An Ideal Transition:
Multi-Campus Rollout
of Echo CVIS at Orlando Health
Benefits Include Reduced Report Turnaround Times,
Standardized Care, EMR Integration—
and Cost Savings
Orlando Health recently successfully unrolled LUMEDX’s physician
structured reporting and image management solution across five of
its campuses. The implementation was smooth and swift, physician
adoption is now at nearly 100%, and the benefits are manifold.
About Orlando Health
Orlando Regional Medical Center
Orlando, FL
“When we started the project,
we gave our physicians the
expectation that the new
system would be more efficient,
that repetitive tests would be
eliminated, and that they would be
able to see their reports right away.
We’ve been able to deliver on all of
those promises.”
Lisa McDonald-Barr
Senior Project Manager – IT Services
Orlando Health
Orlando Health is a not-for-profit healthcare system delivering a wide
range of services to approximately 1.8 million Central Florida residents.
The healthcare system includes six wholly-owned hospitals, two
partnership hospitals, and a skilled nursing facility, for a total of 2,295
beds. In Fiscal Year 2013, Orlando Health caregivers treated over
990,000 patients. With such high volumes, cardiovascular services, one
of the busiest service lines in the healthcare network, is always looking
for new ways to improve efficiency, streamline care delivery and improve
patient safety. The LUMEDX cardiovascular information system (CVIS)
helps Orlando Health accomplish this—and physician reporting is central
to this effort.
Dictation and Transcription: Inefficient and Costly
“Prior to utilizing Apollo LX (LUMEDX’s reporting system), physician
reporting was a manual process—everything was dictated and
transcribed,” says Scott Lynch, RRT, RDCS, Manager of Noninvasive
Cardiology at Orlando Regional Medical Center. Because dictation-andtranscription is a slow method of report creation, it can potentially affect
follow-up treatment and even length-of-stay.
“We needed a way to reduce the time it took to get a report completed
and distributed. We also saw the need to standardize our reports across
the organization. Moving to an electronic system that connected directly
with our EMR (AllScripts) was the obvious choice,” says Scott.
555 12th Street, Suite 2060, Oakland, CA 94607 • Tel 800.966.0699 • Fax 510.419.3699
www.lumedx.com
Electronic Physician Reporting
Reduces Turnaround Time 10-14
Hours per Report
The LUMEDX CVIS has eliminated the need for
dictation and transcription at Orlando Health facilities.
Now once an echo is complete, it goes through the
sonographer’s preliminary report and then is passed
on electronically to the physician so he or she can
read it. The physician can access the complete
patient record-including images and notes-with a
single sign-on. They can even read reports securely
when they are remote.
The new reporting workflow has trimmed between 1014 hours from turnaround time for report completion.
In addition, because reports are now automatically
distributed to referrers, physicians no longer
spend time on the phone giving informal reports to
colleagues who needed patient information faster than
the old system could give it to them.
Best Practices: Standardizing Reports
across the Organization
“The American Society of Echocardiography is our
governing body. When we started with LUMEDX
on our electronic reporting, we knew we needed to
follow ASE guidelines for care,” says Scott. The new
solution was developed and implemented with ASE
guidelines in mind.
“The goal behind implementing electronic reporting
is to strive for clinical best practice and bring every
campus within our organization together so both
the reporting format and the procedure would be
standardized no matter what campus a patient visited.
We wanted our patients to get the same care, the
same best practices, and the same report at every
campus,” Scott says.
Highlights: Impact of Echo CVIS
at Orlando Health
Clinical and Patient Safety/Core Measures
1. Increased patient safety because reporting and image
review/analysis is done with in the same system; automatic
launch of image study in CardioPACS from Apollo LX,
preventing selection of incorrect patient or study.
Workflow efficiency by elimination of study selection.
2. Any re-measurement is saved to Apollo database from
CardioPACS, and calculations are triggered and saved.
Safeguards against data inconsistencies which could
affect diagnosis and treatment.
3. Timely reporting resulting in timely discharges; decreased
costs by shorter patient stays; more accurate diagnosis
and allows for multiple providers to access data and act on
results in real time.
4. Ability to collect and report Core Measures easier and
timelier; enable enrollment in research trials.
Enterprise Strategy Alignment
1. ASE and IAC Echocardiography compliant; enabling
accreditation and allowing for Orlando Health to be the
leader in central Florida with inpatient accreditation;
benchmarking with other facilities.
2. Provide outpatient referring physicians with comprehensive,
up-to-date, evidence-based patient reports to quickly
communicate critical information, increasing satisfaction and
potentially expanding referral base.
Staff/Physician Relationships
1. Increased physician and laboratory productivity by
streamlining workflow and standardizing echocardiography
laboratory technical and physician reporting protocols
throughout all of the adult hospitals of Orlando Health.
