GE Healthcare

Cardiology Consultants of Philadelphia

Cardiology Consultants of Philadelphia (CCP) is the second largest single specialty cardiology practice in the United States. Their practice has 21 office locations in the greater Philadelphia metropolitan area and specializes in providing comprehensive cardiology care.

Beginning in 2002, the CCP Board of Directors began discussing the idea of adopting an electronic health record (EHR). Expectations included an improvement in patient care, ability to participate in pay-for-performance, a marked reduction in filing and transcription costs, a reduction in malpractice exposure and costs and an ability to analyze individual and group practice patterns.

EHR deployment was guided by an EHR committee which was composed of several physicians, an executive director, an EHR project manager, and all IT and EHR related staff. The EHR committee provided overall direction for the EHR project. Global questions such as workflows, needed changes to clinical content, or how much material from existing paper charts should be scanned and so forth were resolved at this committee level. The EHR project manager was responsible for the day-to-day decisions regarding EHR rollout, as well as the deployment of her staff, and the overall timing of the EHR rollout schedule. The physicians themselves determined the order with which offices transitioned to EHR.

General Electric (GE) staff participated in the go-live training of CCP’s first office. Since CCP provides its own clinical content, GE takes care of core software and hardware issues.

IT support was obtained by hiring full time staff to develop an IT infrastructure as well as to implement EHR deployment. CCP’s IT department is also responsible for maintenance of all servers, including backups, as well as maintenance of all hardware and network components.

CCP planned EHR rollout to occur at the rate of one office each 4 to 8 weeks with each office being trained by an EHR trainer. A complete schedule of rollout activities throughout the practice was maintained on the practice intranet. Each site knew well in advance when go-live would occur at that site. Physician office schedules were reduced, initially to 50 percent of pre-EHR levels, gradually increasing until pre-EHR levels were achieved within two to six weeks after physician go-live. Basic Centricity® navigation training was conducted both in live groups by employee function and through WebEx sessions for general staff. In order to simulate office visits, the physicians and clinical staff were given user accounts in Centricity® Network Training, a training and development environment otherwise identical to the production system. As sites went live, CCP identified “Super Users” which are users with above average computer skills that have also shown an aptitude in learning Centricity’s basic functions. These Super Users served as a sounding board for questions arising when an EHR trainer was not on site.

The CCP EHR system makes extensive use of real-time quality checking algorithms. Before the patient can be dismissed, deviations from defined quality measures are identified and presented to the provider. This gives the provider the opportunity either to correct the quality deficiency, or to provide an explanation for deviation. The EHR presents the evidence for the appropriate quality indicator. It is not possible for providers to bypass these quality checks. Examples of cardiology quality indicators include anti-platelet therapy use for patients with coronary artery disease, beta-blocker therapy for patients with prior myocardial infarctions, ACE inhibitor or angiotensin receptor blocker use for patients with systolic congestive heart failure or left ventricular dysfunction, prophylactic ICD implantation in appropriate patients and smoking cessation advice. Now that all CCP providers have been on EHR for more than one year, CCP has begun to collect aggregate quality data, grouped by provider, for use in internal quality improvement, and eventually for pay-for-performance contracts. CCP has also created custom interfaces with three manufactures of implantable cardiac devices. Device interrogation data from patients enrolled in remote defibrillator and pacemaker-monitoring system is forwarded to CCP’s EHR using HL7 messages and appear as lab results in theEHR system.

Results

• Transcription costs have been reduced to under $100,000 from a pre-EHR cost of $800,000--a reduction of 88%.
• Filing clerk positions have been cut in half for a $350,000 savings.
• CCP has received a 3.5% reduction in malpractice insurance expense representing a $70,000 savings.
• Since creating a customized encounter form for warfarin management, CCP has been able to run weekly reports indicating which patients are overdue for their blood tests. CCP found patients overdue as much as 6 to 12 months through this process. Nurses can now contact these individuals to facilitate their compliance with anticoagulation monitoring.
• CCP has been able to negotiate materially better rates of payment for cardiology services with most of their insurers simply because of the presence of an EHR system.
• CCP has entered into pay-for-performance arrangements with several larger insurers, increasing our reimbursement for clinical services.

***Submitted by Jenn Francis, Public Relations, GE Healthcare IT, jennifer.n.francis@ge.com

Published: January 26, 2009