1

Stabilizing Cardiac Services with a

Cardiology Information Management System

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Imagine……..

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Florida Hospital Cardiovascular Services Overview

2001 and 2002US News and World Report listed Florida Hospital as one of “America’s Best Hospitals” for cardiac care.

2001MSNBC featured its cardiovascular program in the prime-time news special, “America’s Heart Hospital.”

• 16 Cath/EPS Labs• 133 Invasive Cardiologists• 14,000 Cath/EPS cases• 32,000 Cath/EPS procs• 500,000 Inventory items• 40,000 Echo/Vasc cases• 350 Technicians/Staff • 18 systems/modalities• 30 Viewing Stations • 100 Workstations

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Now imagine the nightmare of managing all this…...

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• Identify high frequency, high intensity cardiac care procedures

• Identify process metrics that enhance the overall efficiency andefficacy of the cardiac services environment

• Understand how to leverage the power of the CIMS to monitor key process metrics

• Identify a successful format for communicating CIMS benefits to corporate executives and decision makers

• Describe the complexities of implementing a Cardiology Information Management System in a highly complex, highly integrated, multi-facility healthcare system

Objectives

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Stabilizing Cardiac Services with a

Cardiology Information Management System

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What we wanted to do…..

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Florida Hospital - CV Services Vision

Implement an integrated suite of Cardiovascular systems that would facilitate the efficient and effective management of:

• Service line outcomes

• Quality improvement

• Standards of care

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• Develop and implement a seamless ED process

• Further enhance the Regional Cardiac Network and digitalize the complete cardiac episode of care

• Reduce costs, improve charge capture, improve data harvesting capability with strategic systems

CV Services Strategic Goals

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What we had to work with…..

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CCL

ApolloGemNetATLInfomedMacLabMUSEIVUS-HPIVUS-CVIS

CV Services Strategic Systems

EPS

ApolloPruckaBiosenseIVUS-Accuson

Echo

EnconcertSonosAccess DB

CVSx

iPathSuncareSiemens

Sleep

NicoletNCI

EKG

TracemasterHP EKG

Research

Access DB

Rehab

Access DB

“Heart Hospital” Patient Care Areas:3N, 3S, 3E, 3M, Rapid R/O, CCL Recovery,CCL Holding,, Satellite Cardiac Floors, ED

SuncareSiemens

Florida Hospital

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What we did…..

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Altamonte Winter Park

Celebration East

OrlandoIntegrated Flow of:

• Cath Lab/EPS Event Data

• Inventory Management

• Physician/Tech On-line Documentation

Technology Includes:

• SQL Data/Application Server: Prod/Test

• Apollo NT Workstations (2/lab)

• Interface Servers:

• ADT

• Billing

• MacLab

Florida Hospital - CIMS Overview

• Results

• EKG

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Phase 1: Inventory Management 4th Q 2001

Phase 2: Clinical Documentation 1st Q 2002

Phase 3: Echo Integration 2nd Q 2002

Phase 4: EKG Integration 3rd Q 2002

Phase 5: CardioChart 2nd Q 2003

Complete

Complete/Current Rollout

Complete/Pending User Live

Incomplete

Future

CIMS Implementation Timeline

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CLOVERLEAFIntegration Engine

SUNCARE

IS Infrastructure

PatientsBusinessRI, RS, RM, AM

ClinicalOC, PH, SI, AD,

MB

(Proprietary)

Charges

ADT

Charges

ADT

CIMS Integration - Phase 1

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CLOVERLEAFIntegration Engine

Cypress (Routing)

LCR

SUNCARE

IS Infrastructure

PatientsBusinessRI, RS, RM, AM

ClinicalOC, PH, SI, AD,

MB

(Proprietary)

Results

Charges, Results

ADT

SiemensInvision

Results

Charges, Results

ADT

Mailroom Physician’s Office

Floor

Results

CIMS Integration - Phase 2

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What we now have …..

