“Any way you want it.” This is what ECG testing clinics must tell their Referring Physicians when those Physicians ask how they will receive their test results.

During the early days of electronic ECG management, much of the focus was on providing easy, secure, remote access for the physicians that were interpreting ECG tracings. In providing this access to Interpreting Physicians, cardiac testing organizations avoided the cost and inefficiencies associated with printing and delivering the ECG tracings to those Physicians, and in so doing, also elevated the standard of care given to their patients.

Now that the technology for transmitting tracings to Interpreting Physicians is well established, clinics are trying to achieve similar benefits from automating the transmission of test results to the Physicians who refer their patients for testing. In order to retain and expand its base of Referring Physicians, a clinic must be able to send results to each Referring Physician according to that Physician’s preference.

In order to deliver on this promise, a provider must have an ECG management solution that supports delivery of results the old fashioned way, by printing and hand delivery, but also that supports delivery by a number of more advanced alternatives. Therefore, here are five questions that you can ask to ensure that the ECG management solution that you buy will be as progressive as the demands of your Referring Physicians:

1. Does the solution support automated results distribution by fax, e-mail or electronic data interchange?
2. Does the solution include HL7 parsing of results for reporting to other HL7-compliant systems?
3. Does the solution support an option for distribution of results as they become available or in batch mode?
4. If results are being batched printed, can output be automatically sorted by Referring Physician, testing location or by courier route?
5. Does the solution permit results to be reported cumulatively, the latest result being reported in full, with a summary of previous results going back any number of months, years or occurrences?

How do we get more value from our ECG solution? This is a question that our clients start asking about a year after they have implemented an electronic ECG management solution. During the 10+ years that we have been creating these solutions for organizations, we have found that there is an evolution in the manner that they leverage the value of their solutions.

Stage 1 – ECG Workflow Automation

When an organization implements an ECG solution, the focus is initially on automating the tasks related to acquiring and interpreting tests. Results usually exceed expectations. Productivity soars, costs are reduced and profitability grows.

Stage 2 – ECG Workflow Customization

Once an organization has become accustomed to the transformational effect of converting to electronic management, it makes and accepts suggestions on customizations that will incorporate best practices or make workflow more user-friendly. Typical customizations include:

• Creating distinct workflows for tests that are designated for interpretation and those tests that are to go back to Referring Physicians for interpretation
• Integrating paper documents (e.g. – questionnaire) into electronic workflow
• Increasing interactivity by adding dialogue boxes with tips or questions

Stage 3 – Integrated ECG Data Flow

At some point, a typical client will become open to the enormous benefits available by creating a bi-directional flow of information between its cardiac test management system and other systems it already employs (e.g. – EMR, LIS, booking systems, printing systems).

Stage 4 – Unlocking More Value

TeleMED is continually collaborating with our clients to unlock more value from their investment in our ECG data management solutions. We are committed to developing and implementing ideas that will deliver even better service to their patients, wring even more efficiency out of their workflows or capture even more revenue and profit. Current projects include:

• Introducing automated ECG quality review
• Adding mobile ECG testing to in-clinic capabilities
• Adding other test modalities to clients’ ECG testing platform
• Adding functionality for tracking ECG-related costs

Why Your Customers Demand Electronic ECG Data Management

“Our customers are demanding it.” This is the “pocketbook” reason that two healthcare organizations recently gave us for wanting to purchase an electronic management solution for their ECG tests.

Both of these organizations are using paper-based management of their ECG tests and both had, for the past few years, resisted conversion to electronic data management. But suddenly, both organizations have shown greater interest, and a sense of urgency, about making the change. Why? Both organizations gave the same explanation: “Our customers are demanding it.”

A lot has been written and discussed about the benefits that can be achieved by healthcare providers through electronic management of ECG tests. But why do your customers want you to utilize ECG management software?

Compatibility

Customers want results in a digital format so that the results can be imported into and managed within their own electronic information systems. For instance, the diagnostic laboratory is being told by its referring physicians that it must provide digital results so that the physicians can store and manage those results in their EMR systems.

Earlier and easier access to results

Stakeholders want test results as soon as possible. They don’t want to wait for results to be printed out by hand or by fax. The sooner that these end users have results, the sooner that they can act on them. In addition, stakeholders have more options available for accessing results that are in electronic format. Essentially, the results can be available from anywhere and at any time.

Standardization among test modalities

For healthcare organizations that offer a variety of testing services, there is often inconsistency between the way that ECG results are provided to their customers and the way in which that other test results (particularly blood work) are provided to the same customers. The customers of these organizations want to find all their results in one place and are demanding that the laboratories “get up to speed” with respect to ECG results.

