Sometimes we find that Emergency Department physicians prefer to view diagnostic test results directly from within their Epic EMR. Epiphany Healthcare supports this workflow to allow physicians to perform their duties the way they see fit.

Why do Physicians Want This Workflow?

• Physicians already have the EMR open in the Emergency Department.
• Physicians do not want to be logged into multiple systems.
• Physicians want their interpretations charted into Epic without delay.

The hospitals that utilize this Reverse HL7 workflow usually only use it in the Emergency Department. Physicians in ambulatory environments (clinics, outpatient centers, etc.), however, often read their ECGs one at a time, similar to the Emergency Department. Reverse HL7 appeals to physicians in these environments as well.

Many hospital systems have a dual workflow with both this Reverse HL7 setup and a traditional setup (reading and managing studies from within Cardio Server) at the same facility.

How Does It Work?

• An order is created in Epic.
• The study is performed and transmitted to Cardio Server either with the order or with demographics from the patient’s wristband.
• Cardio Server sends a preliminary study to Epic for physician reading within the Emergency Department.
• The physician interprets and electronically signs the study and Epic sends a Reverse HL7 result to Cardio Server with the changes included.
• Updated results and waveforms are sent back to Epic so that the confirmed study is available from within the patient’s chart.
  
  

At this time, our Reverse HL7 workflow is only available with Epic, but Epiphany is open to developing this interface with other EMR companies. Please introduce us to your EMR vendor to discuss implementation of this Reverse HL7 workflow. If they are amenable, we will work with them.

Epiphany is committed to helping you deliver the best patient care—your way. Using the Reverse HL7 workflow allows physicians to not skip a beat when treating patients.

Epiphany is excited to announce that July 2019 marks our 15th year of business. As we celebrate our company’s success this year, we would like to take a look back and share some words from our founders about how we got here.

“Fishing on Russ’ dock,” recalled Jim Stanczak (Epiphany’s Executive Vice President and General Counsel) when asked if he could share the story of Epiphany’s humble beginning. “It all started on the dock January 1, 2004. Me with a notebook and pen and Russ (Epiphany’s President and CEO) brainstorming. It was a nice day of fishing, it was a nice day to start a business. He and I discussed the requests we received from around the world for a multi-vendor, multi-modality management system and put them on paper. We were in business by July. I asked, ‘What do you want to call it?’ Russ responded, ‘Epiphany.’”

Russ added some commentary on his motivation to start a new company. “I have always worked for smaller companies. After a small company I worked for was purchased by a global medical company, my ability to quickly resolve customer issues and enhancement requests went away. New development moved at a very slow pace. I knew our idea for Epiphany was too good to pass up."

“We formed a highly specialized team with a shared vision to provide a multi-vendor, multi-modality ECG management system. The team was comprised of engineers with over 30 years of experience in the medical device industry and clinical professionals who witnessed firsthand the daily workflow challenges clinical staff faced.”

Once a company of just a handful of talented and dedicated individuals with a plan and a passion, Epiphany now has 70 employees across the nation and abroad with its headquarters in Midlothian, VA and service and support center located in Durham, NC. Epiphany’s Cardio Server is the fastest growing ECG management system in the country with almost 1,000 hospitals using our product worldwide. We are proud to have hospital customers all over the US, as well as in Canada, South Africa, Australia, New Zealand, Malaysia, the Netherlands, the UK, Italy, and Switzerland.

Cardio Server was built with clinical customer requirements and hospital department workflow improvements in mind. As we celebrate our 15th year of business and the journey that has led to our success today, we thank our customers who have made our vision and our progress possible.

About Epiphany Healthcare: 
Epiphany Healthcare simplifies diverse clinical workflow using one consolidated EMR interface. Epiphany is committed to serving its customers’ needs through product innovation, the delivery of exceptional service, and an unwavering dedication to interoperability. Discover why Epiphany is the preferred provider when managing multi-vendor, multi-modality diagnostic test data. Contact us for more information.

