Connecting Cardiac Device Data and the EHR Introduction In an age of complex information needs, healthcare providers often use a staggering variety of applications to capture a patient s complete clinical history. Many different types of health records from practice management systems to electronic health records to specialized systems for particular clinical areas and medical equipment provide varying levels of data. These technologies represent a leap forward from the bursting paper charts, stapled reports, and faded faxes of the past. As clinics and hospitals move toward the goal of a comprehensive electronic patient record, they must integrate data from a myriad of information systems that may not talk to one another. Getting data from point A to point B often requires multiple interfaces connecting the systems. Users may have to navigate several applications, manually enter data, print out and scan reports, open files and attach documents, and rename and save files. What s Inside Standards for Seamless Data Exchange A Single Interface for All Device Data Key Benefits of Connectivity EHR Coverage and Implementation Support Conclusion In creating an electronic health record (EHR), healthcare practices can resolve some of these problems by choosing standards-based applications that provide intra- and interoperability with other systems. This white paper discusses the connectivity that allows clinicians to capture the data generated by the device inside the body and move it from there all the way to the patient s electronic personal health record. This paper also focuses on the technology and benefits of integrating demographics, scheduling, and device data in a single interface. Optimize Workflow Efficiencies and Save up to 9 Minutes per Patient Connecting implanted cardiac device data to the electronic health record (EHR) and into a personal health record (PHR) via a single, easily managed interface can help healthcare practices maximize efficiency in the workflow, potentially saving significant time and money. A recent study conducted at The Ohio Heart & Vascular Center showed a 9-minute per patient time savings in the clinic workflow processes 1 when a device follow-up system is integrated into a clinic s EHR (see page 6). The Medtronic Paceart System is the only device follow-up system on the market that integrates demographics, scheduling, and device data all in one place providing a single solution for all device data and unmatched EHR coverage.
Medtronic CareLink Network Cardiac Event Recorder Pacemaker Transmitters Medtronic 2090 Sorin/ELA St. Jude Medical Boston Scientific Paceart System Biotronik Standards for Seamless Data Exchange In-Clinic Surface ECG System Ensuring seamless data exchange between health information systems, including applications that support medical devices and equipment, poses an ongoing challenge. In response, several organizations are developing standards for connecting health information systems. Health Level Seven (HL7 ) is an American National Standards Institute (ANSI) accredited standards organization that develops standards for the healthcare domain. HL7 subgroups create the standards used in the technical exchange of information. Integrating the Healthcare Enterprise (IHE) uses standards created by other organizations (such as HL7) to create a framework (profile) for sending vital health information seamlessly The Institute of Electrical and Electronics Engineers (IEEE) sanctioned subgroup IEEE 11073 is the governing body that provides common nomenclature for cardiac devices These standards provide a common base for communication between healthcare information systems, defining how information is structured, encoded, and sent from one system to another. Health Level Seven s messaging standard allows disparate healthcare applications to exchange key sets of clinical and administrative data. Currently, HL7 message specifications are the industry standard and accepted protocol for information exchange. HL7 Standards Enable Three Aspects of Interoperability 1) Moving data from one system to another 2) Ensuring that both systems understand the data in the same way 3) Enabling business processes that use both systems to work together 2 How HL7 Works The Health Level Seven Messaging Standards specify the encoding, structure, and semantics of data for exchange. HL7 messages contain: Identifiers Used to identify the type of message Content Based on message One practical use of HL7 standards is to transmit information between implantable cardiac device follow-up systems and EHRs. What s needed is a simple interface for all device data. Send Data Data Transformation Transmission Successful Data Read
