"I know I need to implement enterprise-wide mobility. Which service lines should I focus on first?"
I hear that question all the time from hospital CEOs and CIOs. In response, I encourage the development of use cases that address your challenges and strategic initiatives. Through that process, the enterprise-wide approach will almost always reveal itself as the best way to maximize the value of mobility and achieve the highest levels of clinical, financial and physician benefit. That said, if you need to focus on just one area, then the cardiology service line presents the strongest opportunity to make an immediate impact.
Heart disease is the leading cause of death in the United States.1 Every year, nearly 22 million people who present to emergency departments suffer from cardiovascular-related illnesses. The associated costs exceed $100 billion annually.2 At the same time, health systems must work to maintain efficient cardiology services. Fast-changing reimbursement trends and care models are causing some sleepless nights for healthcare providers. This is where mobility can deliver tangible benefits in care quality and coordination, and costs and revenue.3
Improving care quality and coordination
Regardless of your role — CMO, cardiologist or health system executive — your key cardiology goals should include improving patient outcomes by optimizing the quality and consistency of care. To that end, timely diagnosis and treatment are critical. For patients with acute myocardial infarction or other cardiac conditions, a minute can mean the difference between life and death.
Mobility accelerates the availability of ECGs and provides patient history, physical examination and other key diagnostic information on smartphones and tablets. Anytime, anywhere access to this data can dramatically impact clinicians’ ability to make decisions that save muscle and life itself.
For example, door-to-balloon time is one of the most significant cardiology metrics. Today, 90 minutes is the benchmark set by CMS and the Joint Commission. But when cardiologists can access diagnostic-quality ECGs coming directly from the ambulance, they can make immediate decisions — and that saves valuable minutes. With these mobile capabilities, some hospitals have reduced door-to-balloon times to an average of 35 minutes.
By helping to expedite treatment, mobility can have a measurable impact on patient health. Reducing the time to treatment means that patients enter the ICU with less heart damage. A retrospective comparative analysis of STEMI patient cases conducted by AirStrip in which an ECG mobility tool was used, compared to patients with similar demographics and risk levels who did not have access to the mobile ECG, found a host of intriguing results. By providing cardiologists with mobile access to ECGs pre-hospital or just after arrival:
- 22 percent more patients were discharged to home versus post-acute care
- 11 percent improvement in post procedure ejection fraction with mobility
- 60 percent of patients were more likely to have a normal post-procedure EF range (50 percent and higher) versus a mean of 45 percent without mobility
Treating cardiology patients requires immediate multidisciplinary collaboration. Ensuring all team members have rapid, mobile access to live and historical ECGs and other clinically relevant data elements from electronic medical records can dramatically expedite consultation and help ensure timely, appropriate intervention. Hospitals using mobility have achieved a 50 percent shorter median time for involvement in complex cases. In addition, a recent survey conducted by AirStrip found that a majority of cardiologists believe the physician-to-physician consultation process is timelier with mobility compared with traditional approaches. Three out of four physicians believe mobility reduces the time to intervention for critically ill patients.
Furthermore, today's emerging collaborative care models demand secure, mobile access to live and historical patient information, regardless of where that data lives. Mobility enables physicians to make a remote diagnosis. Also, when an electro-physiologist needs to consult with a cardiologist about a patient, the two can review the same ECG in near real-time from different locations.
Mobility can erase the boundaries that separate disparate data sources, resulting in improved responsiveness and efficiency. The AirStrip survey showed that 92 percent of cardiologists found it easier to access patient ECGs when compared to traditional approaches, while 85 percent thought the ability to access historical ECGs contributes to improved diagnosis and treatment decisions.
Lowering costs and increasing revenue
Higher-revenue service lines such as cardiology present hospitals with an opportunity to strengthen overall financial performance. While the goal is to reduce costs and capture maximum revenue from cardiology, regulatory changes are making this more challenging than ever before.
Hospitals are now grappling with a cardiology-related penalty included in the Patient Protection and Affordable Care Act connected to 30 day readmissions that can cost up to 1 percent of Medicare diagnosis-related group payments around AMI and heart failure.
Remember that patients who experience a shorter event-to-balloon time and shorter ICU stay are much less likely to return with complications within 30 days. But there's even more to the story.
