Enhancing Patient Care and Reducing Cath Lab Workload: Atlanta Medical Center`s Focus on Information Technology

Our volume has doubled over the last calendar year, a trend we expect to continue. We expect to perform approximately 2500 procedures this year: roughly 60% cardiac cath and stent procedures and 35% peripheral vascular procedures. The other 5% is a mix of electrophysiology, pacemakers, and cardioversions. Atlanta Medical Center is not focused on becoming the biggest or busiest cardiac service in town; rather, we have created a boutique-style service that stresses highly personalized care supported by the latest in technology and digital flexibility. We believe this results in better patient care and decreased length of stay, leading to more satisfied patients. Our focus on technology and digital flexibility also helps our physicians and staff work more effectively and efficiently. The department’s infrastructure ensures speed, eases data and report access by automating non-clinical manual efforts, and promotes a best-of-breed multi-vendor environment. Atlanta Medical Center is one of the very few digital facilities filmless on both echo and cath. We have immediate distribution of patient reports, providing our physicians and staff with instant access to the necessary data, contributing to much more efficient patient care. Our efforts regarding technology come down to one goal: create an environment in which physicians can deliver excellent patient care with minimal administrative effort. The cath lab’s technology is ahead of the curve, primarily because of our Apollo Cardiovascular Information System and imaging solutions (Lumedx, Oakland, CA). Atlanta Medical Center originally purchased Apollo for the American College of Cardiology/ STS Registry solution. Since then, we have focused our efforts on leveraging Apollo’s extensive capabilities. For example, by implementing the Lumedx imaging software (CardioDICOM), a viewing of echo studies that once took 15-20 minutes using VCRs and phone dictation, now takes only 3-5 minutes. CardioDICOM eliminates the time we used to spend waiting for the processing and storage of film. Doctors can look at the studies on their computers as soon as the studies are loaded onto the server. An equally important factor is that our physicians can generate reports faster because the system captures patient demographics and measurements, and auto-populates the appropriate fields. Cardiovascular procedure reports are printed before the patient leaves the lab. Finalized echo reports, which once took 24 to 72 hours to be transcribed, are now completed in minutes. This has significantly cut final report turnaround time for all procedures, helping to get the right data to the right people as quickly as possible. Atlanta Medical Center believes that technology should make a physician’s life easier through automation, increasing physician access to reports and streamlining the physician’s core activities. Apollo’s Coronary Anatomy Editor (CAE) graphic-driven interface enables physicians to complete and generate a cath report far faster than the previous methods of manual data entry and dictation over the phone. While speed is important, information technology needs to deliver more than simply rapid access to information. The Apollo database enables our physicians to collect richer and more comprehensive data sets. In addition to accessing extensive demographic readings, many other types of data, including costs, outcomes, and inventories, can be extracted from the system. The result is a more comprehensive and accurate picture of the data that is being examined. This is especially critical when participating in large research studies. Imagine the effort and time it would take to manually pull and review 150 charts per month, contrasted against using Apollo to automate the entire process. Apollo’s open architecture also provides the department with the flexibility to purchase equipment from multiple vendors. This has allowed Atlanta Medical Center to pursue a multi-product approach to finding the best solutions at competitive pricing. Support from the Information Systems Department has been crucial to the system’s success. The lead programmer/analyst works closely with the department’s staff, combining clinical knowledge with technical knowledge. The result has been the implementation of a highly effective system, customized to achieve optimal clinical goals. However, the most important factor in our success has been the support and interest of the staff in ensuring data quality. The staff are on the front line, and every attempt is made to provide the best patient care possible in all regards, including data management. The physicians embraced the Apollo Clinical Information System. We recognized the need for having a tool that allowed for quick and easy access to all the data collected across cardiac services. The most important benefit of the Apollo system is that it helps us collect, organize and synthesize both individual patient data and larger volumes of clinical data at the subgroup level. It provides us with a highly encapsulated view of our patient population and serves as an information warehouse. This information warehouse enables us to look at specific patient demographic information, ethnicity, and financial status really, any number of patient variables. We