Saving 30 Minutes Per Case: One Facility’s Philips Cath Lab Experience

Cath Lab Digest talks with Phil Regas, MSM, RCIS, RRT, CPFT, CFAAMA, FSICP, Director of Cardiovascular Imaging/Cardiac Rehabilitation, Tomball Regional Medical Center, Tomball, Texas. Can you tell us about the cath labs at Tomball Regional Medical Center? Tomball Regional Medical Center is a community hospital located approximately 20 miles north of Houston. We recently built a new cardiac/peripheral lab, and currently have a total of three labs, one Philips Allura Xper FD20 flat-panel detector lab, a GE Innova 2000 lab, a Philips Integris electrophysiology (EP) lab, and have a second FD20 on the way. We do both cardiac and peripheral procedures. Recently, we performed an atrial septal defect repair (ASD), which was a first in our area, outside of the Houston Medical Center. We have also started an EP service, with significant growth expected. We have done three EP ablations in the first month. Our total overall patient volume is recorded at 2,800 patients annually, split between pacemaker/automatic implantable cardioverter defibrillator (AICD) devices, cardiac procedures and peripheral procedures. We staff the cath labs with 30 employees, including management, and have 10 cardiologists and 6 electrophysiologists using our labs. Can you describe the new systems your lab has adopted? We have incorporated the FD20 cardiac/peripheral x-ray equipment into our strategy in order to build both service lines. Along with the x-ray equipment, we have purchased the Xcelera, Philips’ cardiac PACS, with mirrored RAID (redundant array of independent disks) for disaster recovery. For remote physician interaction, we have placed the Web Forum (a physician portal for imaging) and the Xper Information Management platform, including the Xper Portal (a physician remote portal) into our plans. In-house, we have incorporated the Xper Whiteboard Viewer for customer satisfaction. How has your experience been with the Xper Information Management system as part of a total cath lab solution? There were definite issues with our previous system; we thought we could do better. One issue was data mining. With our old system, we didn’t trust the data that we had and were not impressed with how the information was mined. Along with the Xper Information Management system, Philips offers instantaneous IT service support; they are always able to help diagnose and find a solution. We participate in several registries, such as the American College of Cardiology (ACC) ICD Registry, the ACC-National Cardiovascular Data Registry (NCDR) and the NCDR CARE Registry. Once the Xper Information Management system was installed, we were able to improve throughput and address quality initiatives, with immediate benefits. We also report ST-elevation myocardial infarction (STEMI) cases and send out a monthly dashboard to our physicians. This data can be taken to our board members or our physician stakeholders in an easily designed report. As an organization, it helps us to be transparent and upfront with our stakeholders. Within the first week of installation, we had our ADT (Admission, Discharge, Transfer) interface up and running, which was huge. We have a RIS system with our x-ray equipment and use a DICOM work list, which proved very beneficial to our workflow. We were able to go to a real-time, electronic same-day billing (versus a manual process) with the Xper Information Management system. We underwent a great deal of training to make sure everyone understood the new processes. Our bills are now dropped a lot quicker and with less confusion regarding charges. We have a reconciliation process, which takes place the next morning after a case; our in-house coding/charge staff member then reconciles charges and coding. We have a paper tic sheet that follows the patient and includes all associated stickers in case of human error. The coding person reconciles the tic sheet with the Xper Information Management documentation and prints out a report of what crossed from the night before into our Meditech system. The Xper Information Management system included an inventory package, which we use to order supplies every day. The system captures all of our items that were used the prior day, and an inventory specialist prints out a one-page report, which is sent to purchasing. Inventory par levels are built into the system and are used in our quarterly audits. What system were you using for inventory previously? We were using a system that was much more disjointed. It involved double documentation and double recording of information. With the Xper Information Management system, we charge for an item and it is removed from our inventory at the same time, which eliminates redundant data entry. What is the savings in the new methodology? In our previous setup, a tech needed to hand-enter each individual line item, which added 20-30 minutes to every case. We now have a process where charges are done during the case while charting. We now also save time on the back end with reconciling charges, because at the end of the case, two people check