Wake Forest's New HIS Interface Streamlines ECG Ordering and Reporting
Wake Forest University Baptist Medical Center
Winston-Salem, North Carolina
Solution in Action:
Through an industry standard HIS interface from GE Medical Systems,
Wake Forest University Baptist Medical Center has enhanced the flow of
cardiology information between the Department of Cardiology and other points
in the hospital. The results have been greatly improved efficiency, greater
accuracy and easier billing.
Our HL7 Interface Links MUSE® with HIS
Wake Forest University Baptist Medical Center has eliminated much of the
time-consuming and error-prone process of manual data entry, improved access
to ECG test results and streamlined the ECG billing process, by using the
HL7 interface to link the center's HIS (Hospital Information
System) to the Department of Cardiology's
MUSE® information system.
"Without the HL7 interface, any cardiology information system would
operate as a stand-alone departmental system -- the ECG results would not
be in our hospital electronic database," says Ruth Saalweachter, manager
of systems development. "We're moving toward 100 percent electronic patient
records, as is every major hospital, so this is the first step in getting
us to that point."
Industry Standard Interface
The HL7 interface is an industry standard product, capable of communicating
seamlessly with the products of all major HIS vendors, including SMS, HBOC,
Meditech, Cerner, IDX, Datagate and HCI. Wake Forest currently uses HBOC's
Clinipac HIS, but will be phasing in IDX's Last Word system beginning in
1998.
Through the HL7 interface, electronic demographic information and ECG
orders generated in the Clinipac environment populate the MUSE database.
From there, technicians can download detailed orders to a diskette onto
Wake Forest's ECG carts without any additional data entry. Then the process
works in reverse; the patient's electronic demographics -- plus the ECG
test data -- are transmitted to a diskette and downloaded into the MUSE
system. The HL7 interface subsequently allows the patient's test results
to be sent to Clinipac. A copy of the results can be printed at the patient's
current nursing station location. At the time the final result is transmitted
from MUSE to Clinipac, a charge is written to a file which is processed
by the billing department.
Electronic System Demonstrates Advantages Over Previous Paper System
The major advantages of the electronic system at Wake Forest are greater
accessibility to vital test data sooner, time savings and fewer errors
through reduced data entry, and streamlined billing processes.
"We've experienced a 80-90 percent decrease in phone calls from nursing
units wanting to know the ECG results from a particular patient," says
Carol Westmoreland, administrative director, Cardiology Diagnostic Services.
"Once we've edited the report and sent it through the HL7 interface, it's
on the computer at their nursing unit more or less instantaneously. The
physicians or nurses can call up the results through Clinipac."
To save time, unconfirmed ECG results are sent across the interface
to nurses' stations. These unconfirmed reports are then available for display
on any of several hundred Clinipac terminals in the medical center or through
Uplink, a software application created by the hospital. The physician can
gain electronic access to the record in the MUSE and can make changes to
edits, redesignate the results as "confirmed" and post it back to the HIS.
In this environment the record is available to any department with access
to a Clinipac terminal, including the patient billing office -- without
a single piece of paper being processed.
Electronic Records Avert Data Entry Problems
Immediate access to cardiology test results has been a clear benefit, but
the most significant advantage of the HL7/HIS interface is elimination
of time-consuming data entry duplication and the potential for error associated
with it. Admit/Discharge/Transfer (ADT) data (basic patient demographics)
collected at admissions, using HBOC's Patient Management module, and orders
entered at the nurses' stations flow into Clinipac.
These patient records are then routed through the HL7 interface to the
MUSE database, where they can be downloaded to an ECG cart.
The ability to download ADT records and orders to the cart is one of
the unique advantages of the system.
Fifty percent of Wake Forest's 200 + ECG orders are downloaded daily
directly from the MUSE system to the cart. Avoiding data entry when possible
helps ECG technicians be more efficient and reduces the likelihood of errors.
"Technician typing errors have decreased by 70 percent," says Jennifer
Cumbo-Jones, ECG technician and medical transcriptionist. "With manual
data entry, errors are common because technicians often do ECGs in bad
lighting to avoid waking patients, or the doctors want the test done quickly.
Being able to download orders and ADT information right to the cart has
prevented errors, and the technicians like it because it's faster. Because
they've downloaded the information on the cart, they don't have to stop
and type it when they get to the patient's bedside."
HL7 Interface Saves Billing Time
Duplicate data entry for billing also has been eliminated through electronic
transfer to billing data from the MUSE system, across the HL7 interface.
The Clinipac system is programmed to create a charge when the final report
is transmitted.
"Instead of having to charge 200 ECGs a day manually, we now send bills
electronically to Data Audit," Westmoreland says. "Data Audit sends us
edit sheets to confirm the charge, and if our numbers total, we know we're
O.K. If they don't for some reason, at least we have the time to research
the cause, because we're not spending time manually billing."
Administrative Management Tool
"Having this interface has been extremely beneficial to the department,"
Westmoreland says.
The HL7 interface to the MUSE database has been useful in the Department
of Cardiology's administrative management, Westmoreland says. Conducting
over 200 ECGs per day is time-and labor-intensive, even with electronic
reporting capabilities. Therefore, the department has used the networked
system to conduct CQI studies and tracking, which can help determine ways
to increase departmental efficiency.
"Right now, we're tracking how many ECGs the technicians are doing per
month," she says. "We can do database searches on how many ECGs were done
in specific areas, such as the CCU or the Department of Cardiology. For
example, we wanted to determine our response time for conducting ECGs,
we pulled a whole month's worth of charge tickets to determine how many
ECGs we did, and whether they were ordered ASAP, or STAT or "routine,"
in relation to when the ECG was actually done. It turned out our response
time was pretty good."
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