Currently, we are in the final stages of a complex interface project. We are interfacing to a proprietary information system (IS), the type of project that we have done many times before. What makes this project different is that we are not interfacing to an IS that belongs to a client; it belongs to a public body that is interfaced to our client’s IS. The TeleMED system receives orders from the Client IS and the TeleMED system sends results to the Client IS.

However, the Client IS has certain limitations that prevents it from receiving the entire ECG Final Report and, therefore, prevents it from sending the entire ECG Final Report to the Public IS. The Public IS does not have these limitations. Therefore, we are interfacing directly to the Public IS to enable a transmission of the entire ECG Final Report directly from the TeleMED system to the Public IS.

The particular challenges that we are facing in this project include the following:

1. It has been necessary to make changes to the order interface that we have with the Client IS in order to receive data in the format that is required by the Public IS.
2. We needed to design and engineer new editing functionality in order to enable our system to generate the type of messages that were not required by the Client IS but are required by the Public IS.
3. We needed to integrate this new editing functionality into an upgraded version of our ViTELflo application that had been developed but had not yet been fully tested or deployed.
4. The new ViTELflo software has to be successfully tested by our client and must be fully deployed by us.
5. All of these tasks have required completion within a very challenging set of timelines.

Keep reading here to learn how it turned out.

ECG recordings are often corrupted by noise and artefact. Among the undesirable results, there are many false alarms and many patient recalls.

In order to maintain and improve ECG signal quality, a great deal of attention is paid to factors such as good skin preparation, use of quality electrodes, proper electrode application, good electrode-to-patient contact, artifact elimination and proper lead selection.

In busy testing organizations, the responsibility for ECG monitoring is shared by a large number of clinicians. Therefore, there must be early recognition of patterns that identify those clinicians who have difficulty in consistently acquiring high-quality ECG signals.

TeleMED’s Feedback Tool offers Physicians, who are interpreting ECG tests, the opportunity to quickly comment on signal quality, request a patient recall and submit these comments to a centralized database, all from the same screen that is used for interpretation.

Users who are responsible for monitoring data quality can generate a report showing all instances of feedback and include a notation of the clinician who acquired the data. Here is a sample excerpt:

To add context and greater meaning to the data in this report, the user can sort data to generate secondary reports. The excerpt below shows such a report.

Capture billing data quickly, but accurately. This is a lesson that organizations learn when converting from paper to digital management of ECG and other diagnostics. Realizing that automation of the processing cycle provides an opportunity to efficiently gather billing data, they usually expect a reduction in unrealized revenue in DNFB (discharged-not-final-billed) and a corresponding increase in cash flow.

Our experience is that there is an improvement in cash flow but the improvement does not initially meet expectations. Automation of the processing cycle accelerates the capture of billing data but the level of back office holds and there is no reduction in the level of back office holds or in claim rejections.

The reason, of course, is that the organizations are collecting data faster but the data is still “dirty.” Expedited data collection is most effective when steps are also taken to ensure that the data is “clean.” This usually means eliminating, wherever possible, manual data entry.

Here are five ways of leveraging technology to further improve cash flow management of ECG-related revenues:

1. Where possible, use magnetic ID card reader and bar code scanning technology to gather order entry data. For years, many of our clients have used scanning technology to gather demographic and insurance data from patient insurance cards.
    
    
2. Use a testing system that “remembers” entered data and will automatically carry it forward on new orders.
    
    
3. Use intelligent alerts to alert users when business logic is violated (e.g. – incorrectly formatted encounter numbers, mandatory fields not completed).
    
    
4. Where possible, interface order entry systems with your testing software to eliminate the need to re-enter data into your testing application. One client, who recently completed this integration, found that the level of back office holds was reduced by over 50%.
    
    
5. Interface the testing application to the system that billing personnel use for accessing billing information. If this cannot be done, give billing personnel access to the database in the testing application so that they can collect the information they need quickly and in a timely manner.

“Never stop automating your ECG solution.” It’s a lesson of which we were recently reminded when we heard about a problem at one of our client’s clinics.

Some time ago, we had interfaced our WORKflo software to our client’s information system. As a result, all pending ECG orders were being transmitted seamlessly to the clinic. As a result of this interface and the advanced automation that our solution offered, Technicians at the clinic had very few steps to take to perform an ECG test. We felt comfortable telling them, “Just enter the case number, hook up your patient and press the Start button. The system does the rest.”

