thoracic Surgery and others.
Today Lopez is looking ahead, not back. The CardioVascular Center has workstations in the cath labs and cardiology department. Physicians can go in and use McKesson’s latest and greatest tools for viewing and reporting. “But we are getting away from that now, because they want the same exact tools—and they want them remotely.” This they already have, but the web-based version is different enough from the workstation version that it’s not as elegant.
That’s about to change. “We’re going to upgrade to the latest version of McKesson,” says Lopez. “And from what I’ve heard, remote access is a lot better with the new version.
Once it’s up and running, Lopez hopes to move toward full mobile access. “We haven’t gotten there because not all the doctors have the latest and greatest mobile device. But once the upgrade gets going, we will look at expanding it to include smart phones and tablets.”
He adds that his vision is for all physicians who use the system to be able to use one interface, wherever they are, to see everything, from echo and EKG to stress tests and labs. “That is the goal now,” he says. “It’s probably more complicated to pull off for cardiovascular than any other single area within the hospital. But, if you think about where we were nine years ago, we are really not that far off.”
Rocking the reimbursements
One aspect of the system that greatly eases the strain of Lopez’s busy workdays right now is its ability to keep track of supplies as they’re being used during procedures. It’s critical to capture this info, he says, because it paves the way to faster and more accurate billing.
It’s proven out in numerous audits run internally by Dignity Health. “In the cath labs we are doing not just heart work but also vascular work, which gets very complex, and we have always come out looking very good after these audits,” he says. “Obviously, it’s important that we get paid and that we’re able to capture everything using all the proper codes.”
Such tracking carries over to new payment models the hospital is trying. Recently the CardioVascular Center entered into a co-management agreement with its cardiologists. Using more than 20 metrics to measure performance physician-by-physician—measures such as starting procedures on time and reading studies without unexplained delays—the department uses a bonus system to incentivize for efficiency and quality.
“To make this work, we have to do our part,” says Lopez. “We have to get them the information so that, when all is said and done, the hospital gets reimbursed at a level to keep us running.”
The physician evaluations are based on reports generated by McKesson.
“We are blessed to have cardiologists who are very involved in our service line,” says Lopez. “They want to help us run it. They want to be more efficient. They know that it helps them to achieve better patient satisfaction, which means the patient stays with them.
“They have access to the information readily. They can schedule a patient for a cath or a stress test while the patient is still in the office. That’s important for them, because it helps show the patient that they are efficient and very good at what they do.”
And so is the CardioVascular Center itself, nine years into its relationship with McKesson.
“We want one place to go to get all the information we need on each patient so that we can treat the patient, we can capture accuratebilling codes for the patient, we can see the quality of the care the patient received, and we can follow up with the patient—all with one simple interface.” There’s nothing quasi about that.