Case Study: Salem Health Improves Accessibility to EMR Data

The Customer:

Salem Health is a comprehensive regional health system serving Oregon’s Willamette Valley. Comprised of Salem Hospital, West Valley Hospital, and a variety of clinics, the health system provides patients with top-notch medical services. The not-for-profit Salem Hospital is licensed for 494 beds, and it’s cath lab performs over 4,000 procedures annually. ²

In 2019, Salem Hospital was recognized as one of the highestperforming cardiovascular hospitals in the nation, receiving the IBM Watson Health™ ³ 50 Top Cardiovascular Hospitals award for the fourth time. ⁴

The Challenge: Getting the Whole Picture from the EMR

Salem Health began searching for a new cardiovascular imaging solution when its existing platform was nearing end-of-life. Faced with a large cost for upgrading, the executive team instead sought an imaging system that could accommodate the needs of the growing organization. Salem Health envisioned a future as a onestop community resource in which the local hospital and its clinician partners were aligned via true, seamless integration.

At the time, the organization used a separate hemo system in the cath lab with no reporting capability. Procedure reporting was painstaking, performed either through transcription or a limited shortcut in the Salem Health’s Epic EMR system.

Cardiologists recall that their notes could only be added to the progress notes section and couldn’t be linked to the images. Additionally, there was no ability to tie together hemodynamics and the procedure log with the report.

The Solution: A Single Platform Offering

Salem Health set out to find a new system with image access, structured reporting, and a seamless integration to their Epic EMR. After significant review and input from its front line staff and providers, the health system soon implemented Change Healthcare Cardiology.

“We adopted this platform for invasive and non-invasive services, as it was the most user-friendly and comprehensive system we could find,” says Valli Brunken, Manager of Angiography, Electrophysiology & Interventional Recovery for Salem Hospital. “The platform fully integrates PACS with our documentation while offering comprehensive provider reporting features.”

The new solution was the first choice for both Salem Health’s Cath Lab staff and its Imaging Informatics team, who support its EMR and PACS. “As reports are easily imported as PDF files, the entire care team can immediately view the procedure notes and the providers’ preliminary reports within our Epic EMR,” says Brunken. “Our experience with Change Healthcare has been exceptional. They’ve partnered with us to create an excellent system.”

With Change Healthcare Cardiology, reports are linked to images through the PACS system, so the care team can retrieve them when necessary. As the solution also links hemodynamics and the procedure log to the report, the care team has ready access to medications, stent size, and other details. Care team members no longer waste time pulling up past dictation.

“Having everything in the same system is an extremely important piece of the puzzle, as it makes reporting after the case or alternate provider review much simpler,” states Kevin Thompson, D.O., a cardiologist at Salem Health. “If you ever do reporting after the case or another provider wants to look at it, having everything in the same system is an extremely important piece of the puzzle for the care team.”

Change Healthcare Cardiology helps ensure accurate data, which in turn improves patient care. “Having our Cath procedure data and reports immediately available from the EMR has been a great benefit,” says Dr. Thompson. “We’re getting more accurate data, and the entire care team can easily access it.”

Each member of the cath lab team can use the solution to document information simultaneously during the procedure. “The cath lab is a team approach, and each user has a different role,” says Brunken. “When everyone’s working on a single platform, the real-time data is much more accessible for multiple users. Everyone is looking at the same record at the same time, but from their own perspective.”

And because the system provides structured reporting, it allows users to query any elements for operational, clinical quality, and financial analytics—a powerful benefit because of the time it saves in inputting and gathering data. “The documentation is going into the system as part of the structured report, so staff can go into Epic, pull up the clinical report and easily see the data,” says Brunken. “We can also use the data behind the structured reporting for analytic purposes.”

The automation that comes with Change Healthcare Cardiology also provides an easier framework for meeting quality initiatives for NCDR reporting of interventional data and The Joint Commission.

For example, the Salem Health cath lab team does a special huddle for high-risk cases, such as an unprotected left main, to ensure all techs and nurses are clear on the procedure. The Change Healthcare system facilitates the tracking of the accompanying quality improvement metrics for such cases.

For Teri Benzinger, Lead Angio Technologist at Salem Health, the ability to quickly turn over reports and data pulls is impressive. “I’ve been in the cath lab for more than 14 years. We used to print out all reports and documentation and put it in the paper chart,” says Benzinger. “Now, our hemo report fully integrates with Epic, so you can pull up the finalized report—within milliseconds—on the floor and in primary care afterwards. You can see the size and kind of stent used and which medications have already been administered.”

When patients return months or even years later, the system auto-populates with their prior history, providing valuable information to their care team.

The physician’s report now captures data ranging from the ultrasound to 3D imaging and intra-cardiac echo, a drastic improvement from the previous workflow, in which data was stored in and retrieved from multiple systems.

“You need a cardiology system that’s going to provide efficient data recording and documentation, for technologists, nurses, and physician providers, and that’s what we have with Change Healthcare,” says Brunken. “The documentation is very clear, and it’s quicker and easier.”

The Results: Across-the-board Efficiencies for More Accurate Care

Salem Health can now ensure that the clinical team is capturing what they need, that documentation is accessible in its EMR, and that charges are captured for accurate reimbursement and supply management.

These changes have had tangible results. Due to new efficiencies in both the nursing and technologist workflows, the cardiovascular service line has increased its capacity. Salem has been able to cut its standard echocardiogram completion time by 15 minutes, and has reduced the completion time for standard coronary cases by 25 minutes.

The addition of readily accessible cardiology data to the system’s EMR is creating savings while improving care. “We’ve eliminated the delays associated with transcription, and reduced those costs,” says Brunken.

In fact, not using dictation is saving 12 hours of time per case. Before a cardiologist even completes a case, the report is now part of the medical record.

From a decision support point of view, readily accessible patient data is invaluable. “A faster turnaround into the charts is important to The Joint Commission, as well as to patient outcomes,” says Dr. Thompson. “We have quicker release of information to the chart before the patient even leaves the procedure room. Any time we have more availability of data, that translates into improved patient care.”

In its quest for better data, Salem Health is proud to have achieved 100% physician adoption among the cardiologists.

“Cardiologists are looking for straightforward structured reporting, linking of images, remote access, hemodynamics and reporting in one system,” explains Dr. Thompson. “We’ve been pleased with the usability and results we’ve achieved using Change Healthcare Cardiology.”

<sub>1. Reported by Salem Health.
2.  http://www.salemhealth.org/about/salem-hospital-fast-facts, Salem Health.
3. IBM Watson Health™, is a trademark or registered trademark of IBM Company.
4. https://www.ibm.com/downloads/cas/MP3BOQWV, http://www.salemhealth.org/for-healthcare-professionals/common-ground/feb-4-2018/we-re-inthe-nation-s-top-50-for-cardiovascular-care-again.</sub>