Here’s the bottom line. Any healthcare provider, like a provider in any industry, knows that it must evolve in order to maintain and expand its customer base. When customers demand change, a business must respond to that demand or risk losing market share to the competitors who do meet that demand.

When we speak to organizations about the benefits that can be delivered by our ECG data management solutions, they initially focus on the 2 Ps: Productivity and Profitability (click the link for an earlier article on the 2Ps).

However, as discussion progress, they find that there are other, less obvious benefits that are available from more sophisticated ECG management systems. I like to refer to these benefits as the 3 Cs of ECG Data Management.

Care

Moving to any ECG management solution should improve the standard of care that you provide to your patients because:

• automation standardizes and enforces your best practices;
• Cardiologists are given easy access to patient history and previous tests
• your ECG management system will reduce misfiling and loss of tests;
• a speedier processing cycle means that diagnoses are made and delivered earlier and means that treatment can be started earlier;

However, you can achieve even better patient outcomes if you add the following “must haves” to your shopping list:

• functionality for Cardiologists to provide feedback on ECG tracing quality and/or to order recall of the patient for re-testing
• functionality for automating retrospective review of ECG tracings
• functionality for automating Peer Review of ECG interpretations

Compliance

A high-quality ECG data management solution should deliver an improved level of compliance and documented proof of that compliance. Shop for these features:

• control of access through password protection (make sure that individual logins can be set up for each Technician that acquires tests at your testing locations);
• encryption of your data at your testing locations and on any site that serves as a repository for your test data (ensure that the data is encrypted before it leaves your testing computers);
• both the application on your testing computers and the application on any repository should create audit trails of all accesses and actions;
• automated documentation of your quality reviews the findings of your reviews.

Control over operations

An ECG management system that includes robust reporting functionality will do wonders for your control over operations. When we talk to busy organizations, particularly those that have multiple testing sites, we find that there is virtually no real-time visibility into their testing operations. It is difficult to detect or resolve operational bottlenecks without actually visiting the testing site.

An ECG system that includes flexible, robust report generating capabilities, offers real-time visibility into ECG operations from any remote location. Problems that are detected early can also be fixed early. The best systems allow reports to be generated automatically or “on the fly.” Exception reporting is utilized so that reviewers can focus valuable time on the problem incidents. Access to information can be restricted as needed so that supervisors and managers see only the information that is appropriate for them to see.

What should we expect from ECG data management solutions?

This is the most common question that we face when we speak to organizations about ECG data management systems. It is understandable to get this question from organizations that still use paper-based management systems. However, organizations that have made the conversion to electronic management also ask this question because they want to be sure that they are receiving all of the benefits that are available from electronic management.

I like to classify the benefits into five categories, the 2Ps and the 3Cs.

This article will discuss the 2Ps, Productivity and Profitability. The 3Cs are the focus of a separate article.

Productivity

You should expect a dramatic reduction in your test processing cycle and must speedier resolution of problems due to:

• The elimination or automation of low-value, non-clinical tasks, such as transmitting information from one person to another;
• The elimination of redundant data entry by “remembering” previously-used information or by automatically transferring it from one system to another
• Putting information at the fingertips of those who need them

Most data management systems focus on increasing productivity for those who access data after the test is performed, such as the Cardiologist who interprets the test. However, a sophisticated ECG data management solution will also enhance the ability of the ECG device software to standardize and streamline workflow during the process of acquiring the test.

Profitability

There are some obvious savings by converting to electronic management of ECG tests:

• reduced consumption of printing supplies;
• reduced costs associated with physical document storage

Your ECG management solution should, not only reduce costs, but generate more revenues for you by:

• capturing all billable services (One of our clients experienced a 15% increase in revenues, based on the fact that its data management system ensured that no test “slipped through the cracks”);
• ensuring the validity of the insurance number that is presented by the patient;
• reducing the rejection of tests by insurers due to submission of incomplete or inaccurate information.

For busy organizations, the most significant financial benefit may be that productivity gains translate into seeing more patients and performing more billable services each day.

Still printing and delivering ECG results? We recently wrote about the productivity savings that you can achieve by automating scheduling and printing those reports.

But if your organization is delivering those reports to a large number of primary care physicians, sorting those reports for delivery may be taking more time than the actual printing.

In an earlier article, we pointed out that centralizing and automating the printing of your ECG results saves a lot of work and a lot of time. However, you still have the same number of ECG reports to sort. But, if you use a sophisticated ECG management solution that is highly customizable, you can leverage that technology to automatically sort those reports.

