St. Vincent's Medical Center upgrades to next-generation IDX Carecast

Bridgeport 22 December 2005IDX Systems Corporation has signed an agreement with St. Vincent's Medical Center to upgrade to the IDX Carecast enterprise clinical system. With Carecast, the long-time IDX customer plans to create and share patients' lifetime electronic health records (EHRs) with independent physicians in the region it serves, and support patient safety initiatives with computerized physician order entry (CPOE) and other advanced functionality. St. Vincent's is a 397-bed leading referral centre for Westchester County, New York, and southern Connecticut.


Since 2002, St. Vincent's has used Carecast's predecessor, IDX LastWord, to integrate clinical and financial processes. Both Carecast and LastWord are distinguished by the ability to fully integrate clinical and financial information on a single database. The St. Vincent's team has combined use of IDX technology with best practices and collaborative work across disciplines to accelerate the revenue cycle. As a result, the organisation's financial performance has significantly improved since 2002.

St. Vincent's has achieved positive outcomes including a reduction in accounts receivable (A/R) days from a 100-day high in 2001 to a current average of 35 in 2005, and a 10-percentage-point increase in its clean claims rate. An important measure of financial health, A/R days represent the average number of days that a bill remains in a hospital's accounts receivable department pending payment from payers. A/R days for United States hospitals averaged nearly 50 days in 2Q 2005, according to the Hospital Accounts Receivable Analysis Report (HARA) (Aspen Publications, 2005).

In 2005, the medical centre also reported that it improved net patient service revenue from $235 to $256 million and exceeded goals for cash collections by $18 million. "IDX technology has already enabled us to achieve remarkable success integrating our clinical and financial operations. The result has been an increase in staff efficiency, a better patient experience, and a significant improvement in the medical centre's bottom line", stated Gary Weiner, St. Vincent's CIO. "Our move to Carecast will position St. Vincent's for the next stage in advancing our patient safety initiatives and streamlining clinical work flow, including building lifetime EHRs that will support seamless, safe and efficient care not only at the medical centre, but in ambulatory facilities across the region."

St. Vincent's also plans to implement IDX Imagecast, closely integrated with Carecast, to streamline scheduling and management of its radiology and diagnostic medical imaging services. The organisation previously purchased Imagecast. The organisation plans to provide referring physicians with secure on-line access to view diagnostic images - with physician notes - as well as the results of laboratory tests completed at the medical centre. The IDX advanced Web framework will enable St. Vincent's to link the Carecast enterprise clinical system with other diagnostic imaging systems, Picture Archiving and Communications Systems, patient monitoring systems, and medical devices in place at the medical centre and at non-affiliated facilities.

St. Vincent's is also currently developing an initiative that will enable independent physicians to use the medical centre's Carecast clinical data repository, as well as other advanced system functionality. The programme will allow caregivers at the medical centre and in ambulatory settings to pro-actively communicate and share patient information via Carecast, building EHRs that follow patients throughout the region.

Two private physician groups already have signed on to the initial phases of the programme, which will offer a range of services, from the ability to store and access diagnostic medical images in the Carecast database to use of the system's registration, scheduling and billing functionality, for a competitive fee paid to St. Vincent's. The programme can enhance health care delivery across the region by making sophisticated health care IT tools available to smaller provider organisations for which a clinical IT system might otherwise be prohibitive. A report in the September 2005 issue of Health Affairs placed the average cost per physician of acquiring a stand-alone clinical IT system at $33.000 in up-front costs plus about $1500 per month to maintain.

"Carecast will be a critical tool to create a lifetime EHR that spans both the physician office and the medical centre, enabling the caregivers at St. Vincent's and the clinicians we work with to provide enhanced patient care across our communities", stated Chief Medical Officer Jose Missri, MD. "We're also looking forward to streamlining work flow for clinicians and improving patient outcomes in our inpatient facility. Among other planned improvements, Carecast's CPOE capabilities, advanced nursing technology, and pharmacy tools will enable us to make care safer and more efficient throughout the medication cycle."

St. Vincent's plans to begin to transition to CPOE in 2006. CPOE is recognized for its ability to improve patient safety by placing sophisticated decision-support technology at the point of care and reducing the risks inherent in handwritten orders. IDX CPOE technology, combined with best practices, has been shown to support health care providers' reductions in potential medication errors by up to 80 percent.

The medical centre also will build on its nurses' current use of LastWord's on-line clinical documentation and electronic medication administration record (MAR) functionality. The tools enable nurses to efficiently capture patient data, such as vital signs and the administration of medications, electronically, making it immediately available via the EHR to physicians, pharmacists and other members of the care team. Moving forward, St. Vincent's will leverage Carecast's advanced nursing assessment capabilities, incorporating on-line protocols and decision support tools to help support high-quality patient care. In addition, nurses will use the system's Patient Summary View, which makes it easier for nurses to see at a glance the status of all patients under their care, and better manage their patient loads.

To further close the loop on medication safety, St. Vincent's also is planning to use Carecast with Pyxis automated medication dispensing technology from Cardinal Health, and incorporate the use of smart pump technology for the delivery of intravenous (IV) fluids and medications. The organisation will also benefit from Carecast Document Management, powered by Streamline Health, which will ensure that paper-based documents, such as patient consent forms, can be managed and stored electronically within the electronic health record.

"For years, St. Vincent's has demonstrated true innovation in integrating clinical and financial work flow, decision-making and underlying IDX technology to realize synergies across the organisation", stated Michael Raymer, Senior Vice President and General Manager, Carecast Operating Unit. "We are very enthusiastic about continuing to support St. Vincent's next phase of patient safety initiatives at the medical centre, as well as its programmes to establish lifetime EHRs and enhance health care for patients across its region."

Carecast is a fully integrated clinical, financial and administrative system, combining core clinical processes for orders, results, pharmacy and clinical documentation with administrative and financial processes for scheduling, registration, admitting, charging and billing. Representing the next generation of electronic clinical information solutions, Carecast delivers unsurpassed response time and reliability to support fast-paced clinical environments. The system automates work flow throughout the health care enterprise and enables rapid access to patient records across the care continuum, from admission to discharge, including inpatient and ambulatory care. The result is a comprehensive lifetime patient record that enhances the quality of care and promotes operational efficiencies.

Developed by and for providers, in collaboration with hospitals, clinicians and health care executives, Carecast builds on 25 years of innovation with the IDX LastWord enterprise system. Customers include health care organisations in the United States, Canada and Europe.

Founded in 1969, IDX Systems Corporation provides information technology solutions to maximize value in the delivery of health care, improve the quality of patient service, enhance medical outcomes, and reduce the costs of care. Its systems are deployed to serve approximately 150.000 physicians and are installed at over 3400 customer sites, including more than 850 group practices and approximately 370 integrated delivery networks servicing more than 500 hospitals.

IDX also provides its enterprise clinical software as a subcontractor to BT, Local Service Provider for the United Kingdom National Health Service's National Programme for Information Technology, an initiative to establish electronic patient records for 50 million patients.

The IDX Web strategy includes browser technology, e-commerce and Web-based tools, built using Internet architecture, that facilitates access for patients, physicians and care providers to vital health information and data managed by the IDX clinical, administrative, financial, and managed care products. IDX has approximately 2400 full-time employees. More company information is available in the VMW December 2005 article Achievable steps for development of RHIOs highlighted in report by Center for Health Transformation and IDX.

Leslie Versweyveld

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