EP Lab Digest Speaks With Dr. Michael Venturini, Chief Medical Officer of Indiana Heart Hospital

Describe how this transition came about. What made Indiana Heart Hospital decide to partner with GE? How long has this been in motion since 1996? Is this transition only for the Heart Hospital or for the whole Indiana healthcare network?

MV: First of all, the partnership with the hospital is a joint venture between a community health network in Indianapolis and my position; all involved are cardiologists or cardiovascular surgeons. The way it is set up is that 70% of equity is brought in by the network and 30% is from the physicians. The board of directors, however, is comprised of 60% physicians and 40% network. Therefore, it is a truly physician-driven organization which still to a great degree will benefit the network financially. When we finally decided on a business model, we had a location in mind that would be in the community hospital on the north campus on the northeast quadron of Indianapolis, which is a rapidly growing area. We had an available piece of land, and we had to ask ourselves now what, what do we do? One thing I think we did that was wise was that we didn't rush during this time we didn't start building or filling the hospital or renaming it the heart hospital. We really stepped back and asked how we could be better at what we do. A few people in the organization had the insight to say let s examine the way we do things: examine the way we admit patients, the way patients are seen in rooms, how we do orders, and how doctors and nurses do what they do. We looked at our own properties and also did several sightings at other large cardiovascular services and heart hospitals. We incorporated all this information and tried to design a building and a set of properties that would do things more efficiently. For example, we didn't want services to be redundant, and we didn't want doctors to have to ask the patient and family the same question 5 times. We realized that with planning that the information technology would be the keystone on which we design the new hospital, because it is a family of information that results in better efficiency. As we did this, we also saw that we would be building a pretty special place, and that we had something that we thought a large vendor might find attractive in partnering in. It would benefit both parties, because if you can get a breadth of services from a single vendor, like at GE, then you would have access to not only cath lab equipment and technology, PT scanners, X-ray equipment, information technology and other support, but also GE financing, air conditioning, lighting, etc. With this higher breadth of services, we could perform and provide services in a better way, and in turn, the vendor would be valuing that they have a place that they could show to the world that they are in the business of integrating this type of care. We wanted a vendor who had an interest in joining in this type of spiritual ownership with us; one who we could have someone who essentially had a shared responsibility. We really investigated all the major vendors, and finally came to the decision to partner with GE because of their ability to integrate information. Also, with respect to images and clinical information, that brought us to the conclusion that they were our best bet.

When will the hospital open?

MV: About two and a half years ago, we were hoping it would be in December 2002. However, in the last year and a half, we have been able to set a date, and we expect it to open on February 17th, 2003.

How long have you have been at the Indiana Heart Hospital?

MV: I have been at my group, Heartland Cardiology, P.C., in Indianapolis, Indiana since 1983. I have been with Indiana Heart Associates, P.C., in Indianapolis since 1995.

Define all digital. What does this involve? How will a patient s experience at the hospital change?

MV: The GE Centricity is a way to handle clinician information that is how I would describe it. A more specific definition might be that we hope to sort and integrate information two-pronged and also a clinician piece which we are helping to develop. It is a documentation tool where all notes from the physician, nursing, respiratory staff, all caregivers are generated through a piece of software. The goal is to generate these notes in a very granular matter. We understand that every patient is unique and modification of that granularity is going to be different with every patient. The goal is to bring to the bedside the ability for the doctor to describe what a patient s clinical situation is by taking their history and then documenting their physical exam in as granular a way as possible, so the doctor can use it for the purpose of measurement. If I can do it in this granular way, such as if I document that you have left shoulder pain, and a year from now I want to determine how many patients have significant coronary artery disease actually have left shoulder pain, then I can go to our database and that information will be available to me real-time. Thus, the more definable and black and white the data is, the more easily you can use it for metrics. The metrics are important to mention because besides improving processes, the measuring and the ability to make measurements of what we do with respect to clinical results and the cost and billing collection is all also very important in doing this business in an effective way. I don t mean not in order to make the most money, but to give the best care and be the most efficient. To be in the business of cardiology, my partners and group not only believe that you have to be a great caregiver, but you have to be able to prove to the world you are a great caregiver, and you need to be able to examine yourself internally so you can always be making adjustments on what you do. Another part that has changed is order entry, which is done online, so that the doctor no longer writes orders. He can go to the computer and order everything activity and diet instructions, prescriptions anything you can imagine in this order entry system, and there are safeguards in that. For example, a doctor can t order two types of medicine that don t go well together. A doctor also will not be able to order medicines without recognizing that a patient is allergic to it, because a pop-up warning will come up and tell the doctor that he can t do this. There will be no handwriting issues or confusion, which will reduce errors phenomenally. The other side is the testing side of Centricity, where we do nuclear imaging, stress testing, Holters, cath lab imaging, and then organize that information again, no film in our paperless digital environment. We are able to organize it in a way that we can view and report on it in a seamless way and have it available to us not just in a cath lab where films and slides are, but in a work station or in a doctor s office in a hospital and call up both images and reports on any patient.

