How Cheyenne Regional Medical Center & Geneva Health Solutions are Changing the Game

We are at a time in healthcare when it is absolutely critical that different systems talk to each other. The clinical, patient care, and productivity value have been documented in detail and cannot be overstated. Improvements in the ability of medical devices and health IT systems to communicate and exchange data could lead to more than $30 billion a year in savings, according to a 2013 report by West Health Institute. The word “integration” is often tossed around to describe system to system connectivity. But at GHS, we do not think about just “integration” but an actual conversation. Well what does this mean and what is the difference?

In the world of remote monitoring (RM) for implantable cardiac devices the difference between EMR “integration” and “conversation” is the difference between a device clinic overworked due to the constant manual entry in the clinic’s EMR and a streamlined device clinic running an effective RM care pathway. You probably are thinking- “I thought integration is supposed to remove manual entry”. Not exactly.

Let’s drill down on this:

The current state in the device clinic at a simple level have three “systems”- the manufacturer device portals, a 3rd party legacy device data management platform, and the EMR.   The remote monitoring schedules (every 30 & 90 days) are maintained in two separate places- the portals and the EMR. In cardiology practices that have deployed EPIC, it is mandatory to create an encounter/visit for every remote monitoring event. Device clinic staff spend an inordinate part of their workday managing schedules in the portals and entering those schedules manually in the EMR. The current state of “integration” looks something like this:

  • Portals maintain the RM schedules (every 30 & 90 days)
  • Staff have to replicate those schedules in EPIC (or another EMR being used)
  • The 3rd party device management platform links the portal schedule with the EMR schedule
  • When the date of service from the portal matches the visit id in the EMR, then the 3rd party platform pushes the device report over to the patient’s record in the EMR. We call this an integration. Most platforms can do this.

But what does that really do? Do staff still have to constantly manually enter encounters/visits in the EMR? Yes.

What happens when patients transmit outside the schedule? Staff have to go back and re-adjust schedules. More manual entry.

Where is the automation? Where is the reduction in manual entry? The answer- there is none.

“When my clinic switched to Epic, we realized that schedule management would be more involved because our 3rd party data management platform lacked the intelligence required to manage the remote monitoring workflow back to the EMR.   My remote monitoring clinical and patient engagement productivity dropped by almost 50%. The administrative duties of creating an encounter for every remote monitoring visit crippled the clinic. This was more than just an integration problem”, stated Deb Halligan, Geneva’s Chief Nursing Officer, who in a previous career managed a large remote monitoring clinic in a Northeast system with this exact setup.

As we traveled to device clinics across the country, we realized this was not an isolated issue to a few device clinics. It was not just an issue at EPIC sites. It was at every site that had an EMR. Existing device clinic staff are either getting drowned with manually entry or in some clinics they hired a separate resource just to manage the daily schedule management. In these device clinics, productivity was getting crushed because the current 3rd party device data management platforms were not solving the real problem- the automation of scheduling in the EMR.

So how did GHS and Cheyenne Regional Medical Center (CRMC) solve the issue?

“At GHS, we wanted to solve the manual entry problem for the device clinic staff. We wanted to remove the daily manual entry of remote monitoring schedules in EPIC (and other EMR systems). If we could do this, we knew we could drastically improve the productivity of the staff. First, we needed to find a forward thinking, highly innovative healthcare system that was willing to move beyond the “business as usual” integrations.   We needed a partner to rethink the paradigm- create a truly automated process in which the Geneva platform is actually conversing back and forth with EPIC, and driving the process.”, according to Jeff Marchese, Geneva Chief Operating Officer, who spearheaded the project for GHS.

Enter CRMC: When you are innovating rapidly, you often encounter roadblocks- people and organizations are resistant to change or they are told by incumbent vendors there is no other way except the legacy process in place. Healthcare is filled with these moments. Often the result is a morass of inefficiency and loss of productivity, which ultimately affects patient care. We experienced our share of barriers and resistance. But we never stopped pushing for more innovation.   We constantly look for partners who are willing to innovate at the same rapid rate as us. We found our ideal partner in CRMC both at the device clinic and IT departments.

We started to discuss our new approach, this paradigm shift, with CRMC back late in 2017. We explained to them that Geneva will be the authoritative source for all the RM schedules because we have patent-pending algorithms that ensures the remote monitoring schedules stay complaint and optimized. We showed them how GHS was purpose-built for the remote monitoring workflow.  We also explained to them that they will no longer manually maintain schedules in EPIC. Geneva would start the scheduling conversation with the EMR. In fact, there would be a constant back and forth conversation between Geneva and EPIC.   By doing this, staff would no longer have to manually create schedules, no longer have to re-adjust those schedules when patients transmit outside assigned service periods, and no longer have to manually close out the charges.

“After going back and forth on the technical design and the backend complexity regarding what we were going to build together, we received buy-in from the device clinic and went for it. The overarching goal was to automate the recurring process of remote monitoring so that staff have more time for patient care. It was a complete collaboration- CRMC IT leadership, CRMC device clinic staff, and GHS. We designed it, we built it, tested it, and deployed it in production.”, stated Brad Verosky, CRMC IT Manager, Applications.

Now Geneva is automating the entire process – managing all the remote monitoring schedules, constantly calibrating thousands of schedules, and driving the automation of these schedules into EPIC without any manual entry by the staff.

At GHS we have learned that in order to innovate and break through barriers, our team always needs a combination of vision, technical competency, trust in one another and courage. We also say at GHS you ultimately need an attitude of grit- you need to battle through the walls of inertia every day, in order to create massive, paradigm-shifting change. Especially in healthcare. I would add one more component- you need to find a partner who embodies all those qualities as well. CRMC is a deeply innovative system with the vision, trust, courage and finally the grit to deliver value to their patients and employees every day.

In the world of implantable cardiac device remote monitoring, we have to move away from just EMR integration and shift our focus to EMR conversation.

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