A Single Interface Saves Time and Money Even if hospitals and clinics use only a few core applications, they may need to integrate as many as 50 to 100 applications with the core set. Consolidating as many applications as possible into a single interface saves time and money. The Medtronic Paceart System connects EHRs to integrate all cardiac device data, scheduling, and registration information. In addition, many EHR systems are also able to forward certain medical information to the patient s personal health record (PHR). Bidirectional HL7 Messaging Electronic Health Record Personal Health Record A Single Interface for Device Data Many healthcare organizations are dealing with dozens, if not hundreds, of interfaces to achieve interoperability. Implementing and supporting each interface is costly and time consuming. Many practices are looking for ways to streamline their interface portfolio to fewer vendors and applications. Specialized applications that can connect seamlessly to core applications are preferable to stand-alone applications. The Paceart System provides a single interface for cardiac device data, including: Implant device programming for all major manufacturers devices In-clinic follow-up for all major manufacturers devices Remote monitoring systems, such as the CareLink Network, Boston Scientific Latitude, and St. Jude Medical Merlin.net Event monitoring Transtelephonic monitoring Miscellaneous patient interactions (phone notes etc.) Instead of having to implement and maintain interfaces between multiple device manufacturers and the EHR, a clinic can rely on just one. This allows for more efficient use of the IT department s time and can save in installation costs for each new interface. Bidirectional Interface While a number of systems offer a one-way interface to or from an EHR, to date, only one device information system can provide a bidirectional interface. The Medtronic Paceart System supports universal integration of device data, and the Paceart Gateway Services HL7 Module provides a real-time message-oriented interface that is commonly accepted by EHRs. Paceart HL7 connectivity ensures the seamless flow of cardiac device information to the EHR (Inbound Messages) and of patient scheduling and registration data from the EHR (Outbound Messages) into Paceart. 3
Inbound Messages Inbound messages from the sending system to Paceart include: Registration (ADT) Patient demographics, admission/discharge/transfer (ADT), add/update/mark for delete Supported Triggers A01, A02, A03, A04, A05, A06, A07, A08, A28, A29, A31, A46, A47 Scheduling Inbound Unsolicited (SIU) Add/update/cancel appointments Supported Triggers S12, S13, S14, S15 Administrative actions related to ADT and SIU include adding a new patient s demographic information, updating existing patients demographics, marking a patient for deletion, changing the patient ID, creating a new appointment, and rescheduling, modifying, or canceling an appointment. HL7 Inbound Message Flow Inbound HL7 Message MSA AR Paceart HL7 Gateway Services Send Reject (AR) Acknowledgment to sending system Failed Filter Inbound Interface Receives message for processing Message Filter The Paceart HL7 Module supports both HL7 original and enhanced acknowledgment mode for inbound messages. A Reject (CR/AR) is sent if the message does not pass the message filter. An Error (CE/AE) is sent if the message could not be successfully processed. An Accept (CA/AA) is sent if the message passed the filter and was sucessfully processed. Passed Filter Perform Patient Processing (Based on Message type and trigger) MSA AE Send Error (AE) Acknowledgment to sending system No Patient Processing Successful? Paceart Database Yes Perform Message Specific Processing (Based on Message type and trigger) MSA AE Send Error (AE) Acknowledgment to sending system No Message Processing Successful? Yes MSA AA Send Accept (AA) Acknowledgment to sending system 4
Outbound Messages Data is sent from Paceart to an EHR or other system via an observation result unsolicited (ORU) message. The data exported includes patient identifiers, implanted devices, detailed device encounter results, and a Paceart summary report. These messages can include both discrete data and an embedded PDF report or a network location (UNC path) for the report. HL7 Allows Data to Be Packaged and Delivered Seamlessly to the EHR Patient Universal Follow-Up Device Packaged Patient Device Universal Follow-Up Data Sent EHR Key Benefits of Connectivity Once device data is integrated in one application, connecting that system with the EHR offers several important benefits for clinicians, information systems staff, and administration over stand-alone systems that are not integrated with an EHR. 1. Better patient care A comprehensive patient record in the EHR helps ensure timely, appropriate care for device patients and allows physicians to collaborate more effectively. Within the device clinic, patient management is easier because Paceart consolidates all device information into a consistent format and provides summary reports. 