Twenty years ago, St. John Medical Center (Tulsa, Okla.) set out to do the impossible: create an outreach program that improves physician relationships and boosts hospital referrals, while generating enough positive revenue to help offset the costs of running a growing cardiology operation.

Today, St. John has one of the country's most successful regional outreach programs for remote ECG services, including physician overreads and record storage of ECG and Holter cardiology data information.

"As an extension of the hospital's own cardiology management system (GE Medical Systems MUSE^®), the outreach program provides enough revenue to reduce department operation costs by 10 percent each year," according to Jeff Biffle, outreach coordinator for the St. John Cardiovascular Institute.

Twenty-three remote clients, encompassing 70 locations, send nearly 900 ECGs and 80 Holter studies a month to St. John. Outlying facilities transmit from a patient's bedside or central station using a toll-free telephone modem. The information is received by St. John's MUSE system, which automatically processes all 12 leads simultaneously within one minute.

Under the program, someone from the Institute's pool of cardiologists is available for overreads and consultation 24-hours-a-day, every day of the year. "STAT requests are ordinarily guaranteed 30-minute turnaround," Biffle adds.

Also, as part of the service, St. John's system will electronically query that site's database for a patient's historical ECGs and produce a serial comparison of the most current ECG with the first previous and oldest available ECGs - all automatically. It does the same for in-hospital use, such as when ECGs are performed in the emergency department.

For Holter remote services, St. John provides three-channel computerized analysis, as well as cardiologist interpretation. Holter cassettes and diaries are mailed to the Center, and data is transferred to the MUSE computer. A highly trained technician analyzes the data to differentiate and confirm the presence of complex dysrhythmias and silent ischemia.

A verbal report is conveyed within 24-48 hours and a written report is transmitted back to the facility's ECG machine. St. John maintains some Holter data on the MUSE system in that site's database for easy retrieval and comparison, as well as assurance against lost hard copy.

The services are available to any site with a phone line, however most of St. John's customers are within a 200-mile radius. They are comprised mainly of physician offices, smaller hospitals, nursing homes, and mobile medical services. "Proximity is important because physicians and their patients at these locations also represent hospital referral opportunities," Biffle says. "We are also looking to work with larger hospitals to put MUSE workstations into their cardiology departments, so they can perform all of the same ECG reading services at their facility. However, they will still use our MUSE storage system as a master database," Biffle says. "This way we can lower our per procedure expense and continue to take operational costs out of the system."

Upgrading the service

From a cardiology department standpoint, the system takes up less space, yet stores more. The current database houses about 450,000 ECGs on-line - dating back to 1978 - and has room to grow to 6.65 million records. "It also costs less to operate, due to fewer air conditioning and ventilation requirements, along with lower service needs," Biffle explains.

From an outreach perspective, the upgraded system has enhanced St. John's service by adding on-line faxing capability. "Previously we had to print out the transmissions from remote sites; take them to the copier machine to be put into a suitable format for faxing to the cardiologist on-call," Biffle says. "This was less than ideal because of the large degradation in quality."

The new system allows St. John to send the electronic transmission from the cardiology management system directly to the reading cardiologist's fax, as well as return confirmed reports back to the attending physician and/or original ECG cart electronically. "It looks like a laser print when they receive it," Biffle notes.

On a monthly basis, St. John can provide its sites with customized management reports on the ECGs performed, patient information and demographics. "This helps the sites keep track of their activities and helps minimize lost revenue due to missed charges," according to Biffle.

For internal customers within the Medical Center, the new cardiology management system provides an order-entry gateway to the hospital information system (HIS). Any request for an ECG can be made through the HIS which connects to me MUSE cardiology management system and sets up a "pending task" order.

The ECG technologists can query this file directly from their ECG carts, located anywhere in the hospital, and identify all of their assignments. This direct link to the HIS also provides an automatic download of the patient demographic information for each order, thus avoiding rekeying the same data.

"Once in the room, the techs can proceed immediately with the procedure," Biffle says. "This is a significant time savings and reduces the change of error in transferring the patient ID."

"There are no more worries about lost records, and the possibility of faster billing now exists."

Cost-effective management of multiple report types

The HIS interface also allows a physician to access a patient's complete cardiology history from any central information workstation in the hospital. On-line access to various and historical cardiac information eliminates wasted time previously spent searching medical records for archived hard copies and assembling them for physical comparisons.

"If everything is working smoothly with the manual method, the hard copy reports should be with the patient files; however, this doesn't always happen," Biffle says. "The electronic access provides assurances that they can get the data, and it also ensures the physician is seeing the most up-to-date information, such as any new studies."

He notes, "There is a time lag in paperwork getting to a patient record, but there is no time lag in electronic patient files. Also, there are no more worries about lost records, and the possibility of faster billing now exists."