For one hospital, a recent analysis of 100 ECGs of discharged patients revealed a significant percentage had difficult-to-detect conditions when discharged and therefore returned within 30 days. Those patients had a condition that was not detected by the physicians on the floor, because not all of them were cardiologists. Mobility enables electro-physiologists and cardiologists to review patient data from anywhere, and prevent patients from leaving the hospital without proper care.
Mobility also impacts the critical post-discharge period. Using sensors that constantly upload ECGs and other data, clinicians can see how patients are doing at home and identify potential causes for readmission. A two-year study of patients with congestive heart failure showed a 44 percent drop in readmissions through the use of home telemonitoring.4,5
In addition, mobility equips cardiologists with the ability to decide whether to bypass the emergency department and send patients directly to the cath lab. This enables hospitals to avoid readmission penalties, as they are not penalized for a readmission under the PPACA when patients go directly to the cath lab instead of the ED.
Going beyond readmission penalties, there are other easily achievable cost savings. For example, a hospital loses $7,500 on average every time a cath lab team is unnecessarily assembled. Therefore, the sooner clinicians can identify and communicate a false STEMI (ST-Segment Elevation Myocardial Infarction) via mobility, the more savings the health system will see. Mobility can help hospitals shave nearly a day from their post-STEMI ICU stays, saving as much as $1,500 per patient.
ECG billing can also enhance cardiology service line revenues. ECG billing is often triggered by a cardiologist's confirmation of the diagnostic algorithm assigned to an ECG after acquisition. To expedite billing and potentially remain eligible for reimbursement, care organizations often institute a 24-hour ECG confirmation policy. Nearly 15 percent of ECGs are not confirmed in a timely manner — potentially forfeiting up to $75 per ECG. Mobile edits and confirms can increase 24 hour ECG confirmations by 43 percent — and by an additional 40 percent with mobile inbox management and smart routing.
In addition, cardiology patients are often undertreated. Mobilizing ECG data can help proactively identify groups of at-risk patients — particularly those with underlying cardiac dysrhythmias that are not the primary reason for admission. An analysis of hundreds of thousands of ECGs across multiple institutions revealed that up to 39 percent of these patients may meet medical necessity criteria for follow-up care.6
The benefits of developing an enterprise-wide mobility platform are too significant to ignore. However, when that is not possible, carefully consider the challenges your health system faces. An honest assessment of pain points can support a mobility strategy that addresses those concerns on a service line basis — whether it is cardiology, diabetes, and so on — throughout the continuum of care. The assessment can also reveal benefits you may not have previously considered. In addition, the strategy has to offer aggregation of clinically relevant data to support caregiver dashboards that are accessible via multiple form factors, including smartphones, tablets, laptops and desktop computers. The user experience has to be the same regardless of the device being used — a feature that few vendors now offer.
1 Kochanek KD, Xu JQ, Murphy SL, Miniño AM, Kung HC. Deaths: final data for 2009. National vital statistics reports. 2011;60(3).
2 Heron M. Deaths: Leading causes for 2008. [PDF-2.7M] National vital statistics reports. 2012; 60(6).
3 Centers for Disease Control and Prevention. http://www.cdc.gov/heartdisease/facts.htm
4 FierceHealthIT, March 2, 2012 – Terry, Ken “Geisinger plan reduces readmissions 44% with telemonitoring.” http://www.fiercehealthit.com/story/geisinger-plan-reduces-readmissions-44-telemonitoring/2012-03-02
5 http://www.advisory.com/Daily-Briefing/2012/03/07/Geisinger-telemonitoring-system
6This analysis utilizes data from hospitals and health systems that have implemented AirStrip ONE Cardiology, a mobile solution that provides clinicians with interaction with mobile digital ECGs, “live” monitoring data and historical patient data. A retrospective comparative analysis was conducted of STEMI patients in which AirStrip ONE Cardiology was used, compared to patients with similar demographics and risk levels who were not covered by AirStrip. For more detail on methodology, please contact the author.
Alan Portela has more than 25 years of experience in bringing groundbreaking medical technology solutions to market. Mr. Portela originally joined AirStrip as a senior advisor and member of the Board of Directors prior to his appointment as CEO in 2011. Prior to joining AirStrip, Mr. Portela was CEO and principal of Hybrid Clinical Transformation, LLC, where he developed successful EHR adoption strategies for the U.S. Military Health System and much of the Veterans Health Administration. He also served as president and chief strategist at CliniComp, Intl., and in senior executive roles in several innovative healthcare organizations.