Data and Reporting at Washington Health System

Tell us about your history with McKesson Cardiology and where you are today.

When Washington Health System first began using the system in 2006, we started out slowly. We began with echo and hemodynamics for the cath lab. We then moved into cath and echo reporting. Since that time, our scope has broadened, so we now have modules for electrophysiology, peripheral vascular ultrasound, stress, nuclear medicine, charge management, inventory management, a medications and lab interface in the hemo system, and support for electrocardiogram review and reporting. I believe we have everything that McKesson currently offers.

Why did you decide to use the McKesson Cardiology Inventory module?

We have always used a form of inventory management from McKesson. The older system was very nice and did provide us with some data. I was always able to tell what I had charged for or used. However, because it had better inventory tracking, we moved to the McKesson Cardiology Inventory Point of Use Supply module. It provides a very effective way to validate all our material use. We needed to know when to reorder according to par levels, but the previous system lacked an order function. We also never had the ability to run a good usage report. If we charged for something, I could tell, but sometimes equipment or a device would be used and never charged for. The nurses could scan with the older system, but we were never able to tell when it was time to reorder. It was a very labor-intensive process on the back end. There were also a lot of hands in that pot. When a stent was used, for example, the nurse took the stickers off the label, put the sticker on a little piece of paper, and at the end of the day, someone grabbed that little piece of paper and then had to manually record the serial numbers, put stickers in the chart, and go somewhere to reorder the product. We usually had an aide or a tech that tracked that piece of paper through the workflow. A clerk or secretary entered the information into the materials management system to reorder inventory.

How does the McKesson Cardiology Inventory module work?

It is part of the nurse workflow. For those in the cath lab, their workflow did not change much. As a product is used, a nurse brings the wrapper to the monitor. The monitor scans the bar code. The product use goes right into the clinical documentation and is decremented in the inventory usage module. McKesson Cardiology can also attach the product usage in the charge manager. If you are doing billing through McKesson and pull your charges, the product will be on your charges. So, with one scan, McKesson Cardiology documents the product use in your report, takes it off of your inventory, and places it in your billing.

How has implementing McKesson Cardiology Inventory affected staffing?

Essentially, we went from having a lot of hands in the pot to just two people. We have one person dedicated to billing and inventory. This person is a nurse that used to work in the cath lab, so they are very familiar with the products. They make sure the billing is correct and overlook the reports. On the back end, when the order arrives and there is a box full of product that has been reordered, one clerk can just scan everything in, and the system adds it to the inventory. Then the clerk puts it into the rooms or wherever it belongs. 

Can you set par levels?

Yes. Prior to the Point of Use Supply system, we were never sure how much was on the shelf. People hoard stuff when they are unsure, because they never want to run out. Let’s say you keep 10 stents on your shelf, because you aren’t sure about the reorder. With McKesson Cardiology Inventory, you can see how much your lab uses on a daily or weekly basis, and adjust your par levels accordingly. Normally, high-ticket items like stents and balloons are overnighted. If we order today by 2pm, we will receive the shipment in the morning. Most of our product has a fast turnover, with no more than 1 to 2 days from order to receipt. With McKesson Cardiology Inventory, you can see how your lab runs with a par level of 8 stents instead of 10, for example. Maybe you then move your par level to 6 and see how that goes. Over the years, we have constantly reduced what was on the shelf, because we found it was unnecessary to keep extra inventory on hand. 

How do you manage registry submission data in your lab?

We participate in the American College of Cardiology’s National Cardiovascular Data Registry (ACC-NCDR) CathPCI registry, the ICD registry, and the ACTION Registry-GWTG, as well as the Society of Thoracic Surgeons (STS) registry for coronary artery bypass graft surgery. Cedaron (software for outcomes data collection, and national database participation and reporting) and McKesson Cardiology work hand in hand. Since we use McKesson Cardiology’s structured report, about 80% of what is in our cath report flows directly into Cedaron. Only about 20% of the data needs to be manually entered, including information such as whether the patient left on meds; basically the back-end or discharge data. With Cedaron, you can pull the data and create reports that actually mimic what is in the NCDR. The NCDR is about a quarter and a half behind. If I submit quarter 1, I then have to wait 4-5 months to see my NCDR report, but with Cedaron, as soon as you submit, you can actually see what is in your database in real time. This is very useful if you are looking for something in particular, something you haven’t collected in cath reports. Let’s say I have been watching my reports and notice that I am pretty poor on my discharge meds. That is actually what we did. We watched our reporting for a long time and noticed that we were delinquent in a few areas, and wanted to make improvements. We asked McKesson if they could create a few mandatory fields in their cath report that placed this info in a better workflow position for the doctors. In our case, it was regarding appropriate use criteria. The doctors now have to address certain functions in the cath report, such as was the patient on medication prior to the procedure, that have created a better data flow into the registry. Whatever we wanted to put in the cath report to help with registry submission on the back end, McKesson added for us within a few months. 