Congratulations! You’ve realized that implementing a Healthcare IT software program such as Cardio Server will help your organization become more efficient, save money, and eliminate manual steps, thus saving time. You’ve done a lot of research to get to this point. However, now you’ve reached a new challenge, which is getting your department and supervisors to agree that implementing this particular software, in fact, is the right decision for your organization. Below are a few recommendations that can help you with the next steps.

1. Leverage testimonials and reference accounts

If you know of another hospital that has been successful with the software you’re recommending, promote their success story to your team. If you need a reference account to contact for more specific feedback regarding their opinions on Cardio Server, just ask an Epiphany Representative and we can provide references that had similar requirements.

2. Get buy-in from your physicians

If you’re making a recommendation that your physicians adopt a new software program, it’s a good idea to make sure they’re on board, or better yet excited, to use the application. Epiphany’s Physician Overview Video is a helpful tool because it’s a tour of our software from their perspective. They can also sign up for a live webinar, customized for a physician’s workflow needs.

3. Put your vendor team to work

Epiphany representatives have the tools needed to provide you with a free workflow analysis to help you position our software to your departments. The end product of this discussion is a visual overview of what manual steps our software eliminates, an estimate of potential cost-savings, and labor costs that can be reduced. Seeing the results is an eye-opener for decision-makers, as it helps determine overall ROI.

4. Reduce uncertainty

Once you make a decision on an application, let your team know what will happen next. Feel free to schedule a consultation with our Implementations Director to talk about the Epiphany process going forward. Having all of these details up front will drastically help your team and supervisors to get the big picture before a final decision is made.

We want to empower you to improve patient care at your organization, and often improving the technology behind your daily workflow is a giant step in the right direction. Consider the steps above to help get your team and/or supervisors on board. Your Epiphany team is here to help you make an informed decision that you’re happy with.

If you scan rhythm strips into your EMR, you know this is a labor-intensive and costly process. Epiphany now offers the ability to automatically store rhythm strips from your central monitoring station in your EMR.

Epiphany’s Rhythm Strip Management solution (RSM) takes rhythm-strip data in PDF format from the Philips Information Center (PIIC and PIIC iX) and automatically transfers the rhythm strips to the EMR as an unsolicited HL7 result. This is an elegant solution for the end user, considering the number of problems it solves for a hospital’s rhythm strip management workflow. 

At many hospitals, rhythm strip management workflow looks like this:

RNs and monitoring techs have to manually print, cut, and paste the rhythm strips; they often hand write a validation signature on those strips. Rhythm strips then have to be copied and scanned so that they can be viewed in the EMR. For those using a telemetry cockpit, complex workflows exist due to the volume of patients that are being monitored.

Epiphany’s RSM solution:

With Epiphany’s RSM, no more printing, pasting, or scanning is necessary. The costs associated with scanning and paper (thermal strip chart recorder or 8.5 x 11) are eliminated. The RN strip–validation process can occur in the EMR or in Epiphany. The rhythm strips are automatically transferred and quickly available in the EMR.  Epiphany’s RSM supports an unlimited number of rhythm strips per patient. Overall, after implementing Epiphany’s RSM, workflow is faster, accurate, and more efficient.

Ask for more information about this product and an Epiphany representative will contact you to discuss your rhythm strip management needs and review next steps.

Pictured above: NEW Cardio Server Mobile

Here’s What This Means for the Healthcare Industry

In the healthcare industry, a large selection of applications for mobile smart devices are now available and increased usage of these devices is transforming the practice of medicine. These tools help doctors and nurses perform important tasks and are used in many areas, such as health record maintenance, patient management and monitoring, decision-making, and communication with patients and colleagues.

Mobile devices and iOS apps benefit healthcare practitioners by giving them increased access to tools and helping them make better clinical decisions that improve patient outcomes. Here are some recent findings on the increasing use of mobile smart devices among medical practitioners and what this trend means for the future of healthcare.

Growing Use of Mobile Smart Devices in Healthcare

The use of mobile smart devices in the healthcare industry has grown dramatically in recent years. A 2016 Spok survey found that 63% of organizations have a plan for mobile devices, which is a 34% increase from 2012.