2. More efficient workflow Paceart s EHR connectivity enhances workflow because it: Manages data from the time it is captured from inside the body to the time it is available in the patient s personal health record (PHR) Reduces duplicate scheduling and registration Reduces scanning, printing, and manual data entry and saves time in entering and searching for patient information Provides easy access to device data in real time for physicians and other clinicians outside the device clinic and optimizes efficiency in the workflow 2 3. More accessible, complete patient record With device-ehr connectivity, the patient record is more complete and device data is widely available throughout a health system. This facilitates identification of implanted devices in the emergency department or surgery, for example, and helps physicians outside the device clinic understand a patient s cardiac device history. 4. Increased accuracy through automated data transfer Integrating Paceart and the EHR reduces the need for manual data entry. Automated data transfer may help reduce errors associated with manual entry. 5. Easier reporting and analytics Paceart connectivity obviates manual aggregation of device data for documentation, third-party payers, and audits. We like the ability to have the data from Paceart available in NextGen so all physicians are able to review. It speeds up the patient visit and decreases our workload by not having to record the info on a separate flow sheet and then scan it into the EMR later. It is easy to use and presents the data in an organized manner. Lisa Dye, RN, MSN, Director of Clinical Operations, The Ohio Heart & Vascular Center 5
Time Study Finds Efficiency Benefit with Paceart and HL7 Connectivity A recent study 1 found an up to 9-minute per patient time savings in clinic workflow processes when using a Paceart System that was integrated with a clinic s electronic health record (EHR). The study measured the time it took to complete a variety of device clinic workflow processes, comparing the use of a Paceart System that is integrated with an EHR system to the use of a stand-alone Paceart System that is not integrated with an EHR and relies on manual entry. The study was conducted at The Ohio Heart & Vascular Center in Cincinnati, Ohio in October 2008. Note: The results documented in this case are unique to this clinic. Not every clinic experiences the same results. Your results may vary. Observers Monitored Scheduling of a patient Capturing new patient demographic information Interrogation of the patient s device Syncing of information and documentation in Paceart Interfacing of information to and the review of information in the EHR The results showed that, in the areas of scheduling and new patient demographic and clinical data entry, Paceart Connectivity saved approximately 9 minutes per patient for the patients observed. Minutes 12.00 10.00 8.00 6.00 4.00 2.00-1.30 Time Savings with Paceart Connectivity 1.04 Scheduling 2.73.70 New Patient Demographic 7.17.33 Clinical Data Workflow Components 11.2 2.07 Total Time savings of approximately 9 minutes per patient with Paceart connectivity for the patients observed at The Ohio Heart & Vascular Center. Manual Entry Paceart Integrated There was an increase in workflow efficiency when Paceart was integrated in the EHR. 6 The Study Found the Use of Paceart Connectivity Resulted in Immediate and seamless data flow to the global EHR A reduction in the scanning of information and easier review of data in discrete data fields versus a single scanned image, facilitating faster access to patient data The ability to easily report on key data both internally and externally Immediate completion of billing A reduction in paper and printing of information for review Findings The integration of Paceart with the EHR optimizes efficiency in the workflow, resulting in an up to 9-minute per patient time savings in clinic workflow processes. Number of Patients Seen Time Saved per Task with Paceart Integration 1 Entry of Potential Total Time Saved by Number of Patients Time to Complete Manual Data Entry to EHR (minutes) Paceart Integrated with EHR Time to Complete Data Entry using Paceart Integrated with EHR (minutes) Time Saved 1 11.20 2.07 9.13 minutes 10 112 20.70 91.30 minutes 25 280 51.75 Manual Entry to EHR Scheduling information 1.04 minutes 1.30 minutes New patient demographic information 0.70 minutes 2.73 minutes Clinical data 0.33 minutes 7.17 minutes 228.25 minutes (3 hours and 48 minutes)