For many of our clients who automatically print their ECG reports, we have also set up an automatic printing of the courier route and stop number on each report and have set up an automatic sorting of the reports according to the route and stop number. If they regularly deliver results to several physicians in the same building or office, we have added a secondary sorting based on the name of the recipient physician. By automating the printing and sorting process for them, we have increased their workload capacity, eliminated sorting errors and helped them to “deliver” an improved service to their patients.

If your organization is still printing ECG Reports, here are two simple changes you can make that will make your distribution process less costly but more productive.

When we speak to organizations like yours, we often find that they are printing blood work results centrally, usually at the location where the analysis was performed. This makes sense because the blood samples have been acquired at multiple testing locations but have been centralized for analysis. Yet, if the same organizations are providing ECG testing at multiple locations, they are often printing ECG reports at multiple locations. This practice is inefficient because it requires staff to manage printing and distribution at each printing location.

Closely linked to this issue is the fact that these organizations usually print the ECG results manually, during normal business hours. As a result, human resources are tied up during the printing process and printers are unavailable for other uses.

For organizations that follow these inefficient practices, we recommend two changes that produce powerful results but that are easy to implement: centralize and automate.

Reduce the number of printing locations to one central location or a very few regional locations. TeleMED technology makes it possible to route any interpreted test to a central or regional print server, no matter where the test was performed and no matter where the interpreting physician was located.

We also recommend using TeleMED technology to schedule and run an automated, batch printing of ECG results once, or several times, during the day. This procedure requires no oversight by staff. If the printer is used for a variety of purposes during the day, we often schedule printing to take place during non-business hours.

Although these changes are easy to implement, they will have a powerful impact on the efficiency of your ECG distribution processes and free your staff to use their time more strategically.

We speak to many diagnostic testing organizations that have successfully converted to electronic management of most of their ECG processes. They acquire their ECG tests electronically, they transmit them electronically to Cardiologists for remote interpretation and they store the test results electronically. However, when it comes to distributing the ECG test results, these organizations are printing the results from electronic files and delivering those results by hand.

As it turns out, most of the Ordering Physicians that refer their patients for testing still prefer to receive results in paper form. However, in accommodating their wishes, the organizations that serve them are suffering with processes that are error-prone and inefficient. Therefore, they look for our assistance in making these processes more productive.

When we analyze their typical distribution cycle, we usually find the following pain points:

1. ECG test results are being printed at numerous locations, despite the fact that the printing of other types of test results has been centralized or regionalized.
2. ECG test results are printed during regular business hours and the printing process is managed manually.
3. A great deal of time is required to sort the tests for delivery. Often tests are sorted by courier route and stop number; sometimes they are sorted by the name of the Ordering Physician. Always, they are sorted by hand.
4. A great deal of time is required to address and label envelopes for the delivery of test results. The envelopes are only used for the delivery of ECG test results because the delivery of other types of results is being done from a more centralized location.

In future weeks, we will be exploring how creativity and electronic ECG management technology can resolve these problems and streamline ECG results distribution, while keeping it paper-based.

If your organization offers ECG testing at a number of testing locations over a wide geographical area, you are probably facing demands that can only be met by an ECG management system with sophisticated test routing capabilities. In our experience, these demands are based on clinical, operational and marketing needs arising from some of the following situations:

1. some Ordering Physicians have preferences as to the Cardiologist that will interpret their tests;
2. some Ordering Physicians request that your clinic perform the test and send the test data back to the Ordering Physicians for interpretation;
3. you utilize a Pediatric Cardiologist to interpret all pediatric ECG tests;
4. some of the tests you acquire require STAT treatment; or
5. for logistical reasons, you need to print and deliver test results from regional locations.

In all of these circumstances, you must be sure that your system will transmit each test from the testing site to the correct Cardiologist, then to the correct printing location and then into a centralized database. Here are some questions you can ask in order to be certain that the ECG management system that you are looking at will satisfy your data routing needs:

1. Can your system identify and segregate tests that are not intended to be interpreted?
2. Can your system identify, segregate and highlight STAT tests?
3. Can your system identify and transmit all appropriate tests to our Pediatric Cardiologist?
4. Can your system transmit any specific test to any specific Cardiologist, on a test-by-test basis?
5. Can your system transmit tests from multiple testing sites to the same, specific Cardiologist?
6. Can your system route an interpreted test to a specific print server, on a test-by-test basis?
7. Will all tests be stored in a single database, regardless of where the test was taken, where it was interpreted and where it was printed?