What began as an effort to improve consistency and reduce turnaround time for ECG readings has turned into a major cost savings program for Martha Jefferson Hospital (Charlottesville, Va.), a not-for-profit community hospital. Since implementing a MUSE^® computerized cardiology data management system (GE Medical Systems) in 1993, the Non-invasive Cardiology Department has saved about $315,000 in operational costs.

"The big breakthrough occurred when we decided to set up a physician on-line reading program," says Barbara Elias, director of Cardiopulmonary Services at Martha Jefferson. "The efficiencies we gained through automation significantly reduced the amount of time physicians and staff spent in the ECG reading process -- and enabled us to amicably negotiate a reduction in reading fees."

The department staff showed physicians how to view and overread a computer-interpreted, 12-lead ECG on-line. This eliminated the need to read from a department hard copy. Instead of dictating an interpretation and having transcribers edit report changes, physicians could edit interpretations on the screen.

Handwritten report signatures were replaced with electronic signatures at the time of reading. This eliminated a second trip by the physician back to the department to sign reports. Once a report is confirmed, the final reports automatically print out at the technologist workstation and are ready for distribution.

"We have gone from an average of five minutes per reading to as little as 30 seconds each," Elias says. "Even physicians who had previously not used computers routinely, learned quickly with the tools we provided them, and the user-friendliness of the system."

It also helped to have a physician champion. Dr. Larry Goss made extra time to orient his colleagues. The four cardiologists then promoted the benefits of the new system to the rest of the 23 reading physicians. "They believed in using the system's ability to create a paperless process - and we did," Elias adds.

As a result of the new efficiencies, the department was able to save $46,000 in physician fees in 1994, and project a savings of nearly $51,000 in 1995. The department also was able to save about $8,000 a year (.3 FTE salary) by eliminating the role of the transcriptionist.

In addition, Elias identified five more areas impacted by the MUSE cardiology data management system , and has generated precise cost savings results.

1) Elimination of lost billings. For manual operations, the national average of lost ECGs is about 10-15 percent, according to Elias. "We conservatively estimated that even if we lost five percent of our ECGs annually (65), before they were billed, we would recover almost $35,000 a year," she said. "The MUSE system saves all ECGs automatically, eliminating the problem of missing order entries."

2) Use of microfilm paper and processing. Martha Jefferson had limited storage space, so every month all ECGs had to be recorded on microfilm for long term archiving. The new on-line database is capable of holding 6.5 million cardiology records in its file servers (2 million copies/server), which at the hospital's present rate of 14,400 a year provides a true replacement for all paper and film storage of ECGs. "We eliminated all of our card files and save $1,200 a year on microfilm paper and another $2,000 a year on film processing costs," Elias says. "In addition to reducing the concern over lost copies."

3) Single source for ECG cart supplies. The hospital also replaced its fleet of six ECG carts, which had been made up of different vendors, to a single vendor (GE Medical Systems). This move allowed Elias to consolidate and simplify the supply requirements, which saved an additional $5,000 a year. "The use of one report format has simplified reading and improved the consistency and quality of recordings," Elias says. "We've also attained volume discounts for electrodes and paper."

4) Elimination of special laser labels. The hospital saved $400 a year by eliminating the need for purchasing laser labels. The labels had been required to make different kinds of ECG paper recordings compatible with the transcription service. Subsequently, one paper type has been used on ECG recordings throughout the hospital. "It's these types of little things that really add up," Elias says.

5) Increasing staff efficiencies. At the same time the cardiology data management system was activated, Martha Jefferson expanded its non-invasive cardiology services. The addition of three cardiovascular physicians over a two-year period increased patient volumes and justified increasing staff levels by another half-time (0.5 FTE) person. However, the cardiology data management system eliminated the manual ECG process and enabled staff to spend more time providing technical patient services instead of doing paperwork.

"As a result, we've been able to manage the volume increase with the same five staff members - which saved us from spending another $15,000 a year on additional personnel," Elias says.

Improved patient care from better turnaround and accuracy

Not only was Martha Jefferson able to achieve considerable savings with its new MUSE cardiology data management system , it substantially improved the quality of its ECG services.
 

Martha Jefferson receives ECGs from a variety of sources within the hospital, its satellite offices and contractual arrangements. The main receiving station is in the cardiology department. The department also set up a special physician's workstation with large-screen monitor in a separate reading room.

All ECGs coming into the system are coded by location, the cart used, and staff member performing the study. The codes allow the department to track where the recordings come from, and monitor the quality of exams. Complete files are developed, including all historical ECGs, with waveforms, for serial comparison, as well as information from other cardiovascular studies performed on that patient. "This gives physicians access to a complete cardiology diagnostic history," Elias says.

"Before the MUSE system , we had to do everything manually, which created a significant lag in ECG report turnaround time," according to Elias. "The national standard for ECG results is availability within 24 hours - we were taking 48-72 hours and sometimes longer.

"Now, with the automated system, we deliver patient results usually within 12 hours, and often in less time than that," Elias says. "We can turn reports around immediately - in as little as a few minutes if necessary. This has a positive impact on the delivery of care because the reports get to the physicians sooner. Having this information available helps expedite their treatment decisions," she adds.

On the issue of accuracy, Elias and the department cardiologists believe that the computerized interpretation capabilities built into the MUSE system provide increased consistency in interpretations between readers. This results in fewer mistakes and higher quality readings. "It's been estimated that the average manual-reading-error rate for ECGs is about 20 percent per 100 tracings. That number drops to less than five percent with the computer," she says.

Managed care drives cost savings

Although less than five percent of Martha Jefferson's business is under managed care contracts, health plans are aggressively targeting the area, and employers are becoming more oriented toward managed care, Elias warns. "Managed care is growing rapidly in our community. We have two plans actually practicing, but nine plans are licensed to operate within our service area."

The result of this change is that service providers will look at capital investments more closely and will scrutinize them for how they impact the cost of delivering healthcare. "We need to find ways to work more efficiently, which means doing more with less without compromising patient care," she says.

"The MUSE system is a good example of how technology helped us to optimize our resources. We have exceeded cost savings by nearly 50 percent. This provided a return on our $280,000 investment in about 22 months, which is very good."