Implementing EMR Integration at Parkview Health: Perspectives From the Electrophysiologist, Outpatient Cardiac Monitoring Coordinator, and Practice Manager

In this feature interview, EP Lab Digest speaks with Jonathan Shirazi, MD, Ryan Augenstein, Outpatient Cardiac Monitoring Coordinator, and Tina Allmandinger, RN, BSN, to learn more about the Philips BioTel Heart^® EMR integration at Parkview Health in Fort Wayne, Indiana.

Jonathan Shirazi, MD, electrophysiologist:

Tell us about your practice and the work being done at the atrial fibrillation (AFib) Clinic.

Our atrial fibrillation team consists of four electrophysiologists and two nurse practitioners; thus far, it seems that the atrial fibrillation clinic has been successful. The clinic has been enrolling patients from Parkview’s Emergency departments as well as primary care offices. It is quite common for patients to have their AFib first detected on an event monitor; we work hard to quickly get those patients into the atrial fibrillation clinic. Patients with newly diagnosed atrial fibrillation are being seen in clinic either the next day or within the week. I think we feel it is a success. Patients certainly seem happy not being admitted to the hospital and being evaluated expeditiously. Freeing up hospital beds has been a help as well, especially during the coronavirus pandemic. Having this clinic has been a resource to the community and the hospital system.

The initial clinic visit is comprehensive. Specialist visits can sometimes seem kind of overwhelming to the patient, particularly with a new diagnosis, so we are always trying to gauge how much patients want to know or not want to know. We do our best to get them appropriate therapy for stroke risk reduction. We also typically start with some form of rhythm or rate control strategy, depending on how symptomatic the patient is with atrial fibrillation. Follow-up visits focus primarily on whether initial therapies are working to the patient’s satisfaction.

What advantages have you seen since the Philips BioTel Heart EMR integration was implemented at Parkview?

The primary advantage has been speed and ease of use. For me, it has been very satisfying to see everything work the way it’s supposed to work. For instance, when a patient has an event just after a few days of wearing the monitor, I am able to get access to those events in Epic without having to wait for a faxed and scanned copy to be uploaded to their chart. Acquiring that information faster has benefitted patients as well. For some patients, it means starting therapy sooner. That also means less time anxiously waiting their results.

For the members of our staff that were previously scanning in documents, it has also been a big benefit to their routine to not have to do that anymore, especially in this digital age. It was cumbersome to have to wait for tracings to be scanned into the EMR, followed by waiting on an in-basket task to update the physician that the data is now available for review. Now, we can just go straight to that information in that patient’s cardiology tab in their Epic chart.

How has the reduction in time to access these reports benefited you and your patients?

I can provide an example that happened today. I had a patient who didn’t press their symptom activation button the entire time that they wore their monitor; the patient mailed their monitor in and was scheduled to see me in office the day after it was mailed. While that monitor had not officially been read yet, I still had access to all the reviewable tracings in the patient’s EMR during that clinic visit. I was able to pull their tracings up and review it with them that day. In real time I was able to show them what I saw without having the formal report. For this particular patient, we discussed their PVC frequency and whether or not they wished to start therapy for a modest PVC burden. Without having that monitor available for review, the office visit would have been entirely about hypotheticals and would require a later phone call with the patient to go over updates on the event monitor results.

I would also expect the neurology team to be more pleased with this reduction in time as well. For instance, when we have patients who are being discharged with a monitor after a hospital stay for a cerebrovascular accident or transient ischemic attack, patients with atrial fibrillation detected earlier can get started on appropriate therapy faster. It may only be saving a handful of hours, but that is still progress.

Can you share any stories on how this integration has helped facilitate patient care?

My patient from clinic today who had just mailed in their monitor got everything they needed from our visit because of this integration. Getting to the event monitor tracings before they were officially processed and read saved us time from having to schedule a phone visit later on to discuss results and potential treatment options. It is also about getting to the treatment plan a little bit sooner, particularly when we’re trying to give patients less time “in limbo”. I am sure we will continue to encounter more examples in which this integration improves patient care.

Ryan Augenstein, Outpatient Cardiac Monitoring Coordinator:

Can you share why you explored an EMR integration with Philips BioTel Heart?

At Parkview, we strive to use innovative technology that helps us provide better patient care. As our numbers have continually increased, we knew we needed more time to focus on patient education, analysis of our Holter monitors, and appropriate routing of study results. We found we were spending up to 10 hours per week or more scanning reports into Epic, and it just didn’t seem like the best use of our time. We knew that EMR integration would allow us to give more focus to patients so they could be comfortable with the use of the MCOT monitors. By giving patients more time for education, we also could get the best results possible from those monitors. So that was why we began to explore this.

How was the overall experience with the process of building and implementing this EMR integration at Parkview?

EMR integration went smoothly. We had a kickoff meeting that included all the appropriate players, including our chief of staff, the EMR team from Philips BioTel Heart, and clinical staff from Parkview. It was evident right from the beginning that Philips BioTel Heart had done this integration many times. They knew answers to our questions before we even asked them. As it got closer to go live, we had weekly meetings during which issues would be discussed and the problems were solved. The Philips BioTel Heart team was always helpful and able to quickly find resolutions working with our Epic team. We had a few unexpected issues come up, which happens with any technology or process, but they were resolved quickly and efficiently by the Philips BioTel Heart EMR team.