The survey also found that 78% of participants intend to use mobile devices for doctor-to-doctor communication and 74% said they would use mobile devices for nurse-to-doctor communication and test results management. In addition, 78% of hospitals surveyed indicated that they supported smartphone usage. The study also revealed that the top three systems being accessed by mobile devices are electronic medical records (EMR), directory lookup, and drug reference.

Benefits of Mobile Healthcare

There are many ways that mobile usage is transforming the healthcare industry. Here are some of the major benefits of mobile healthcare:

• Allows for remote viewing of test results
  Specialized iOS tools can be used to remotely view diagnostic tests. With these tools, medical practitioners can access test results from anywhere. This gives them the opportunity to read the tests sooner and get results to their patients faster. With these apps, doctors can also store studies and share them with their colleagues when necessary. In many cases, viewing test results on mobile devices is just as effective as viewing them at a standard workstation.
• Increased workflow efficiency
  The use of mobile applications increases workflow efficiency by automating much of the paperwork and reducing clerical errors in recording patient history. This automation decreases the risk of misplaced files and records. There are also apps that assist with data collection and entering patient information into an EMR. They provide secure access to patient information like medical history, test results, and scans. Doctors can easily access patient information on their devices from anywhere, which can save crucial time in a medical emergency.

• Improves communication between doctors and nurses
  Recent studies have shown the use of mobile devices improves communication between doctors and nurses in medical wards. The devices provide a variety of ways to communicate, such as texting, phone calls, and video conferences and helps doctors to respond to emails more quickly.  In another survey, over 80% of participants said they used mobile devices to communicate with their colleagues about patient care and found texting to be more efficient than phone calls or in-person meetings. Most importantly, using mobile devices to communicate also saves time in emergency situations, which can save lives.
• Assists communication between doctors and patients
  The growing use of mobile devices in healthcare allows for more real-time communication between doctors and patients inside and outside of a hospital or medical office. This makes it easier for patients to get in touch with their doctors if they have a question or concern and for doctors to check in with patients about their treatment. Patients who believe their doctors are truly invested in their care are more engaged and more engaged patients are more likely to follow their doctor’s care plan, take medications, and incorporate healthy practices.

• Allows for direct patient monitoring
  Mobile devices are increasingly being used to directly monitor patients with many chronic diseases. iOS devices can be used to take patient vitals, which allows data to be gathered electronically.  This can reduce the need for office visits and provides a way for doctors to monitor patients with chronic conditions such as diabetes, Alzheimer’s, and heart disease from anywhere.

How Mobile Smart Devices Are Transforming Healthcare

One of the main advantages of mobile smart devices is they allow doctors to check in on their patients anytime. These devices increase efficiency in healthcare settings, which can save lives in emergencies. Epiphany’s Cardio Server Mobile is one iOS application that is transforming healthcare by allowing doctors to access ECG data remotely. This means that a patient who has an ECG in an ambulance can have the results sent directly to their cardiologist’s mobile device. By viewing the test results immediately on an iPhone, the doctor can make a diagnosis and have the Cath Lab prepare for the necessary procedure before the patient arrives at the hospital. This saves critical time in a cardiac emergency and dramatically increases a patient’s chance of survival.  

Cardio Server Mobile is optimized for iOS smart devices, which makes it extremely responsive and easy for a doctor to use. It is also a secure-data application and no patient data is left on the device after the doctor finishes with the test results.

Another cutting-edge iOS app is Kardia by AliveCor, which allows a patient to record a single-lead electrocardiogram using the KardiaMobile device with a smartphone or the KardiaBand with the Apple Watch. After taking the ECG, AliveCor’s algorithm’s will tell the patient if they are in atrial fibrillation. The patient can send the results directly to a cardiologist or a cloud-based platform and save the information in the patient’s records. This allows the cardiologist to quickly detect an arrhythmia, which can cause sudden cardiac death if untreated. AliveCor allows an arrhythmia patient to get treatment immediately, which can save lives.

Epiphany added over 100 devices to our compatibility list in 2017, including this device. When launched, this integration will make it possible for patients to transmit ECGs taken from the Kardia device and have them available in Cardio Server for a cardiologist to compare with previous studies.

