Leveraging IT to Boost ECG Efficiency

Sharp HealthCare is a not-for-profit, integrated regional healthcare delivery system that includes four acute-care hospitals, three specialty hospitals and two medical groups and multiple clinics in the San Diego area.

The entire Sharp HealthCare system emphasizes clinical excellence and performance improvement. The commitment has translated into multiple national awards recognizing the system for clinical excellence and high-quality patient care. In recent years, Sharp has garnered a Malcolm Baldrige National Quality Award and the American Heart Association’s Gold Performance Achievement Award among others.

Clinical teams across the enterprise strive to match the system-wide commitment to clinical efficiency, quality and innovation. For example, the enterprise cardiology team has put Sharp’s values of innovation, excellence and efficiency into practice, partly by smart investments such as the GE Healthcare MUSE cardiology information system.  “As our hospitals centralize electronic medical records, cardiology is leading the way in terms of standardizing procedures across a large enterprise. We’re demonstrating how integration can work and the value that can be derived in terms of efficiency and quality by use of standardized systems,” explains Krista Fine, clinical imaging, information systems, and former clinical lead for Heart and Vascular Services at Sharp Grossmont Hospital.

In 2007, the healthcare system established a strategic plan focused on enterprise access to ECG data. The goal was simple: develop a system-wide enterprise cardiology database to support best practices in cardiology. Specifically, Sharp HealthCare sought to improve efficiency, raise quality and reduce costs.

The clinical and administrative team spearheading the project turned to long-time cardiology partner GE Healthcare for support in the endeavor. The team decided to expand the MUSE cardiology information system across four hospitals and 19 clinics to better meet the needs of physicians and patients. Three years into the enterprise project, Sharp HealthCare has realized impressive results. Since upgrading MUSE:

• ECG interpretation accuracy has increased from 85 percent to more than 99 percent;
• Turn-around times have decreased from an average of 15 hours to less than five hours; and
• Physician satisfaction has increased.

The enterprise deployment of MUSE benefits both workflow and patient care. On the workflow side, the software enables streamlined sharing of information and knowledge, training and best practices. And on the patient care front, immediate, enterprise-wide access to current and historical patient data accelerates clinical decision-making and patient care. “Having a comprehensive, customizable and easily accessible system gives us the ability to correlate care across 19 clinics and four hospitals,” shares Fine. 

State-of-the-art CIS at a glance

Sharp Grossmont Hospital operates one of the enterprise’s largest cardiac caseloads. It is one of the busiest STEMI centers in California, and it completes more than 4,000 inpatient, outpatient and emergent ECGs monthly, which accounts for nearly one-third of the enterprise’s 13,000 monthly ECG exams. Sharp Grossmont was the natural leader for the enterprise MUSE project.

MUSE transformed ECG workflow from a paper-based to a digital model. The process is simple, says Colin Ramsey, manager of heart and vascular services. After a tech obtains an ECG, the data are archived to MUSE and become immediately available throughout Sharp HealthCare. “This represents a fairly dramatic workflow improvement,” states Ramsey. “There are fewer steps, and the entire process is smoother.”

Prior to the enterprise MUSE project, physicians located at one Sharp hospital or clinic couldn’t immediately access ECGs acquired at another Sharp HealthCare site. Now, any physician can log on to the system to view a new or archived ECG. “As a result, physicians can provide faster diagnosis and treatment for our patients,” explains Ramsey. Take the case of a STEMI patient who presents to the Sharp Grossmont ER. Within minutes of acquisition, a physician can compare the new ECG data to a previous exam acquired anywhere across the Sharp HealthCare enterprise. The capability provides the physician with the information needed to decide if the patient needs to proceed to the cath lab or if he can avoid cardiac catheterization.

It’s an appealing new model. Before physicians were tied to paper results and paper processes, which disrupted workflow and compromised optimal patient care. “When a patient arrived at any Sharp facility, the only way to check for a previous ECG was to ask patient history and call the facility or department (if the patient remembered the location). If there was a previous ECG, it had to be located, retrieved and then faxed,” explains Ramsey. 

“The flexibility to read ECGs from anywhere at my convenience helps tremendously,” shares Sharon Sadeghinia, MD, a Sharp Grossmont-affiliated cardiologist. “I can review results in a timely manner and compare present and previous ECGs without running around to physically locate the previous results, and these capabilities are available to almost every physician in the system.” In addition, cardiologists electronically sign ECG results from their offices, eliminating the need to travel to the hospital.

The MUSE workflow is a stark contrast to traditional, paper workflow, which impacted both patients and physicians as inadequate information or a lack of shareable information ultimately affects continuity of care. “By using MUSE, three key elements are satisfied: data accuracy, data accessibility and data consistency,” states Ramsey. 

Sharp HealthCare accrues efficiency in other ways as well. “The key is standardization,” states Ramsey, “We use the same workflow for ECG techs across the enterprise.” Ramsey recommends making sure interested and relevant stakeholders are engaged early in the process to ensure standardized workflow across all sites.

Another key factor in the workflow  process is to standardize how the ECG test is acquired.. The current focus at Sharp HealthCare is standardizing all ECG devices to the GE Healthcare MAC 5500 ECG analysis system, which offers wireless, LAN and SD card connections to MUSE.

In addition to boosting workflow, the enterprise solution delivers other bottom line benefits. MUSE helped eliminate the need for on-site paper storage and the time associated with managing paper records. With MUSE, Sharp HealthCare sites also spend less time completing, recording and correcting billing.

Similarly, MUSE provides streamlined access to data needed for quality and compliance objectives. “With MUSE, we can track every ECG performed across the enterprise and ensure that there is an order for each,” explains Ramsey.

Finally, the software-only system offers 24/7 availability and support. Sharp’s IT staff maintains the centralized server to minimize downtime and provide a higher level of security to ensure HIPAA compliance. 

The right connections

MUSE helps Sharp HealthCare make all of the right connections. The software helps its disparate sites readily connect to each other, expediting patient treatment and care and trimming costs. In addition, the technology provides a solid platform for the future. “With a fully integrated MUSE system, Sharp now has a strong foundation to build on for future cardiac expansion at our hospitals and clinics,” explains Fine.

The expansion includes integration of other applications such as Holter and treadmill to enable continuity of care and system-wide online clinical information access.  The plan also incorporates implementation of system-wide CVIS with structured reporting, less manual entry, fewer mistakes and faster turnaround, shares Ramsey.