2. Standardizing staff workflow, enabling cross utilization of
staff between facilities, possibly eliminating the need for
contract/agency coverage
3. Allow for accurate metrics to be measured and validated
for all echocardiography technicians and interpreters to
more readily promote process improvement.
555 12th Street, Suite 2060, Oakland, CA 94607 • Tel 800.966.0699 • Fax 510.419.3699
www.lumedx.com
Engaged Physicians, Executives and
Staff Ensure Successful Implementation
Avoiding the problems sometimes associated with
large-scale software deployments required strategic
planning and step-by-step communication with all
internal stakeholders-including hospital leadership,
clinical staff, and physicians. CVIS administrators
and the Orlando Health CVIS-Information Services
team [Lisa McDonald-Barr, IT Services Senior Project
Manager; Nancy C. Davis, RT(R), CV Consultant;
Nick Bergeron, IT System Administrator; and Oleh S.
Brezden, BSN, MHA, CHTS-CP IT Clinical Informatics
Specialist] worked closely with LUMEDX to develop a
successful implementation plan.
From December 2013 to March 2014, the hospitals
upgraded to a newer version of LUMEDX’s
CardioPACS image management system while the
Dr. P. Phillips Hospital Echo team built out scripts for
Apollo LX Echo and mapped measurements to ensure
that the new software solution aligned with the Echo
workflows at each individual hospital.
Physician champions were engaged early in the
process in order to ensure their suggestions were
incorporated into any workflow changes and/or
customizations. Orlando Health then chose a go-live
date for a pilot that would allow several physicians
at the Dr. P. Phillips Hospital to begin using the
reporting solution.
On the go-live date, the implementation team arrived
at Dr. P. Phillips Hospital at 6 a.m. to ensure that
they met with all physicians in the pilot program, and
to answer any questions that they had. Within an
hour of releasing the solution to a few doctors, every
physician at the facility-even those not involved in the
pilot-came into the reading room and asked to start
using Apollo LX.
“When we started this project and talked to the
physicians, we gave them the expectation that the new
system would be more efficient, that repetitive tests
would be eliminated, and that they would be able to see
their reports right away,” says Lisa. “We’ve been able to
deliver on all of those promises.”
Multi-Facility Echo Implementation:
Timeline to Success
December 2013
ƒƒIS CVIS team plans Echo workflow reporting solution with
CardioPACS 6 upgrade.
ƒƒDr. P. Phillips Hospital (DPH) identified as pilot site.
December 2013 – March 2014
ƒƒIS CVIS maps fields with DPH Echo team.
ƒƒIS CVIS, DPH Echo team and physicians meet weekly to
discuss workflow or technical issues and enhancement
requests.
ƒƒIS CVIS team brings all problems and enhancements to
physician champions weekly for approval.
ƒƒWeekly project status meetings held with IS CVIS team,
Orlando Health executive team sponsors, co-chairs and
physician champions.
May 2014
ƒƒPilot unveiled to physician champions and staff at DPH on
May 9.
ƒƒWeek of May 23 - IS CVIS leaves two members of their
team at DPH and moves to South Lake Hospital to roll out
Echo solution.
ƒƒWeekly meetings with physicians and staff continue at
DPH and begin at South Lake.
ƒƒWeekly project status meetings with Orlando Health
executive team sponsors and others continue.
June – August 2014
ƒƒSteps and process above repeated at each site.
ƒƒSeptember 2014
ƒƒAll five campuses live with high user adoption rate.
555 12th Street, Suite 2060, Oakland, CA 94607 • Tel 800.966.0699 • Fax 510.419.3699
www.lumedx.com
Cost Benefits of Electronic Physician Reporting
By September 2014, all five Orlando Health facilities with Adult Echo were using the new reporting software. Of 1,987 Echo
reports, only 60 were dictated, leading to an overall cost savings of $8,238. With an average of 1800 Echos a month, over
the course of a year Orlando Health could see a potential savings of $100,000 by using Apollo LX structured reporting
instead of dictation and transcription services.
Month
Number
of Echos
Electronically
Signed
Dictated
Echos
Dictation
Cost
Savings
September
1987
1927
60
$257
$8,238
October
1892
1883
9
$38
$8,050
November
1852
1848
4
$17
$7,900
December
2045
2039
6
$26
$8,717
Consistent Communication Results in a Smart CVIS
Lisa, Nancy, Scott and other key stakeholders also developed online training modules for new users, and created a communication plan
to keep physicians and staff informed of the status of the Echo CVIS project.
“Many physicians and other clinical staff felt that regular, bidirectional communication about the implementation allowed them
to know exactly what was happening-and to shape the solution-so that there were no surprises,” says Lisa. “I was told by
some physicians that this was the best software deployment that they’ve taken part in, and I believe that communication was a
huge part of that.”
After the go-live date, the team continued to meet weekly for several months in order to address any problems that arose and to
make enhancements based on user requests. Since then, the cardiology department has instituted a monthly Echo meeting where
the enhancement request list is discussed.
