Transitioning from a Legacy Hemo System to the McKesson Cardiology Hemo Solution

Rideout Health is building a new tower that will be complete in late 2014. At that time, the entire cardiovascular theater and interventional radiology will be consolidated into the same area, with two brand-new cath labs to replace our current labs, one interventional radiology room, and a new hybrid room. 

How long has Rideout Health been using the McKesson Cardiology Hemo system?

Joe Olson: We have had the McKesson system for two years. Our previous system had been in place since 2000. 

Why transition to a new system?

Joe Olson: We had an immediate need for an upgrade and serviceable equipment, but on a larger scale, obtaining the McKesson system was part of a comprehensive plan to provide improved resources in cardiovascular care, which was motivated by Rideout’s mission to provide the most advanced cardiovascular care to our community. 

Jerry Birk, Vice President of Cardiovascular & Thoracic Services: Some of the McKesson advantages, along with some of the other systems we have recently acquired, were desired in order to help simplify and manage complex operations, and enhance the data and records resources used in the care delivery environment. Our objectives are to improve the overall use of information and its integration, leading to improved processes and better business intelligence regarding things like labor, productivity, inventory, and cost management. 

Tell us about workflow with the old hemo system.

Joe Olson: There was a computer document in our old system, but it was separate from the nurse charting. The old workflow involved nurses documenting on paper charting. Physicians had to dictate into the health information management (HIM) system, which would then be transcribed and placed into the paper file. 

How did this workflow change with the McKesson Cardiology Hemo system?

Joe Olson: Nursing documentation is now done on the McKesson system, along with the hemo report. Much of what physicians had to dictate in the past is now prepopulated into the clinical reports, saving them time. The workflow is much easier and more accurate, because information is being populated into the system in real-time as opposed to after the fact. 

What areas are you still hoping to transition?

Joe Olson: We would like to integrate the McKesson Cardiology Hemo system with the ordering of our supplies, which would make the entire process more efficient. We have a new Omnicell automated inventory management system, and along with the McKesson Hemo system, we want to leverage both to manage our inventory and our cost control.

What did you see arise out from the workflow changes with the McKesson system?

Joe Olson: It is a great deal more efficient. All the information we gather during the case is now located all in one area. We are not using paper charting and electronic charting. The RN charts in the McKesson system, and along with the hemo charting, all that information automatically populates the physician’s reporting at the same time. The McKesson system condenses multiple sources of information, making it easier for the rest of our hospital team to access files and have necessary information at their fingertips to make decisions in the care of the patient.

How did the physicians react?

Joe Olson: Our physicians like it. As they used it more and more, they became quite accustomed to the new workflow and found the system easier to use. Rather than having to do dictation on the back end of a case, the McKesson system populates the case report automatically. The physician just has to touch up their report at the end of the case as opposed to later dictating and remembering the case in its entirety. 

Do you have specific positions dedicated to developing reports and evaluating data?

Jerry Birk: Ideally, we certainly would. It is a resource I think is essential, as the demand for optimizing financial efficiency grows along with the importance of evaluating all influences on clinical outcomes. As an independent hospital, I don’t think Rideout is unique in terms of being very resource-limited in this area, where we have various constraints in the ability to supplement our existing workforce with dedicated analyst roles, for example. Many feel the pressure of having to do more with less. So far, we have been able to partner with existing staff, often traditional nursing and technologist staff, and creatively modify levels of responsibility to meet diverse needs. It is important to find the right synergy with staff who feel that analytical or management functions are aligned with their interests, and are willing to innovate and contribute to how the lab adapts to dynamically changing needs.  Long-term, it is likely that demand for comprehensively mature analytics will overstretch our capacity to accommodate with existing resources. We are very grateful to our team, and fortunate to have such a flexible and responsive group.

What reports are most valuable?

Jerry Birk: Outcomes measurement is one area. We use the McKesson system to feed our registries, particularly the American College of Cardiology’s National Cardiovascular Database Registry (ACC-NCDR) and the ACTION registry. We do our own quality assurance and improvement, and track all kinds of metrics. The McKesson system will be a key source of data to feed dashboards we envision for the cardiovascular service line that we are working to consolidate from several systems. The system also has the ability to provide inventory utilization and cost data, which ultimately improves our understanding of our consumption and purchase behavior, and allows us to look for opportunities for improvement.

You mentioned tracking metrics. Has the McKesson system helped measure room turnover?

Jerry Birk: Room turnover is a huge target for us, and one that can feature a lot of attention and criticism. Cath lab staff can break down, in a stepwise fashion, all the unique functions or tasks involved in turning the room over and identify the amount of time it should take for each of those elements. In its sum form, the result or process map provides a baseline target time from which to work and compare. Our physicians and administrators obviously want those rooms turned over as fast as possible. It’s a key place to examine opportunity to improve throughput. Due to the multiple forces that can affect room turnover, like readiness of housekeeping staff or PACU bed availability for example, we are using information we are gathering from McKesson and other sources to consolidate and compare. We feel we are at a point now that we have a grip of what our limitations may be, and continue to measure our overall consistency and variability with our performance in regard to our baseline.

How has McKesson supported you in the system use?

Joe Olson: A customer support representative visits periodically, and if there is anything we would like to improve, the representative will spend a few days on site to help. If there is an immediate technical problem or something a staff member isn’t totally familiar with, we have an 800 number to call for support.

Jerry Birk: McKesson’s been very industry forward in providing very strong customer service-oriented resources. They are clearly very interested in collaboration, and on the learning front, from their healthcare partners, they are doing a great job of creating a platform of interaction. McKesson recently hosted a user group meeting in northern California, which part of my team was able to attend. These meetings facilitate not only business to consumer interaction, but consumer to consumer, i.e., our peer group. It has enabled us to understand what other organizations are doing with the same system. We have utilized that information to improve our own knowledge and processes. One example is the process of creating custom queries to pull out very specific information by qualifying various ranges in terms of dates, procedures or other metrics. We had been at the lower end of sophistication in our ability to create queries and enhance our reporting. The meeting was a great benefit because other, more experienced users had already pioneered various pathways. We were able to obtain turnkey solutions from their experience that had already been trialed and proven.

Any final thoughts?

Jerry Birk: The environment is forcing us to get much better at creating practical and strategic application of the information we have at hand. McKesson both enables us to collect that data in a more efficient way, but also, on the back end, consolidate and report it. We now have a meaningful aggregate of information that allows us to be smarter in the process and design of our workflow and management. 

Joe Olson, Cath Lab Manager, and Jerry Birk, Vice President of Cardiovascular & Thoracic Services, may be contacted at jbirk@frhg.org.