Martha Jefferson Community Hospital
Charlottesville, Virginia
- 201 Beds
- Provides non-invasive cardiology services for metropolitan
Charlottesville (pop. 60,000)
Solution in action:
Cardiology data management system saves $160,000 a year in department
operational costs, along with providing improved turnaround of patient
reports.
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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.
"We have exceeded cost savings projections by nearly 50 percent.
This provided a return on our $280,000 investment in about 22 months,
which is very good."
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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."