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1. Patient Case

(scheduled or unscheduled)

2. Clinical Activity**

•Supplies

• Labor

• Other

• Procedure 1

• Procedure 2

• Procedure 3

3. Charges Captured*

• Supplies

• Procedure 3

• Labor

• Other

4. Cost Tracked by Finance

• Supplies

• Volume

• Labor

• Other

5. Financial Budget• Based on historic Volume

• Projects Supplies

• Projects Labor

• Projects Other

6. Inadequate $to Manage Cardiac Services Activity due to inaccurateVolume

CVS Procedure Process

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May 2002 Procedure Volumes - Orlando Cath Labs

0

20

40

60

80

100

120

1 3 5 7 9 11 13 15 17 19 21 23 25 27 29 31

May 2001

Vo

lum

e o

f P

roce

du

res

Daily Lab Volume - Apollo

Average Daily Lab Volume - Apollo

Interventional Procedure Volume - Apollo

The CIMS allows the study of clinical volume trends and patterns

* Interventional cases include an average of 2.75 procedures

Florida Hospital - CIMS Data Harvest

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Apollo will facilitate the comparison of clinical volume trends against financial volume

Volume of Procedures - Orlando Cath Labs

0500

1000150020002500

JAN

FEB

MAR

APR

MAY

JUN

JUL

AUG

SEP

OCT

NOV

DEC

Month

Volu

me

of P

roce

dure

s

2001 Volume - Finance

2002 Volume Prediction -Finance(12% gw th)

2002 Clinical Volume - Apollo

Florida Hospital - CIMS Data Harvest

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Apollo clinical labor and procedure data shows detail procedure data and case time trending

LHC Case Time Analysis1 Day Sample (13 Cases / 35% of Total Cases for the Day)

020406080

100120140160180

1 2 3 4 5 6 7 8 9 10 11 12 13

LHC Cases (LHC Only)

Cas

e Ti

me

(min

utes

)

Case TimeAverage Case Time

Average - 53

Standard Deviation - 15.6

Range - 52

Florida Hospital - CIMS Data Harvest

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Apollo clinical labor and procedure data shows detail procedure data and case time trending

Stents - Case Time Analysis 1 Day Sample (12 Cases / 32% of Cases for the Day)

020406080

100120140160180

1 2 3 4 5 6 7 8 9 10 11 12

Stent Cases

Case

Tim

e (m

inut

es)

Case Time

Average Case Time

Average - 106

Standard Deviation - 28.2

Range - 100

Florida Hospital - CIMS Data Harvest

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Apollo clinical labor and procedure data shows detail procedure data and case time trending.

Question: Do we acknowledge the same “RVU” factor to a LHC case as to a Stent case? Perhaps the Labor standard can be analyzed….

LHC Case Time Analysis - 1 Day Sample (13 Cases)

020406080

100120140160180

1 2 3 4 5 6 7 8 9 10 11 12 13

LHC Cases (LHC Only)

Case T

ime (

min

ute

s)

Stents - Case Time Analysis - 1 Day Sample (12 Cases)

020406080

100120140160180

1 2 3 4 5 6 7 8 9 10 11 12

Stent Cases

Cas

e T

ime

(min

ute

s)

Florida Hospital - CIMS Data Harvest

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A c t u a l C o s t O f W a s t e ( B y I t e m G r o u p )

$ 7 .9 8

$ 8 .1 9

$ 8 .9 5

$ 1 5 .4 0

$ 5 4 .0 0

$ 8 4 .3 3

$ 1 4 6 .9 4

$ 2 0 0 .0 0

$ 3 4 8 .9 4

$ 3 9 0 .6 8

$ 6 1 5 .0 0

$ 1 ,3 6 6 .3 0

$ 3 ,5 0 3 .4 9

$ 4 ,0 4 8 .5 0

$ 4 ,6 4 5 .0 0

$ 7 .6 5

$ 5 .0 7

$ 2 .9 0

$ 1 .0 2

0 1 ,0 0 0 2 ,0 0 0 3 ,0 0 0 4 ,0 0 0 5 ,0 0 0

W o u n d C a r e

T u b in g

D i la t o r

G o w n

IV

S o lu t io n s

C lo s u r e D e v ic e

N e e d le

S w a n

T r a y

A c c e s s o r ie s

A t h e r e c t o m y

S h e a t h

P T C A

IA B P

W ir e

C a t h e t e r

D i la t a t io n C a t h e t e r

S t e n t

Florida Hospital - CIMS Data Harvest

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Reasons for Delays Given-July (Pt Entered to Start of Case)

29.00

53.32

72.00

32.00

42.00

30.34 30.95

796

1 1

773

191 10.00

10.00

20.00

30.00

40.00

50.00

60.00

70.00

80.00

ProcedureExtended

PhysicianLate

Lab notReady

HCRU full EquipmentFailure

No ReasonSpecified

Overall

Reason

Tim

e (M

inu

tes)

0

100

200

300

400

500

600

700

800

900

Occ

ura

nce

Time (Minutes)Occurance

Florida Hospital - CIMS Data Harvest

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What we can now do…..

