Managing Clinical Workflow in the EP Lab: Interview with Nicholas Skipitaris, MD

Dr. Skipitaris is the Medical Director of Cardiac Electrophysiology Operations at the Leona M. and Harry B. Helmsley Charitable Trust Center for Cardiac Electrophysiology. In this interview he describes his experience implementing the Perminova EP software (Perminova, La Jolla, CA) into the EP lab at Mount Sinai Hospital in New York.

Discuss the size of your EP program at Mount Sinai Hospital.

We have three EP laboratories that are fully operative as well as a large holding area. Our program has 12 full-time physicians, 5 Fellows, and we perform more than 3,000 procedures a year.

How long has Mount Sinai Hospital’s EP program been using Perminova EP? When was this implemented in your EP program?

Perminova EP went live in our program in February 2012. However, we’ve been working closely with the Perminova representatives for about a year to tailor the system to our program’s needs. The company has been very cooperative and willing to customize this system for us.

What were your reasons for choosing Perminova EP? What types of challenges was the EP program previously facing?

Initially we were looking for a better reporting solution than the one that we had. Prior to Perminova EP, we had an in-hospital designed EP report that was not quite to our liking in terms of the kind of data that was being collected and the types of reports that were generated to send to our referring doctors. They were not really the quality that we wanted. In the simplest analysis, we wanted a better report. We also wanted a reporting system that would be very robust in terms of gathering data and allowing us to sort data to support our many research interests and quality initiatives. Perminova EP gave us this comprehensive data management ability as a significant plus over what we had.

What were some of the ways you customized the Perminova EP software to meet your lab’s needs?

Instead of it just being a basic reporting system and database, the project actually morphed into being more of a complete solution, with Perminova EP giving us the opportunity to customize our whole workflow. This included scheduling a patient, having a single place to know that the patients were cleared financially, getting the actual procedure done, generating a report, keeping the data in one potentially searchable and usable place, getting the report out to the referring doctor, and at the same time, generating the appropriate billing information that was necessary for the hospital and the physician components to be billed out appropriately. Previously we were doing all these things separately with pieces of paper and emails — therefore, nursing notes were being done with one set of paperwork, the billing was being done on a different set of forms, and the report was being generated after the fact by entering handwritten information into another reporting system and generating a report that we were unsatisfied with. What Perminova EP has allowed us to do is streamline the workflow and work more proactively: we schedule a patient into the Perminova EP system, follow the financial clearance process, and make sure that it’s being tracked in Perminova EP. On the day of the procedure, there are no surprises. We’re able to track the stats, keep the nurse notes and MD notes in the same place, and at the end of the procedure, we’re able to generate a report and the appropriate billing information that then gets transmitted to our billers electronically. Now at the end of each case, a great majority of the work that used to be done by hand and on paper that would take an inordinate amount of time to complete, can be done more efficiently, as we’re finishing the case. This is the way it has been customized for us. Perminova spent quite a lot of time going over what our particular needs were by understanding what was unique about the workflow in our institution. By analyzing and understanding how patients go through our system, starting from the day they are scheduled and ending with report generation and billing after their procedure, with some tweaking, we were able to create a workflow in which everything gets done through Perminova EP.

Who are the main users in your lab of the Perminova EP software?

Everybody — at this point it is our central system for the work that is going on in EP. It’s the place where doctors can look at their schedule and sign reports, where our administrators and office assistants can schedule patients, where we know what types of procedures are being done and what needs to be available for a scheduled case. All that data on the intake side is being input and used by physicians, administrators, nurse practitioners, and financial associates. Initially the demographics for the patient are put into one place and our financial clearance staff can go into Perminova EP to see what the schedule is to make sure the upcoming cases have been financially cleared. Perminova EP is an essential organization place from the time that a procedure gets scheduled. During the procedure, nurses and technicians are inputting the equipment used and fluoroscopy times, the nurses are documenting their nursing notes, and the physicians are documenting the other clinical information and the results of procedures, all in Perminova EP. At the end of the case we’re able to sign off on everything and generate the diagnosis and procedure codes, and a billing ticket is electronically dropped to financial areas of the hospital, so again, an administrator or business associate will be interacting with Perminova EP at the end of the case as well.

How has your program benefited from this technology thus far? What are some of the differences you’ve noticed? 

I think that there are fewer surprises on a day-to-day basis — specifically, fewer cancelled cases because of administrative or insurance issues, that kind of thing. It has also streamlined the amount of paperwork that I have to do. At the end of the case, I’m not signing my name as many times as I used to, and everything is done with an electronic signature that is secure. That certainly has been a benefit. The other thing is that it is a centralized system such that everything that we require to run the day — for instance, scheduling — is in one place. The other advantage is it’s a web-based system, so I can actually access Perminova EP from anywhere — I do not have to wait to use the PC in the laboratory that three other people are waiting for — I can access it in my office or from home.

What was the implementation process like with Perminova EP?

There definitely was a learning curve. However, I would say that overall it is a pretty intuitive system, so once staff started using it and became familiar with it, they began to adopt it wholeheartedly. I think the training of the nurses probably began about a month or so before we went live with the system. We’re hoping Perminova EP will continue to be a complete solution for us, including everything from scheduling to reporting and data collection to billing. We went through quite a lot of tweaking to make sure that when we went live with the system that we wouldn’t miss out on losing a month’s worth of billing or something like that. We wanted the transition to be as quick and as fluid as possible, so we did a lot of work customizing with Perminova EP before we went live. In addition, before we began to train the staff we wanted to make sure the system was working to our satisfaction. It wasn’t just a clinical decision, it was also an administrative business decision to make sure the appropriate billing information was getting to the right person in a reliable manner, and that sort of thing. Once all of that was in place, and we started to introduce Perminova EP to the nurses and technicians, I would say that it took about a month for everyone in our lab to become comfortable with the system. Once everything was ready, we were all in — there wasn’t a gradual move over to Perminova EP. Having laid the groundwork initially, when we decided to go live with the system, we went live and that was it — we haven’t looked back!

Is there anything else you’d like to add?

There are a few key points that I think are important about Perminova EP. First, it’s the only system that I’m familiar with that potentially offers a more complete, integrated solution for all the needs of running an EP laboratory. We’re able to keep clinical data and gather data for research purposes, billing information, nursing notes, scheduling, and financial information all in one place rather than in different systems. The fact that it is a web-based system is another plus. The other thing I want to mention is that the company has been actively engaged and responsive in customizing the system for us. They are also very willing to spend the time necessary to train our staff. The potential for this being a complete, integrated solution in the EP lab is the thing that I think makes Perminova EP better than anything else we’ve seen so far.