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Being Data Driven in the ED

August 1, 2014
by Gabriel Perna
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The University of California (UC) San Diego Health System, a two hospital health system, serves a population of three million people in metropolitan San Diego. More than 70,000 patients pass through its emergency department (ED) per year.

In case you weren’t aware, that’s a lot of people.

On any given day, UC San Diego hospitals may see 200 people come through its ED. According to Theodore Chan, M.D., UCSD Chair of Emergency Medicine, approximately 20 percent of patients seen in the ED are admitted.

Time is of the essence in any ED, especially one that is located in a large urban area like UC San Diego’s UC San Diego Medical Center. When patients come to the ED with implantable devices, like pacemakers, it can traditionally take hours to get the information on the device from an electrocardiogram (ECG) test. In turn, this wait can create bottlenecks in the ED.

Leaders at UC San Diego recently invested in technology (from San Diego-based Geneva Healthcare) that can take information from the implantable device and upload it onto a dashboard immediately. It reads the information off the pacemaker or other device and gives providers access to it. The end result is that UC San Diego saved significant time in deciding whether to admit or discharge a patient, decreased length of stay by more than an hour, and ultimately, helped reduce bottlenecks in the ED.

Dr. Chan and Jim Killeen, M.D., UC San Diego’s emergency department’s director of information technology recently spoke with Healthcare Informatics Senior Editor Gabriel Perna about this technology, how it came about because of the San Diego Beacon Community, and its future integration with the electronic medical record (EMR) system. Below are excerpts from that interview.


 Theodore Chan, M.D.              Jim Killeen, M.D.

How does this technology work?

Killeen: In the old workflow, if a patient had a pacemaker we’d have to figure out who the manufacturer was. If they had a card, great, if not, we had to figure it out a different way. Then we had to call the (vendor) rep and wait for them to come with their device and interrogate the patient. Traditionally this would take four-to-six hours, depending on the time of the day and the day of the week. You built in four-to-six hours waiting for a critical read before you could do anything.

Today, when they see a patient has an implantable device, they immediately interrogate the device using the Geneva cart, which consists of all four major manufacturing device readers on a single platform. If the patient doesn’t know what the device is…it can run through all the (potential devices)…and only the one implanted in their chest will read the computer information off the (device). The information is then uploaded onto the platform, where the ED providers have immediate access to it.

Geneva also took those complicated summary reports, which previously required a cardiologist, and highlighted important windows of data that any provider could interpret what’s good, what’s bad, or what they have to be cautious on based on a green, yellow, red light on their portal. They made the summary webpage easier to read for all providers.

How did you and your colleagues find about the technology?

Killeen: This was part of the San Diego Beacon project that was funded by the Office of the National Coordinator for Health (ONC).  San Diego and Minneapolis are both big healthcare industry places. We were talking to cardiologists about some of our issues and what we couldn’t do and having bad wait times, and we found Geneva. At the time, it was a start up. They told us about the portal and working with the national vendors of the devices. We thought it was a great marriage to try. It brings the right information at the right time, which was a Beacon goal, and also it was very innovative as far as wireless devices within the San Diego community.

Chan: As Jim said, our involvement was funded by ONC as a pilot project in the San Diego Beacon Community. San Diego has a well developed wireless community and there was a lot of interest at the federal level to fund this and see how technology could improve care and timeliness of care.

Was this a specific task given to you as part of the Beacon project, or was it something you came up with on your own?

Chan: The Beacons were sort of an interesting project. On the large scale, there were efforts to look at communities and say, “Develop innovative techniques to improve the flow of information and see how that health information can improve the quality of care, reduce costs, and improve population health.” Within that rubric, they said, “Fund projects within that sphere.” We weren’t given the charge to look at this specific issue, but they said, “Your Beacon is led by emergency physicians, we have interest in emergency issues, and we think this project would be fruitful.”

What data sources does it take from? Is it integrated within the EMR?

Killeen: It’s not integrated directly into the EHR. It takes wireless data that is normally held on an independent disk by the cardiologist, similar to a paper record, but is also uploaded to the manufacturer.  Recently, these manufacturers have started to send out standardized messages, if an EMR was able to grab this data, they can take the data and display it in the EMR. It’s possible but we haven’t found an EMR that has done that or is interested in that. It’s too much of a small niche area.

However, it’s on a web-based link to the portal within the EMR and because of that, it’s fairly easy to install within the EMR. It has active directory access, so it’s the same sign in providers use for other applications.

Did you ever find any inaccuracy with the data?

Killeen: No, what we did find is that legacy devices, older than five years, were manually typed in as far as a name on the device itself. So we essentially had to do a visual match, this John Smith is the same John Smith I’m caring for.

After it was done in one hospital, did it expand?

Killeen: It expanded to both hospitals in our system, the Sharp Healthcare system in San Diego, and you’d have to talk with Geneva, but I’ve been talking with the Mayo Clinic (about putting it in). They’ve asked us to do some of the training.

How have doctors responded to it?

Killeen: They certainly like the technology. It’s sort of a hard concept to introduce to the different providers, whether you’re a primary care doctor or not. Most of the times, they want to send it off to a cardiologist and have them deal with it. It’s opened up the ability for any provider to care for that patient without having to call for the cardiologist. So it was cost-savings for the patient and cost-savings for provider. They liked and understood that concept and have adopted that. We are able to decrease length of stay and for (general practitioners), they wouldn’t have to call cardiologist every time a patient has an issue with their device.

What are the next steps?

Killeen: UCSD is an Epic shop. Our main goal is getting that information into the EMR. We’re working with the Geneva folks to incorporate into the EMR. Not the web portal, but the discrete values into the Epic system.

What advice do you have for other CIOs and IT leaders looking at something like this?

Killeen: I would push this out to other CIOs, other academic centers, and non academic centers and say, “This is a true cost savings, not just for the academic centers but for patients that have these devices.”

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