However, our client told us that problems were occurring at the clinic because the Technicians were making errors in entering the case numbers, despite the fact that all they had to do was copy the case numbers from the test requisitions in front of them. If a test result became linked to an incorrect case number, the client’s information system could not match that test result to a pending order. The discrepancy had to be resolved by human intervention and the service could not be invoiced until the problem was resolved.

The solution to the problem was easy. Each test requisition also included a bar code sticker that the client’s information system generated and this bar code included the case number. Therefore, we sent the clinic a bar code scanner. Now instead of entering the case number using a keyboard, a Technician simply enters the case number by scanning the bar code. Some time is saved, and more importantly, it eliminates the risk of incorrectly entering the case number.

The lesson to us was that an ECG management solution provider must always look for ways to automate tasks. The impact of automating even a small task can be significant to users. In the case of this client, we now say: “You don’t have to use your keyboard to perform a test.”

Do you need data management services to support your ECG management technology?

ECG management does a great job of standardizing work flow and automating data entry. However, there will always be unusual situations that require some corrective action relating to your data. The busier your ECG operations, the more often these situations will occur, and when they do occur they require timely intervention.

Our clients have found that it is in their best interest to purchase data management services to deal with these issues. Here are typical requests for assistance that we get:

Data Editing

1. “I entered some information about the patient incorrectly. I need to have the information edited in the system.”

Test Re-Routing

1. “I just sent a test to Cardiologist X to interpret. I just noticed that the patient is only 10 years old and I need to re-route that test to our Pediatric Cardiologist before Cardiologist X interprets it.”
2. “I just sent a test to Cardiologist Y for interpretation, but the Referring Physician did not want the test interpreted by us. She wanted to interpret it herself. I need to take that test off Cardiologist Y’s list before he interprets it.”

User Account Management

1. “We need to set up user accounts for a new staff member that starts today.”
2. “I forgot my password. Can you help me?”

Delete Test

1. “I took 2 ECG tests on the same patient because I didn’t like the quality of the first tracing. I accidentally sent both of them for interpretation. Can you delete the first one before it gets interpreted?”

Print Queue

1. “The ECG system shows that ECG numbers 123456 to 135222 were automatically printed, as scheduled, at 6am this morning. However, the printer ran out of paper. Can you put the tests back into the print queue and force them to print off right away?”

All of these situations are out of the ordinary, but that’s exactly why they have to be resolved right away. When purchasing an ECG management system, you need to decide whether you want to have your own people resolve the problems or whether you prefer to outsource this responsibility to your solution provider. If you want your provider to handle these tasks, then you must satisfy yourself that your provider has the infrastructure and the willingness to act responsively.

Pleasing all the stakeholders

A variety of departments provide input on the selection of an ECG management solution in most organizations. Each has a different set of needs and a different viewpoint on what is the “right” ECG management system. In order to satisfy a client, an ECG data solution provider must satisfy each department.

Here are the questions that we often face from stakeholders representing these departments:

Finance

1. How will we save money from the productivity gains you promise?
2. What value-added services do you offer?
3. What options do you offer for licensing?
4. How will you help us grow our ECG business?
5. What other modalities can we add to your solution? How much will it cost?
6. What is our cost to convert to your solution from our current management system?

Operations

1. How will your solution save us time and expedite our patient flow?
2. How will your solution eliminate errors in processing ECG tests?
3. Will we able to download patient demographics and orders from our existing systems?
4. Can we use devices from multiple vendors? Do you standardize the workflow?
5. What options are available for reporting ECG results?
6. Will you customize the application’s workflow as needed?
7. How quickly can we retrieve a test result when we need it?
8. Do you have a solution for mobile ECG testing?

Clinicians

1. Can we access ECG tracings from anywhere, with any computer?
2. Can we use our hand held devices to read ECGs?
3. Will we have access to previous ECGs and can we compare tracings serially?
4. Can we adjust viewing and editing settings according to individual preference?
5. How quickly can we work on your application?
6. How do we export results from your application to our EMR?

IT

1. What platforms does your solution utilize?
2. What hosting options are available?
3. How can we interface your solution to our existing information systems?
4. How will you store our data? How will you back it up? How long will you store it?
5. How will you protect our data?
6. Is your solution completely scalable?
7. How much involvement do you need from our department to rollout your solution?
8. How do we migrate data from your solution when our relationship ends?