“We consulted LUMEDX and put a lot of work into
the planning process. The fact that we could show
how the solution streamlined patient care right
away sealed the deal for our cardiologists,” says
Lisa. “They no longer had to spend time on the
phone explaining what they’d just done to referring
physicians, as they often had in the past. That was a
big time saver for everyone.”
CVIS Supports Improved Quality and
Staff Development
Because the reporting solution automatically connects
to the EMR, physicians and clinical staff across the
continuum of care can access comprehensive, upto-date patient reports. Cardiovascular service line
Orlando Health at a Glance:
ƒƒ One of Florida’s most comprehensive private, not for profit
healthcare networks
ƒƒ A healthcare leader for approximately 1.8 million residents
ƒƒ Six wholly-owned hospitals, two partnership hospitals, and a
skilled nursing facility
ƒƒ 2295 beds
ƒƒ Renowned for its cardiac, cancer, and surgical care for
children and adults
ƒƒ Central Florida’s first designated teaching hospital
555 12th Street, Suite 2060, Oakland, CA 94607 • Tel 800.966.0699 • Fax 510.419.3699
www.lumedx.com
staff can also easily review overall performance and
determine areas for improvement.
For example, Orlando Health uses the new system
to track whether or not a physician has read the
sonographer report within 24 hours. It is also simple
to drill-down to each individual physician in order to
compare his or her average Echo report turnaround
time with the network’s cumulative average. “Our
leadership team can take a look at physician reporting
to see how everyone is doing,” explains Nancy. “It’s
much easier for us to get the hard numbers and
actually review how effectively we are working-and
where can we can improve.”
Orlando Health also uses the reporting solution to
evaluate sonographer performance, set networkwide standards, and improve the overall quality of
sonographer reports. There is a tab built into the
report that allows physicians to note the quality of a
sonographer report as they’re viewing it.
“One of our goals was to bring up the level of our
sonographers. We wanted them all to meet the same
consistent high standards, both at the bedside and in
the report,” says Lisa. “Before, our sonographers were
accustomed to only noting abnormal observations.
With the new reporting workflow, they are prompted
to report on everything. This makes the patient report
more thorough.”
Results and Next Steps
Dr. P. Phillips Hospital has now received IAC
Echocardiography (formerly ICAEL) program
accreditation, the first hospital within the Orlando
Health network to achieve this. “Without a doubt, our
reporting solution has been instrumental in helping
us meet the expectations and goals set forth by
governing bodies like IAC Echo,” says Scott.
Orlando Health Hospitals with Echo CVIS
Dr. P. Phillips Hospital: 237 Beds - A full-service medical/
surgical facility offering 24-hour emergency services;
surgical services, including robotic surgery, neurosurgery,
vascular surgery and orthopedics; cardiovascular care;
and diagnostic imaging. Dr. P. Phillips is an accredited IAC
Echocardiography, Chest Pain Center and a designated
Stroke Center.
Orlando Regional Medical Center: 804 Beds - Orlando
Health’s flagship medical center, ORMC is a teaching hospital
and Central Florida’s only Level One Trauma center. ORMC
specializes in cardiology, trauma, critical care, emergency care,
orthopedics, neurosciences, internal medicine and minimally
invasive bariatric surgery. An accredited Chest Pain Center,
with an accredited Heart Failure Program.
South Lake Hospital: 122 Beds - South Lake Hospital is
a community hospital that includes emergency services,
women’s health services, cardiovasvcular services, an
outpatient surgery center, an endoscopy center and a National
Training Center that provides total body fitness, advanced
rehabilitation services and athletic training.
South Seminole Hospital: 206 Beds - A full-service medical,
surgical and behavioral community hospital dedicated to
offering quality healthcare services and programs to meet the
needs of the Seminole County community. The hospital serves
as one of Orlando Health’s three Air Care Team helicopter
bases, allowing critical patients to be transferred to ORMC’s
Level One Trauma Center.
Winnie Palmer Hospital for Women and Babies: 285 Beds
Dedicated to caring for the unique needs of women and
babies, Winnie Palmer Hospital is home to leading physicians,
surgeons and specialists as well as the world’s largest
neonatal intensive care unit (NICU) under one roof. Physicians
provide specialized women’s care for all stages of her life, from
comprehensive gynecological services and minimally invasive
surgery to obstetrics and high-risk pregnancies and births.
Orlando Health plans to implement structured reporting for EP and Cath across the health network next. “We had a great deal
of physician engagement when we rolled out Echo reporting. Now that we’re moving onto other projects, our physicians have
expressed support and enthusiasm,” says Lisa. “Planning ahead has paid off for all of us.”
HealthView
Cardiovascular Information Systems
555 12th Street, Suite 2060, Oakland, CA 94607 • Tel 800.966.0699
Fax 510.419.3699 • sales@lumedx.com • www.lumedx.com