the charges prior to closing the case (this saves time by having more timely and accurate charges). Ultimately, we have saved at least 10 to 30 minutes of time just by not having to reconcile inaccurate charges so frequently. Total saved staff time is estimated at between 20 to 30 minutes per case, which also saves in turnaround time. With the addition of structured reporting, transcription costs will decrease and accurate transcriptions that match the procedure report will also improve our level of rejected claims. What was your experience with training and implementation? We had project managers from Philips work with us at all levels: administration, implementation, and field service. We had quite a bit of attention, which hadn’t been the case in years past. The methodology has changed. A Witt system purchased back in 1995 might include dropping it off and saying, “Here’s your system.” You might have had to learn a lot on your own. Now, when we went live, in the first week we had two Philips clinical applications specialists in our procedure area, and also in our pre and post area. We have Philips patient care monitors (PCMs) that are in our pre and post area. All the pre workup and charges, as well as the post care, are done on the Xper Information Management system. It’s a continuous workflow; the final report is printed at the end, with a copy sent to Meditech and Xcelera. The integrated cath lab, which is where I think Philips really shines, is a whole new era. The physiologic monitor and imaging server “talk.” The imaging server stores waveforms, printouts, and images, all in one patient file. If the physician wants to review the report, he or she can look at the report, or the actual waveforms and images. The physician can access the Xper Information Management system via the Xper Portal, whether he or she is in the office or at home. That is a big improvement over what we’ve had in the past. We have also done some out-of-the-box things with the system. You can create repositories, meaning you can create databases from different hospitals and unify them in one, searchable system, or you can even include other departments. We are using the Xper Information Management system in the cardiac rehab area, for billing, documentation, and as a database, which is completely out of the box for that product. In addition, the system has a SQL database, meaning querying is much better than it was in the Witt Series IV. We’ve added specific charting elements and spent the time to build queries. This was also possible in Series IV, but it is a lot cleaner in the current platform. Several custom queries have been built, but if I need a new one, I could have someone from Philips on the phone with me within minutes. The report function is also something easily sent to an Excel spreadsheet, if you prefer to work in Excel, Access or another program. I print many of my reports to a virtual printer and then send it to my administrators. They can see exactly what I’m looking at without having to waste paper or time walking around. We have also built dashboards using batch-reporting function; monthly reports are then produced in minutes instead of hours. Have you seen any other benefits? I have personally used the Witt Series IV as well as other systems, and now Philips Xper Information Management. There are definitely positives with the new platform. The integrated cath lab is a big one, as I mentioned. The Xper Whiteboard Viewer communication system is also going to be big. Typically, the pre/post area will call the cath lab and ask for patient status, but now the whiteboard gets updated from charting. If the system is updated to show that the patient is in progress or the patient is started, the pre/post area can see it immediately. They don’t have to call and ask if we have started the case yet. Then, as soon as you are pulling the sheath or putting in a closure device, the whiteboard will show “procedure completed.” The pre/post area sees that as well and knows that they will shortly receive a call to take a report on that patient. The real benefit comes from a customer service standpoint. The patient names are made anonymous and HIPAA-compliant, so we can allow patient families to see updated status reports in the waiting room, much like when you are in the airport, and you can see your plane has a delay or is boarding. A family member does not have to ask the nurse if their loved one is done yet, have they started, or what’s the status, because it is instantly updated on the board. We purchased a 52” LCD screen for our cath lab; the schedule is easily seen from the hallway. We went away from the dry-erase boards to LCD monitors for status updates and schedules. With the whiteboard, you can move the patients around from room to room, as well as other alerts that really help in communication with all stakeholders. Obviously, the customer is one important stakeholder. The advantage to them is tremendous in terms of knowing the status of the procedure. Phil Regas can be contacted at pregas@tomballhospital.org

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