Fletcher Allen Health Care (Burlington, VT) was selected as a finalist for ECRI Institute's 7th Health Devices Achievement Award for its implementation of a cardiology information system to provide cardiologists with access to a comprehensive cardiovascular patient record regardless of where in the network care had been, or would be, provided.

The Health Devices Achievement Award recognizes outstanding initiatives undertaken by member healthcare institutions to improve patient safety, reduce costs, or otherwise facilitate better strategic management of health technology. ECRI Institute announced the winner and five other finalists for the 7th award in October 2012. Learn about the other submissions that achieved recognition.

ECRI Institute congratulates the Fletcher Allen Health Care team: Barb Paganelli; Theresa Fortner; and David Schneider, MD. 

The Concept

The Cardiology Division at Fletcher Allen Health Care (FAHC), in alliance with the University of Vermont, has a history of extensive outreach throughout its region. Through the coordinated network that has been established, the Cardiology Division can provide patient evaluation and management and perform noninvasive testing at a facility close to the patient's home, while performing invasive services at Fletcher Allen.

To more efficiently support this model, cardiologists at FAHC, led by Dr. David Schneider, director of cardiology, initiated the selection and phased implementation of an integrated, single-platform cardiology information system. The goal was to provide all cardiologists associated with the network immediate access to a comprehensive cardiovascular patient record anytime, anywhere. Planning for the cardiology information system started in 2009, and the system is now operational in several departments, with additional implementations under way.

Key aspects of the system that FAHC selected (and helped design) are that it is web-based, allowing easy access both at Fletcher Allen and at remote hospitals, and that it supports the integration of images and diagnostic reports, so that providers anywhere in the network can view the full spectrum of cardiac care for the patient.

As noted by Dr. Schneider, the system supports local cardiologists while also helping Fletcher Allen support facilities that lack dedicated cardiologists. Among the benefits he describes are that the system allows FAHC cardiologists to provide remote interpretation for several hospitals, that it helps reduce the need for repeat (redundant) noninvasive testing, and that it supports more efficient workflows, facilitating the delivery of improved healthcare in cardiology. Thus, the system is seen as helping FAHC improve access to care and enhance the quality of care, while also saving time and money and improving the experience for patients and families.

Now, as implementation nears completion, the system is also being viewed as a key component supporting FAHC's move toward creating an accountable care organization within Vermont. Once fully implemented, the system will facilitate patient-centered care delivery, advanced care coordination, and increased information sharing between patients and their healthcare providers, with the goals of improving the quality of patient care and eliminating unnecessary expenditures.

A case study described by FAHC illustrates some of the advantages the system offers: After a patient's routine physical had revealed issues that required additional examination, the patient visited his local hospital for an electrocardiogram and stress echocardiogram test. Images from those tests were reviewed by experts at FAHC, who determined that invasive investigation was required. When the patient arrived at FAHC, his health history was already available to the physicians there, and an invasive cardiac catheterization was performed without the need to repeat any tests that had been performed at the local hospital. After being discharged to home, the patient again visited his local hospital for follow-up tests, the results of which were shared with his team of cardiac physicians at FAHC.

During the cardiology information system selection process, FAHC looked to partner with a single vendor that could provide an enterprise-wide solution. The organization wanted to achieve a high level of integration among all diagnostic modalities used in the care of cardiac patients, and it wanted a system that allowed reporting packages to be customized for each cardiac department. FAHC's research revealed that none of the vendors offered a fully developed solution that was ready for use within its busy academic medical center. However, the organization determined that the portfolio offered by Merge Healthcare would best meet its needs. FAHC then worked closely with the vendor to map out current and future workflows and to develop extensive knowledge bases supporting the creation of customized diagnostic reports. The selected system could also be integrated with FAHC's Epic electronic health record, allowing cardiac patient reports to be viewed by other providers caring for the patient.

FAHC reports that the system has facilitated remarkable improvements in communication among multiple care providers, and that it has led to fewer repeat procedures since both images and reports are now readily accessible. In addition, the use of standardized but departmentally customized reports with mandatory elements is described as facilitating improved billing, refined communication among providers, and enhanced analyses of patient services data. 

Best Practices

The Fletcher Allen submission illustrates some of the benefits that can be realized through the integration of systems: Physicians at various locations can have ready access to a patient's health history and test results. Patients can benefit from consultations with distant physicians. And time and money can be saved by avoiding repeat testing, as well as by using a system that supports efficient workflows and streamlines the report generation and distribution processes, factors that FAHC considered when designing its system.

Even with the promise of such benefits, however, obtaining cooperation and buy-in from system users can be difficult. What was needed in this regard—and what FAHC had, according to Barb Paganelli, project manager at FAHC—was "not just a champion for the project, but a champion with authority." She cited Dr. Schneider's hands-on involvement with all stages of the project as a key to successful development and implementation.

The initiative also illustrates that integration is a long and complex process, that careful planning is required to achieve the desired level of interoperability, and that organizations need to be prepared to work with vendors to customize solutions to meet their unique needs. Ms. Paganelli stressed the value of strong project management support for such complex implementations, noting that "it's difficult to manage a process if you don't apply good methodology and rigor to it." For example, the FAHC process included a comprehensive architectural review phase, in which the "back end" of the proposed system was scrutinized to identify and address in advance any potential security, interface, or interoperability issues.

Careful planning and thoughtful implementation can also help minimize the risks to patients: As we discussed in our list of the Top 10 Health Technology Hazards for 2013, achieving interoperability to allow the appropriate exchange of data can be difficult, and patient harm can result if this is not done effectively. (For details, refer to hazard number 5 in the list published in the November 2012 Health Devices.)