What are some of your expectations for this merging? How long do you think it will take to work out the details and/or possible problems? Are there any possible pitfalls regarding protecting privacy?

MV: The HIPAA and privacy issues are very important, but in reality, they are no different from the paper world they just need to put it on the front burner and examine what they are doing. Our system will have passwords, secured access and firewalls. Right now, if I am a physician on staff at a community system or hospital, and I want to examine a record on a patient, regardless of whether that person is my patient or not, that record is the possession of the hospital. As a staff member, I have the right to examine that that is a fact of life. However, in this new digital world, I have a badge that says I am staff and when I walk into the medical records department, I have a password that specifically gives me access to certain things. For example, this system will determine by staff status that a nurse won t have the same rights that I have to this information or that someone in a non-staff position would not have any rights at all. Therefore, the rights to information are no different, the availability to that information to the person who has the rights will change dramatically.

What benefits do you think both patients and hospital staff will see? What are some of the things they will be able to do now that previously they were not able to do before?

MV: That is what I am most excited about. You know, this sounds like a sales job, but it's not. That is really why we are doing this you will be able to just walk through and seeing the changes of the new hospital. For example, if you were my patient, and you come to the emergency room and I've never met you and once we are in business for a year and there is some populated information and databases are in place and the place is really working when you come into my hospital, how I can approach you and how I can care for you is dramatically different than today. Currently, you come in and I don t know you and you tell me your past history. If you have been in the community system, I might be able to get the old paper record and if and when I get it from the hospital, it s usually by a matter of chance you may have had x-rays, if I want to look at those I walk over to radiology. You may also have had an echocardiogram, if I want to see them, I have to walk over to medical records, and if I want to see the images, I may have to walk over to where it was done. Tomorrow and in the future, when a patient comes in, I have a laptop that when I open it is wirelessly connected to the network. If you have any records at all and are registered in the emergency room, I can pull up in my laptop your records not only for that encounter, but for your entire medical record. I can pull up every document that has been generated on you. This is important, to be able to differentiate every image that has been documented on you, so I can actually look at your cath films from a year ago or last week, and I can see an echocardiographic image in my laptop while sitting in the patient s room. Now, wouldn't that give you confidence that the care is going to be more cost effective and you are not going to have to repeat things? It is going to be more pointed and just flat better because I'll be able to get to the heart no pun intended of the problem much more efficiently.

What other new technology will be incorporated into this hospital? I have read about the world s and only first gender-specific ECG to test women s heart waveforms, called the GE GenderSmart 12SL.

MV: The ECG is part of the new system and part of a new tool that GE uses to generate in people. Some other exciting things that are another indicator of the patient focus on this place is that the IT is also being applied to the patient's experience. We are confident that we are going to be able to deliver to the patient, and the experience in their room will be very unique. For example, the patient will be able to look at the TV in their room and be able to use a keyboard to bring up educational material that is specific to their diagnosis. Through their TV, they will be able to see their diet online and also be able to order room service and tell them when they want it delivered. Thus, our services are going to be applied in a way that our mission states it should be applied, that is, it is not going for IT, and it is not for the sake of cutting edge. It is for the sake of doing it better.

How long do you think it will be before other hospitals begin to model after yours?

MV: That is a good question, but I'm afraid I do not have a good answer. I thought you might be asking how long it will take to work, and I think that is a better question. It will work. This is a major change in the culture of dispensing health care. However, about 80 or 90 people from GE right now are around Indianapolis working with our staff to educate our news staff, our hospital staff and the community, our doctors, housekeepers and respiratory therapists, etc. This is a major change, and as we open, it is going to be an ongoing learning experience, especially for those first special couple of months. The other thing that is exciting is that we have enough humility about what we have bitten off here as far as the challenges we are going to face. We have brought in through GE about 6 large trailers and we built up mock-up cath labs, admitting stations and patient rooms. We placed in those the breadth of our IT endeavors. There were about 50 patient scripts (scripts as in a play) and we walked through each patient s experiences with our staff, checking that our system would work and educating our staff. Another trailer was a large education trailer where we had work stations educating staff on the software. We also had regular classrooms where we educated on other processes. So it is a major undertaking. When it begins it will work, but it will be a constant self-education, and the metrics will help us with that and the ability to measure our performance. Whenever the rest of the people catch up I don t mean to be dismissive but that s not my problem right now. We have to do what we think is right. We are not doing it, honestly, to build a dynasty. We are not doing it for the sake of attention. The culture down in Indianapolis now is so attractive and people are so bought into this and they are so excited; it is like 400 people with a new toy! They are so proud of what we are trying to do that once people see how it's done; I think it will catch on quickly. I hope so.

Susie Nichols, Media Relations Manager: They have such an opportunity here because they are building from the ground up, so they are able to start from scratch with the technology in mind.

MV: That's right, we don't have to rebuild. The hospital structure is built around no paper, no film it has got to work. It is made to take the nurses and doctors to each patient's room, so that experience with the information is right there with the patient.

For more information, please visit: www.ehealthindiana.com.