Can you share some of the differences you have noticed before and after the integration?

The primary difference was the time saved, including 10 or more hours of scanning studies into charts per week. Of course, having urgent and emergent results going into charts 24/7 really helps as well. On-call weekend and night physicians no longer have to wait to validate urgent results, and they can act immediately for the patient, which really helps expedite treatment.

The extra time also had allowed staff to spend more time per patient to properly educate them on the use of the monitors as well as schedule more patients each day. We find that our numbers are going up even more because we have more time to put new patients on these monitors.

Have there been any memorable patient outcomes since Parkview’s EMR integration that you can recall?

We’ve had quite a few, but one in particular was a recent patient with a 12-second pause. Generally, the process that we would go through when that happens is one of our on-call nurses would be notified and they would ask to have those urgent results faxed to our office. That generally took a little bit of time, and then they’d have to find the physician to review those results, so the process could take up to half an hour to an hour. However, with use of Philips BioTel Heart EMR integration, the rounding nurse told me that we had those results within five minutes. The doctor was able to call the patient, tell them to go to the ER, and the patient was treated quite quickly. Generally, an hour wait is not going to make that much of a difference, but in this case in particular, it made a big difference. We were able to quickly get them into the cath lab and undergo a pacemaker implant. It has really helped our practice more efficiently and effectively treat these patients.

Tina Allmandinger, RN, BSN, practice manager:

What needs led you to begin an EMR implementation with Philips BioTel Heart?

We knew we needed to improve our workflow. We had a very manual workflow, and we needed something that was going to allow us to use less time managing reports and more time for patient care. We are always looking at ways to improve costs and maintain safe, quality care for our patients. However, we knew the long-term sustainability of our previous workflow was not working with the patient growth and cost-saving needs that we had.

How has EMR integration helped your office and staff?

It has helped tremendously. It has provided us with much more efficiency within the department, giving us the ability to manage more reports without the need for more staff. Everyone is needing to do more with less and still maintain quality of care that our patients deserve. It has reduced the time spent getting the reports from one EHR to the other. The previous process required all of the assistance from the staff; it is now automated. The time spent printing reports and scanning them into the patient chart is no longer necessary, and that has allowed the staff to spend more time on patient care, which is where their focus should be.

What time-savings differences you have noticed in your staff, patients, and physicians after the integration with Philips BioTel Heart?

We have a relatively large healthcare system, and with the EMR interface, we have a complete interface that we put together. It involves the ordering and registering of the device, and allows those staff throughout the whole health system to work in the EHR system that we function out of. It doesn’t require them to go from one to the other, from Philips BioTel Heart and Epic. It allows the staff to work just out of Epic, which is what they’re used to doing. They are able to work out of the system they work in every single day when providing patient care, so they don’t have to worry about logging in or remembering a different password. That process is now much more streamlined.

It has allowed the physicians to more quickly view the reports. Previously, they would have to click through every page of the report. Those reports can be quite lengthy. Now it’s just one PDF, and they can easily scroll through a report they’re looking through. Honestly, I don’t know if most of the physicians are even aware that we put this EMR together, because the transition has been seamless for them, which was very helpful. I was recently talking to one of our physicians, and he stated he recognized the change but didn’t realize it was in relation to the EMR.

Having access to data is much quicker than it previously had been for urgent notifications. There have been times previously with our other process that it could take a couple of hours or more for us to get all of the data that was required to make a definitive action plan that was needed for the patient. Now, because the data flows from one system to the next when it becomes available from Philips BioTel Heart, the information is available in a much timelier fashion, to where those action plans can be implemented quickly for patient care.

Not only that, but the staff would previously have to print out those reports and then manually scan them in. During off hours when staff wasn’t in, that information would not be available to anyone within the healthcare system until the staff was back in the office. Now, those reports flow automatically from one EMR to the next when they become available. So they’re available even during those hours when the office is closed — weekends, holidays, and evenings — to anyone within the healthcare system.

Are there any specific advantages that you would like to share that might encourage others to consider doing an EMR integration with Philips BioTel Heart?

We partnered with Philips BioTel Heart because we felt that they had always wanted to deliver the same quality of care that Parkview felt was important. It made sense for us to make that long-term commitment in creating this EMR to make sure that quality of care was continuing to improve throughout our whole process within the healthcare system and to assist our staff that was performing the function, applying the devices, managing the reports for our physicians, and reading the reports. It was an investment that we felt was important and allowed us to continue to ensure the safe quality of the care of our patients, which is what our patients expect and deserve. It has continued to allow us to put our patients first and let our systems work for us. It allows us to continue to provide excellent care every day to every patient, which is what Parkview’s standard of care is based on and what Philips BioTel Heart helps deliver. Everything about what we started with Philips BioTel Heart years ago is based on that hands-on care that Philips BioTel Heart and Parkview feel is important for our patients. 

This article is published with support from Philips BioTel Heart.

Disclosures: Ryan Augenstein reports consulting fees and payment for presentation from Philips Biotel Heart. Jonathan Shirazi, MD, reports consulting fees from Biosense Webster and support from Medtronic for leadless pacemaker implant training. Tina Allmandinger, RN, BSN, has no conflicts of interest to report regarding the content herein.