EHR Coverage and Implementation Support EHR adoption is a multiphase process. Whether a practice is just starting the process or the installation has gone live, an important consideration is interoperability with implantable device data. Paceart can interface with any HL7-compatible system and is actively sharing data with more than 41 EHRs, including such industry leaders as athenahealth, EPIC, GEMMS, and NextGen Healthcare. Implementation Support The Medtronic Paceart team offers complete support through the implementation process to ensure successful integration. Medtronic has more than 200 interface contracts with 100 customers, and Paceart s experienced team stands ready to help any clinic, hospital, or other practice get connected. Is your EHR ready for HL7 integration? Consider these questions in preparation for adding an HL7 interface: Does the current version of your EHR support HL7 integration? Do I need to purchase any hardware, software, or services from the EHR vendor? Does the IT staff have sufficient resources to support an interface? What is the timing for implementing a new interface? Do you face any resource constraints from the EHR company or internally? Conclusion Continual advances in healthcare technology guarantee that new applications and interfaces will be rolled out regularly. Keeping pace in this environment makes interoperability a necessity. Many healthcare executives regard comprehensive acquisition and integration of clinical data as critical to remaining competitive and moving to the next level of care. 2 Connecting implanted cardiac device data to the EHR and into the PHR via a single, easily managed interface can help healthcare practices achieve these goals. Paceart is the only device follow-up system on the market that integrates demographics, scheduling, and cardiac device data all in one place providing a single solution for all cardiac device data and unmatched EHR coverage. 7
Learn More Interested in learning more about how Paceart s device management functionality can work in an EHR environment and help you in your move toward the paperless transfer of data? Find out how Paceart s Get Connected edition enhances connectivity and efficiency. Call 1(800) PACEART or visit the website, www.paceart.com. Visit the following websites for more on the connectivity standards being developed. Health Level 7 (HL7) www.hl7.org Integrating the Health Care Enterprise (IHE ) www.ihe.net Institute of Electrical and Electronics Engineers (IEEE) www.ieee.org/portal/site References 1 Paceart System and EHR Integration, conducted by Validus Consulting, Inc. at The Ohio Heart & Vascular Center, Cincinnati, Ohio October 2008. 2 Healthcare and Management Systems Society. Healthcare Integration and Connectivity: Results of a Survey by the Enterprise Systems Steering Committee, 2008. Brief Statement Paceart For further information regarding Paceart, please call Medtronic at 1 (800) 722-3278 and/or consult Medtronic s website at www.paceart.com. The Medtronic CareLink Programmer The CareLink Programmer is a portable, microprocessor-based instrument used to program Medtronic and Vitatron implantable devices. CareLink Monitor/CareLink Network The CareLink Monitor and the CareLink Network are indicated for use in the transfer of patient data from some Medtronic implantable cardiac devices based on physician instructions and as described in the product manual. These products are not a substitute for appropriate medical attention in the event of an emergency and should only be used as directed by a physician. Do not use a cellular phone while the antenna is positioned over the implanted device. The CareLink Network is currently available in the continental United States, Alaska, and Hawaii. See the device manuals for detailed information regarding the instructions for use, indications, contraindications, warnings, precautions, and potential complications/adverse events. For further information, please call Medtronic at 1 (800) 328-2518 and/or consult Medtronic s website at www.medtronic.com. Caution: Federal law (USA) restricts these devices to sale by or on the order of a physician. www.medtronic.com World Headquarters Medtronic, Inc. 710 Medtronic Parkway Minneapolis, MN 55432-5604 USA Tel: (763) 514-4000 Fax: (763) 514-4879 Medtronic USA, Inc. Toll-free: 1 (800) 328-2518 (24-hour technical support for physicians and medical professionals) UC200901197 EN Medtronic, Inc. 2009. Minneapolis, MN. All Rights Reserved. Printed in USA. 03/2009