can drill down in the database for finer clinical detail all of which helps us to figure out if we’re treating people appropriately and most effectively based on known risk factors and demographics. From a procedural standpoint, the Apollo system has substantially reduced manual operations. For example, with a database, you can readily identify every cardiovascular procedure performed on a patient. Most physicians would relate to the fact that many of us spend hours waiting hours for information to become available. You have to make a request for an old record to be pulled, and then wait for someone to physically retrieve the medical records. This can take several hours. Often, in the case of cardiovascular care, you need data in minutes versus hours. The point is that with immediate access to data, you can provide better care. You have all the data you need now to make clinical decisions instead of delaying care to wait for information. Most clinical and medication errors occur because the physician did not have all the necessary patient information. In addition, having access to a patient’s complete history also contributes to reduced costs because you eliminate duplication of procedures or tests. The referring physicians appreciate our technology as well. Instead of waiting days or weeks to receive a mailed patient report, our system enables us to fax patient reports to the referring physician automatically, as soon as the reports are completed at the point of care. They receive a report complete with images, data, and analysis the information they need to help them treat their patients more effectively. Comments From Across the Cath Lab At Atlanta Medical Center At Atlanta Medical, we focus on delivering excellent clinical care and outcomes. To achieve these specific goals, you need to know where you've been and the milieu in which you're traveling. A clinical database is an absolute necessity, because it enables you to more readily collect, manage, and analyze large volumes of patient data, helping you document the present and better plan for the future. Our clinical database allows us to know where we've come from and where we need to head in order to provide our patients with the best of care. Paul Douglass, MD The use of information technology systems has reduced the manual effort and time spent in the cath lab. Much of data entry has been automated. For example, before Apollo, it wasn’t uncommon to input the same data on a patient two or three times across the service line, or go back repeatedly to the case notes to generate a final report. With Apollo, the data is collected at the point of care, the physician reviews the report, signs off on it, and the case is complete. There’s no redundant data entry. Doing the report right after the case is completed removes a lot of the paper involved and cuts down on carrying around reports, hand-written notes and all the paperwork generated by each system. Collecting data automatically at the point of care reduces potential data errors, contributing substantially to quality patient care. Mike Feutrel, RN, BSN The Apollo information system has substantially changed the process of how reports are produced and distributed in cardiac services. Before Apollo, hard copies of the doctor’s report were manually faxed to the cardiologist’s office and to the referring doctor’s office. In addition, the reports were added manually to the chart and to the floor. With Apollo, the press of a button automatically generates and faxes the required reports to the physicians involved. Reports are sent automatically to the chart and to the floor. Physicians and clinical staff are getting the data they need sooner and in a more useful format. Cath labs are highly organized and Apollo helps improve the department’s organization and workflow. Cindy Phillips, RN With the Apollo system, Atlanta Medical Center’s staff can view data as it is generated across the hospital. As the patient goes from area to area, data is generated and updated. Apollo cuts down on redundant data entry as well as provides the mechanism for easier access to the information on the computer. The Apollo Coronary Anatomy Editor translates data into images, making the information easier to visualize and understand. The difference in our workflow today is that physicians can pull the reports they need right where they are. In the past, we had to pull the data manually, generate a report, and then deliver it to the physician. Chris Atkins, RN Record keeping is critical in the cath lab. The Apollo system has helped tremendously in report documentation, making it easier to record results report on lesion location and track adverse outcomes. All this has been streamlined under Apollo and centralized in one database. Before Apollo, the cath lab staff manually reviewed each chart. When the process was totally manual, the ability to collect data and generate reports was not as comprehensive as when the process became automated. Now, under Apollo, much of the data is captured automatically, making it easier to pull up the necessary data and reports all of which can be linked to other computers in the hospital. Apollo also has made participating in the ACC Registry easier Atlanta Medical Center no longer resubmits data due to incomplete data sets. Barbara Turner, RN

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