Can you share some of the clinical and operational reports you run, and their impact? 

There is an appropriate use criteria report out of Cedaron that we use all the time. We constantly look at that report for inappropriate procedures, because that is where you are going to get the most, moneywise. We look at core measures. We are constantly reviewing our registry data. We look at our data, try to make improvements, and then we can run our reports again to see if we have actually made improvements. We look at monthly stats, and we always want to know our volumes and what procedures are being done. Inventory usage is reviewed on a daily/weekly basis. We are constantly running inventory reports. Doctor credentialing is another regular report. Every other year the doctors need to know how many nuclear stresses they did, for example. Then there are a lot of ad hoc reports you can run. Sometimes you want to know how many of a particular balloon you used last month. McKesson Cardiology Inventory allows you to easily find those data points. 

How have the reports affected workflow and your ability to respond to what you are seeing?

Both systems, Cedaron and McKesson Cardiology, help us respond faster. Let’s say we were audited and found we were a little poor in one area. Having McKesson and Cedaron has actually helped us improve faster, because then we can build in mandatory fields into our reporting. Sometimes just by showing doctors the data, they come to understand the need to improve their documentation.

What reports do physicians request?

They want to know how many radials they are doing, because there is a big shift now from femoral to radial access. They also like to know who is doing radials. The doctors always want to look at their complications. We will run a report on our doctors to see how many products they have used during a case. We may look at left heart caths, and see that Dr. X uses a lot more inventory than Dr. A. You can show these reports to the doctors and ask why they are using so much more inventory. I like McKesson because it is very flexible with reporting. You get a lot of analytics through the system.

How have physicians and staff adapted to McKesson Cardiology? 

A nice thing about McKesson is that it is user-friendly. As far as training, the staff hasn’t had a difficult time adjusting to, for example, electronic documentation. Nor did the doctors have a hard time adjusting from dictation to a structured report. The training showed us that McKesson Cardiology was very simple, with a very good user interface. I think McKesson does a nice job of keeping up on things. If they see there is a way to have integration with lab results or medications, they pool that data into their module, so people don’t have to go into their hospital system and then go back into McKesson Cardiology. It keeps us all in one system. The integration has been good. 

How long have you had structured reporting in place?

Since 2006. The doctors used to like to dictate a certain way: “I have an 80-year-old woman that has X disease” and so on. They would pretty much always say the same thing, so we developed a few fill-in-the-blank paragraphs for them, called “Procedure Report”. McKesson is also starting to use Dragon speech recognition software. So we have a structured report, but then a portion of it can be tailored to the personal preferences of the doctors. Believe it or not, I do have some doctors that like to type a little personal note. We keep the structured reporting because we like to pull data. We have certain fields that we always make the doctors fill out so we can get the data back out. But if the doctors want to add some niceties and put some extra stuff in their report, they have no problem doing so. 

Have you seen a financial impact from the use of McKesson Cardiology?

We definitely have had a financial impact, but unfortunately we don’t have any real data, because we started so early. We can’t actually say, well, back in 2005 we were here, and now in 2015, we are at this dollar amount. I haven’t had any reduction in staff, but we keep adding and improving things. 

What are your future plans? 

McKesson offers a module called QICS (Qualitative Intelligence and Communication System) for Cardiology, which is a very analytical tool. We do a lot of quality analysis (QA), including ICAEL (now IAC Echocardiography), cath QA, and nuclear medicine QA. Right now it is a very labor-intensive process, because we look at a lot of correlation. We correlate, say, our cath report to nuclear stress, and look at certain features, like ejection fractions. With the McKesson QICS module, you can actually tailor the report to what you are looking for. I am working with McKesson on that right now.

Any final thoughts?

I personally like how the McKesson Cardiology Charge Manager and Inventory modules are so nicely tied together, because for me, this is the money piece. After product use, it is easier to pick up your charges. Sometimes, when you separate your charge manager and inventory, they become two different workflows and then things get missed. McKesson Cardiology helps us better capture our product use and bill faster.