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Cardiology Evolves: How a team of cardiovascular specialists is changing heart care

Condition Critical: How Cardiologists Forced EHR to Evolve

Technology does not always get it right the first time around. Cardiologists know that well. Search engines such as Lycos, Alta Vista and Excite preceded Google, in much the same way Friendster and Myspace came before Facebook. At other points in time, new technology outpaced those that were well established. Examples include Netflix redefining the way we watch movies, or broadband giving consumers a better experience than dial up could deliver.

In no other industry is this evolution more necessary than in healthcare. During the past 5 years, the healthcare sector has experienced unprecedented growth in the use of electronic health records, but this has come at a price that is not just monetary in nature.

Without question, the monetary costs are substantial. There are costs to taxpayers in the form of incentives that are provided to purchase such technology, and the cost of the systems themselves can add up to hundreds of millions of dollars. But the other price that has been paid is a deep resentment that this technology has not helped but has only gotten in the way of patient care. This slowdown in productivity coupled with declining reimbursement is a substantial one-two punch.

To make matters worse, many physicians have been labeled as being “averse to technology”. We could not disagree more. The problem lies not in being technology averse, but in wanting technology to actually assist with the delivery of patient care. Instead, EHR has become yet another process that must be performed during the course of a patient visit.

One underlying reason for the deep resentment of EHR is this: No matter how hard one tries, a system simply cannot be all things to all people. At Objective Medical Systems, our founders are cardiovascular specialists with over 100 combined years of clinical experience, and our technology is exclusively focused on cardiology. Here is what that means for those of you that dedicate your life to treating heart disease.

To start, I will be talking in some detail about discrete data, so let me help to define what that means. To put it simply, discrete data allows software to analyze captured clinical information in lieu of it simply being text on a document. Let me provide one example. Let’s look at a patient that has 3 ejection fractions measured over time, with those results being 55%, 48% and 36%. Discrete data allows us to analyze and trend those results in such a manner as displayed below.

Fig. 1 – EF being trended over time.

Fig 1Alternatively, if you are dictating or not capturing this information discretely, you must now review 3 reports to determine this trend. This is a considerable disadvantage as you will see.

Discrete data is valuable in all sectors of healthcare, but perhaps none more so than in cardiology. At OMS, we capture over 5000 discrete data elements per patient. When we break that down, more than 4000 of those discrete data elements are captured from our cardiovascular diagnostic imaging modalities, while approximately 1000 are captured from our EHR repository. What this means is that if you have a general EHR and you work in cardiology, chances are you are missing out on 80% of the clinical data that will drive clinical decision support and allow truly transformative care within your practice.

Next let’s look at what we begin to accomplish with discrete data. This is where software actually begins to work for you, and where those previously labeled as ‘technology averse’ become a physician champion. For the sake of simplicity I am going to continue to focus on EF, but this evolution is much broader.

First, capturing discrete data in and of itself is a very efficient process. The first thing to happen is that we interface directly with your medical device(s), and discrete data flows automatically to our database. At this point, discrete data captured from CV diagnostic tests are compared against a fully customizable reference table, and a real time ICANL, ICAEL or ICAVL compliant report is generated. Because of discrete data, the physician no longer has to dictate or free-text type the report. To take this one step further, this analysis happens not only within the same modality, but across modalities as well. The graphical comparison of EF noted earlier may be performed whether these values are captured from an echocardiogram, a myocardial perfusion imaging test, or a mixture of the two. This has substantial benefits from an accreditation, quality and operational perspective. As soon as the physician signs the report, it then flows directly into the patient record within OMS EHR. Again, OMS is actually working for you.


Echo Snippet LinkedIn

Fig 2. – Remember the EF graph displayed in Fig. 1?  Here, OMS is analyzing the echos that produced those results…automatically.

Now that we have captured this discrete data, what else can we do with it? The possibilities are endless. Let us look at setting up a clinical decision support rule that addresses heart failure with EF as one of five components for analysis.

Figure 2

Fig. 3 – A custom rule is being generated to identify patients who meet criteria for symptomatic systolic heart failure not on diuretics.

Figure 3 Fig. 4 – The upper portion of the screen is being used to identify current patients with symptomatic heart failure, while the lower half of the screen allows the end user to configure customized prospective alerts.


Figure 4

Fig. 5 – Doe, John meets criteria for symptomatic heart failure. In response, OMS EHR generates a clinical alert for the physician, including intervention and goal recommendations.

Looking at Figures 3 and 4, we are retrospectively searching patients that meet criteria based on 5 discrete data elements (remember, we can do this with over 5000). In an instant, you are presented with the patient population that meet this criteria. Alternatively, imagine having to go chart by chart trying to locate this same patient subset because you are not capturing all data discretely. Take this one step further and imagine the implications this has for identifying candidates for clinical trials and medical device trials. This is OMS working for you.

As shown in Figure 5, that same data set is now being used to drive clinical alerts on a prospective basis. If a patient meets any of the custom rules that you find important, OMS will trigger intervention and goal recommendations that you have defined as being the best course of care in that instance. Figure 5 shows OMS working for you.

This article is only beginning to scratch the surface of possibilities, and my hope is that you have gained some degree of insight into what we may accomplish together. It is important to note that our technology is able to drive tremendous value for your current clinic or hospital based EHR as well.

The final point I would like to make before closing is this: OMS was founded by cardiology professionals that have experienced all the angst that this new era in healthcare has brought about. A key difference between OMS and the traditional vendor is not only the infrastructure that is completely developed around discrete data and cardiology, but also the fact that our founding physicians use this software every day during the course of their practice. Your pain is our pain, and we simply will not settle for an EHR that gets in the way of your chosen profession. We must enhance your ability to provide the very best in patient care, and that is what we promise to do.

For more information or questions, email contactus@omscardio.com or call Toll Free 1 (855) 378-3431.