The Benefits of an Integrated Solution for ECG Management
The "Electronic Medical Record" - a truly paperless hospital environment; that's something we've been hearing about for years. Back in 1985, ISDN (Integrated Services Delivery Network) was the "big buzz" word in telecommunications and it was going to provide all kinds of great new capabilities like "video on demand". Well, most local cable companies just began offering "video on demand" during the last 12 months, only a short 19 years after we first started hearing about the concept!
The point is none of us should be shocked that the Electronic Medical Record is still far from a reality in many cases - at least from a true enterprise standpoint. While major hospital information systems vendors, such as MEDITECH, have done a great job on core clinical and financial solutions, few hospitals can boast that ALL of their clinical data is fully integrated. Most facilities have numerous pieces of important clinical data still being generated by a multitude of third party solutions that are totally paper based or only viewable from their host system. Electrocardiogram reporting systems at many MEDITECH hospitals are at worst, still primarily paper based, and at best, while perhaps computerized, lack any significant degree of integration with MEDITECH (either MAGIC PCI or it's Client Server counterpart, the EMR). See if you recognize the following process:
Doctor "A" requests an ECG test on Patient "B" and a nurse enters the order into the MEDITECH Order Entry system.
A hard copy requisition prints off down in the Cardiology Department and is placed in a bin with others recently ordered.
A technician grabs the requisitions and re-enters the patient information either into a central management console or directly into a standalone ECG cart and then proceeds to make rounds acquiring the ordered ECG's
Once each ECG is acquired, they are printed on thermal paper from the integrated printer on the cart and multiple copies are created for distribution for attachment to the patients' chart, Medical Records, cardiology, etc.
The acquired hard copy ECG reports are placed in a bin in cardiology awaiting interpretation by a cardiologist or other assigned physician who comes by once or twice a day.
The reading physician would like to compare the data with past ECG's but of course those are buried in a file cabinet in Medical Records and therefore must be requested.
Once read, the physician jots down his notes on the hardcopy file for possible transcription into MEDITECH.
Once complete the "read" ECG goes into another bin where a tech then enters the billing information into MEDITECH.
If a scanning system is available, perhaps they are now manually scanned one by one, into the system for future retrieval from MEDITECH.
The good news at least is that more and more IT and cardiopulmonary staffs are starting to take steps to rectify the situation as part of larger efforts designed to enhance patient care, improve efficiencies and reduce overall costs. Our discussions with various department heads about existing ECG environments and process have often included issues such as those listed below and based on the steps outlined above you can see how these and other problems can be manifest:
Lack of access to data when needed
Lack of access to data where needed
Re-testing due to lost/misfiled report data
Lost billings due to incomplete, lost or mismatched ECG order data
Excessive time spent _________ ECG report data (fill in blank: "printing", "copying", "faxing", "scanning", "searching for", etc.).
Inability to easily access historical data
Difficulty in comparing historical data to current report data
Increasing "footprint" of storage needs for hardcopy historical ECG data
Cost of off-site storage for historical data
Lack of digital diagnostic tools
Proprietary ECG data files requiring expensive conversions
Lack of, or inadequate customer support from legacy providers due to older, "sunset", technology (and expensive!)
High cost and low quality associated with use of thermal paper
High cost of specialized "grid" paper
Image degradation due to scanning
You can likely think of a few more. In any event, the issue is real and worthy of consideration as part of a comprehensive strategy to move toward a true computerized patient record and paperless hospital environment.
So now that we've listed some of the challenges and issues currently facing MEDITECH caregivers in this area, let's look at some of the benefits than can be achieved by upgrading your ECG system. We'll do this in three phases. First we'll look at some of the benefits to be achieved through implementation of a "true" digital ECG management solution. Then, we'll add the benefits of interfacing with your MEDITECH MAGIC or Client/Server system and finally on to a truly "integrated" system. In closure we'll discuss some other "niceties" you might want to look for as you consider various vendor options.
ECG Management Benefits
As mentioned earlier, many MEDITECH hospitals are still using essentially paper based ECG systems that offer little or no digital capability at all. Some folks have been using the same carts for 10 years! Needless to say, there have been some improvements in not only technology but also in the software used to manage the process. An ECG Management System can provide better management of data by offering:
Easy download of ECG data from the cart to the central system console (via modem, removable media, or better still, direct network access).
Easy and IMMEDIATE access to, and retrieval of, data through same.
