The push for healthcare to be digitally transformed and paper-free means having access to electronic medical records anytime/anywhere. This effort amplified, has left many cardiology departments struggling to catch up. According to the Administration on Aging people 65+ represented 12.4 percent of the population in the year 2000, but are expected to grow to be 19 percent of the population by 2030. The increase in longevity-on top of advances in medications, less invasive treatments and diagnostic testing will greatly increase demand for cardiology.
With the implementation of a cardiovascular information system (CVIS), cardiology departments can remain competitive while meeting the demands of their customers. Considering a CVIS solution is a major financial investment, and implementing a CVIS will have a long-term effect on daily operations and patient care efficiencies. There are a few different purchasing and implementing strategies that can be used to guarantee the best results:
CVIS Rip and Replace
Certainly, the superlative strategy would be to evaluate key vendors and select one vendor to implement all facets of cardiology from hemodynamic monitoring systems to ECG solutions to structured physician reporting. Typically by selecting one vendor and doing a “rip and replace” (or upgrade for some systems) the interoperability and interfacing can be significantly easier. Being able to do this would require a significant budget and a dedicated implementation team. There are some healthcare systems that have budgeted for this large-scale project and have implemented successfully, but the majority of hospitals usually need to take a different approach.
CVIS Phased Approach
If your healthcare system does not support the budget to do a full rip and replace, then a phased purchase and implementation approach is taken. Typically the servers and imaging components are purchased for the first phase and then based on funding and end-of-life systems, other modules and devices are added. By taking this approach, the biggest concern is how your current systems will function and interface with the new CVIS selection.
Finally, the last strategy is very similar to the phased based approach and that is purchasing a CVIS solution while keeping some current cardiology systems with no intention of purchasing from the new vendor. For example, a healthcare system may want to keep their current ECG system because clinicians are happy with it, or they have an enterprise-wide standard. Another example is a department may want to keep their current hemodynamic monitoring system because they still have years left on contract. Once again in these instances, verifying inter-operability and interfacing is crucial during the selection phase.
No matter what approach your healthcare system chooses, there are practical guidance items for planning and implementation.
Assembling the Appropriate Team for Planning
Selecting the appropriate team is crucial to the selection and procurement process. The team should be composed of people who can address operational, technical, and financial items. It also should include key physicians who will use the system along with clinical support roles and IT staff. For example, physicians are generally best to include for what features they would like or need to have, but the IT department will likely be able to address interfaces and technical implementation responsibilities.
Current State Assessment
The most common mistake made is not conducting a review of what current systems exist in the healthcare enterprise. Anybody who has ever done an assessment of the cardiology department cannot believe two things: 1) how different it is from other imaging areas, and 2) how many different devices and systems are used. Therefore, by understanding what systems are currently used that will aid in the selection process of interconnectivity and inter-operability to future vision.
A healthcare system should consider other factors such as the volume of procedures, the different modules needed (cath, electrophysiology, echo, etc.), its financial resources and in-house technical staffing capability. In addition, it should work with other imaging departments to see if they are moving towards a vendor neutral archive (VNA) or other enterprise initiatives. This could decrease cost for back-end storage and while sharing operational costs.
Issue a Request for Proposal
It is important to exercise due diligence in determining which vendor provides the best fit for your organization and dependent on your legacy systems, politics, budget, clinical requirements and to-be vision. For years, this process — called a request for proposal (RFP) — has served to provide the best available tool for making an educated decision and alleviating some of the risks associated with selecting the wrong vendor. Requiring multiple vendors to submit responses to an RFP allows for the comparison of each system and in order to make an informed decision. A good RFP should address functionalities, technical and hardware requirements, interfaces, implementation responsibilities, training, key maintenance, migration, warranties, support, data security and other key expectations. In addition to the RFP, all the selected vendors should provide a demo. CVIS vendors are naturally more likely to offer better pricing and terms when they know that their potential customers are considering other vendors and not already committed to their products.
Timing is essential with a RFP, and a shorter timeline also increases the accuracy of the final RFP decision. Products are changing at a breakneck pace in order to keep up. Keeping a short timeline between vendor responses, scoring the responses, and vendor selection means a greater likelihood that the information upon which the decision was based has not changed significantly. In a legacy RFP, there can be as much as six months between vendor response and vendor selection, adding to the chance of significant vendor changes during the process.
Make an On-site Visit
After reviewing the RFP, the healthcare system should ask for a site visit at locations where the CVIS solution is already being used. If a site visit is not possible, then a conference call can be arranged to discuss the install site’s experiences with the product. It is important to discuss with fellow healthcare systems how the product is functioning in real world application. Many of our clients use industry conferences as a watering hole to share experiences and lessons learned.
Budgeting is one of the single most important factors in the process. To properly budget all costs must be associated into the calculation. Healthcare systems will need to factor in implementation, software, licenses, equipment, ongoing maintenance, training, third-party software, customization, migration and interface development fees. Typically the two costs that are commonly forgotten are the ongoing maintenance fees and migration. Ongoing maintenance fees should be negotiated up front before the CVIS system is purchased for better negotiating strategy. Budgeting appropriately will be the key deciding factor on what purchase and implementation strategy will be used.
Based on the authors experience with CVIS implementations any one of the three purchases and implementations can work and have been successful at healthcare systems across the United States. Healthcare systems need devote sufficient time to planning process in order to be successful. In addition, they need to be savvy when negotiating their CVIS contracts or they can be exposed to significant financial losses and operational disruptions. As CVIS vendors finally start to deliver on the integration and functionality the cardiology market has been waiting for, it is time for cardiology to break out of stagnation.
Editor’s note: Jen Ireland is a senior consultant at Ascendian Healthcare Consulting. She is a frequent contributor to publications and forums focused on the topic of cardiovascular information systems and HIT innovation. She can be contacted at [email protected], or visit www.ascendian.com.