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• A CIMS accurately tracks true clinical procedure Volume and event activity

• Finance says….. “If it isn’t attached to a Pricefile code we can’t count it.”

• Volume drives the Labor Costs which drives the Labor Budget (based on the LTS)

• Volume drives the Supply Utilization which drives the Supply Budget

Know Our Volume

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• A CIMS facilitates improved revenue capture

• Documented procedural data from the CIMS cross-checked with charged items at the point of care

• Discrepancies and omissions identified and investigated at the point of care

• CIMS clinical data can help justify payments for procedures and devices.

Bill Accurately

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• A CIMS helps Reduce Overall Device Costs:– 1. Facilitating Volume / Bulk Purchases - reduces per

device cost to hospital– 2. Tracking par levels according to predicted volume– 3. CIMS Data allows for committed volume purchases -

reductions from vendor

• A CIMS facilitates Utilization Management: – Track– Review– Compare, and – Optimize device utilization per patient case

Minimize Costs

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Key Patient Process Points (>13 Date/Time Fields)

Pt In Pt Ready MD Called MD Arrival Case Start Access Time Case End Pt Out

Pt on EKG Inflation Times

Pt Registration/Admission Pt Transfer Pt Discharge

Manage Throughput

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Key Quality Drivers Collected in the CIMS

Ionic SolutionType

Volume/cc

Non- Ionic SolutionType

Volume/cc

Fluoro TimeTotal Flouro Time

Total Cine Runs

Total Dose

Total Cumulative Dose*

Improve Practice & Patient Safety

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How we are justifying it…..

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Florida Hospital

• 2002 inventory savings (bulk purchases, EPS consignment, price reduction):

$178,585 (Feb. – April)$251,240 (Anticipated June)$50,000 - $100,000 (Other Program)

• 2002 Projected net revenue increase due to increase charge capture.

$83,304

• 22 Patients not converted from outpatient to inpatient followingstent deploymentIP Stent - Increased Revenue - $54,831

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Orlando EPS

Orlando Cath

Altamonte

East

Celebration

Oct Nov Dec Jan Feb Mar Apr

$61,344

$64,752

MD Live Events

* Savings based on 8.2 Procedures/Lab/Day (5 day week) completed 100% in Apollo

Cumulative Savings 1Q 2003 = $66,456

Cumulative Savings 2003 = $ 311,832

Winter Park $66,456

$10,224

$46,008

$56,232

2002 2003

Cumulative Savings 4Q 2002 = $4862

Transcription SavingsFlorida Hospital

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• Engage Physicians, Engage Physicians, Engage Physicians

• Success with Physicians is completely dependant on success with technicians

• System has to accommodate work flow

• Implement CIMS around the data you need for:– Discoverable legal documentation (EMR)– Non-discoverable QA analysis– Administrative Dashboard

• Be prepared for an emotional and difficult install due to the nature of the environment

CIMS Summary Notes

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• Identify high frequency, high intensity cardiac care procedures

• Identify process metrics that enhance the overall efficiency andefficacy of the cardiac services environment

• Understand how to leverage the power of the CIMS to monitor key process metrics

• Identify a successful format for communicating CIMS benefits to corporate executives and decision makers

• Describe the complexities of implementing a Cardiology Information Management System in a highly complex, highly integrated, multi-facility healthcare system

Objectives

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Questions?

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In the pursuit of quality no one is an island. We areall implicated; we are all concerned. We all win or

lose together. It is in this spirit of comradelysolidarity that we should set out to assure for

everyone the full measure of benefit that modernhealth care affords.

AvedisDonabedian

rhonda.bartlett@flhosp.org