Data sort by patient, ID number, date/time, technician, cardiologist, order status, etc.
Digital diagnostic tools and hi-resolution images
Electronic, serial comparison and "overlay" of historical data with current on a single graph.
Transcription via data entry direct to the digital report.
Print report data directly to network printers.
Centralized storage and data backup to removable media.
Use of plain, "non-grid" paper thus reducing paper costs
Integrated faxing capability
Secure passwords and data protection
Not every ECG Management solution will offer all the benefits listed above and some will likely offer more.
Remember that the terms "interface" and "integrate" are NOT the same thing. The dictionary defines "interface", in computer terms, as the ability to "communicate information from one system to another" while "integration" means to "incorporate parts into a whole" or to "combine to produce a larger unit or whole". So while the communication of information between the ECG solution and your hospital information system is certainly beneficial and likely a significant step up from any standalone, non-interfaced system, you want to strive to achieve a seamless approach to the greatest extent possible. We are creatures of habit, and maybe even more so in the MEDITECH world, so the more we can create an environment with standard logons and access procedures from within the HIS, the greater likelihood we can improve system use and reduce the number of user errors.
So what's really the difference? A conventionally interfaced system should support the following:
Passing of order messages to the ECG system
Passing of order updates to the ECG system
Matching of STAT ECG's with orders entered "post-acquisition" in MEDITECH
Notification to MEDITECH, by the ECG system, of order updates (triggering order status update and charge posting in MEDITECH)
Transfer of ADT's (name changes, account merges, transfers) to the ECG system
Transfer of "interpretive report" text back to MEDITECH by the ECG system
These benefits alone would, of course, be a huge step forward from what is found today in many MEDITECH facilities, however, simple interfacing should be the minimum requirement in the attempt to go "paperless".
The ability to create, as much as is possible, an environment of seamless integration, not only making information available but also improving workflow and efficiencies by minimizing the steps required by caregivers should be the goal of any ECG Management Solution.
A more "integrated" solution may provide benefits such as these:
The native "digital data" generated by the ECG solution can be accessed directly via access through the MEDITECH system.
Clinicians and caregivers have access to the complete palette of the ECG solutions diagnostic tools without the need to leave the primary MEDITECH environment (in other words - the ECG software is launched from "within" MAGIC PCI or Client Server EMR).
Support for integration of "draft" status reports and images to be updated and replaced with new revisions as updated by the ECG system.
Immediate access to images from within the HIS upon acquisition and relative real-time updates of orders and ADT's.
Obviously there are a tremendous amount of benefits that can be achieved by upgrading your existing ECG system through implementation of a centralized system, interfacing that system to your MEDITECH hospital information system, and doing so with a solution that offers as much true integration capability as possible. As you evaluate the various vendor solutions available to you, we'll close by suggesting a few other areas to consider:
Select a solution that gets you away from proprietary technology to the greatest extent possible - in this day and age there is no reason not to maximize use of commodity components and to have those components be capable of multi function support. (Why shouldn't your ECG cart be capable of functioning as a MEDITECH Workstation for example?).
Select a vendor that supports and can work with all major archive and storage formats - DAS, SAN, NAS, etc.
Select a solution that promotes "open architecture" file formats. Many sites today are confronted with significant costs to "convert" legacy system data files to newer systems, sometimes even when changing technology with the same vendor. (Digital data storage is irrelevant if you can't view the files in the future because you switched vendors and they employed a proprietary file format!).
Look for a vendor who can help convert your existing digital ECG files to a more open file format.
Look for a solution that can be adapted to the way YOU work while bringing about the major benefits you want to achieve. A major change in the paradigm can result in user resistance. Try and allow yourself the ability to phase in changes slowly if necessary in order to win user acceptance and make sure your users have significant input and exposure to your selection process.
Look for a vendor that can "add value" in other areas beyond simply doing ECG's. As mentioned earlier, ECG is just one of a number of areas needing integration so if you can find a vendor who can help bring some of these smaller, ancillary systems into your "paperless" environment as well.
Finally, anyone who has been in the MEDITECH environment for any length of time knows that there "is" value to experience in this marketplace. We believe it is one of the reasons the MEDITECH community is as tight knit as it is and why people tend to stay within it (just changing business cards every few years perhaps). So select a solution from a vendor that knows the difference between MAGIC and Client/Server, PCI and EMR and knows that "MUSE" isn't necessarily a reference to a certain vendors ECG system.
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