The use of mobile smart devices and apps in medical settings continues to grow. An increasing number of doctors and medical professionals are making use of smartphone technology to view test results and to communicate more efficiently with colleagues and patients. A vast selection of apps for mobile smart devices are being developed and refined, which will continue to transform the future of healthcare.

Managing a multiple-hospital, enterprise-wide IT infrastructure is challenging. Epiphany offers broad flexibility to hospitals in this situation. 

Hospital groups usually have legacy devices from multiple manufacturers and want to avoid the expense of replacing these products. Epiphany is compatible with 260 devices from over 80 manufacturers supporting 23 diagnostic modalities, so you can leverage your existing devices, workflow, and infrastructure.

Our customers have shared that in multiple-site systems, each hospital needs to be able to define its own workflow. Epiphany supports the ability to adjust Cardio Server to fit different workflow preferences for each site in a multiple-hospital implementation. Examples include:

1. Epiphany migrates data from your legacy management systems and uses that data to provide serial comparison reports on diagnostic test results from different manufacturer‘s devices.
2. HL7 messages, including order updates, preliminary results, image updates, final results, and billing messages, are transferred between multiple applications. For example, Cardio Server supports customized results for Epic, Cerner, Meditech, McKesson, and all other major EMR vendors.
3. It is common in multiple-site hospital systems for patients to have different patient IDs from different sites. Cardio Server identifies a patient's previous studies, even if they were performed with a different patient ID in another site, by using patient name and date of study and other unique identifiers of your choice.
4. Cardio Server can be configured to not require order linkage for outpatient and clinics studies, but to require orders for inpatient procedures. With our system, you can add not only your hospitals but your clinics and physician practices as well.
5. Some physicians confirm studies within the exercise stress application. Epiphany enables those stress studies coming from the hospital/clinic to be received as “confirmed” and pass onto the EMR while allowing physicians at the other sites to confirm using Cardio Server.
6. For university hospital systems, Epiphany has a workflow for cardiology fellows. The cardiology fellows receive a “usertype” unique to them that does not contain the ECG’s preliminary interpretation from the cardiograph. In this way, they are able to provide an unbiased interpretation before the reading MD confirms their work on the study. There is an additional option of a “training” version of Cardio Server, which strips interpretations from the ECGs, de-identifies patient information, and creates an archive of ECG training files for future use.
7. Multiple time zones are supported for enterprises that extend beyond a single time zone.

Epiphany values feedback from our customers. Listening and learning from our customers has allowed us to be active, adapt, and expand the functionality of our products to be flexible in supporting multiple-site enterprises.

An enterprise hospital using Cardio Server in Alabama contacted us to look for a way to improve their ECG billing workflow.

OPPORTUNITY FOR IMPROVEMENT

For ECG interpretations, there are two bill types: technical and professional. In this particular hospital’s case, the staff would manually change the study status in the EMR to generate the technical component of the bill.  

Of course, if any part of an organization’s workflow is manual, there is always a chance of inconsistency or clerical errors. At times, their manual process led to the hospital not billing the technical fee for performing an ECG. The hospital was losing revenue because, in their EMR, the trigger for dropping the technical charge required that the order status needed to change. In their previous workflow, this was a manual entry, it did not change automatically, and, therefore, the technical bill occasionally was not dropped. The hospital staff realized there was room for improvement and asked Epiphany if there was a way to automate this process. Epiphany’s answer was “absolutely.”

RESOLUTION

Epiphany now sends an order-status update message from Cardio Server automatically when the study is promoted to Unconfirmed. When Cardio Server sends the automatic update, the EMR changes the order status, which triggers the bill for the technical charge.

Patricia Brewer, an Epiphany Project Manager who worked with the hospital on the implementation, adds, “We are passionate about solving our customer’s problems here at Epiphany and this workflow fix is one of the many things we can do with Cardio Server’s flexibility to better the customer’s use and appreciation of our product.”

The resolution in Cardio Server for this hospital’s problem is not an uncommon request. This type of workflow improvement is what we at Epiphany work to achieve daily. When you calculate the time spent manually entering status change, in addition to lost revenue, automating the process with the help of Cardio Server and your EMR is substantial. If your EMR is able to accept an order-status update message, we can leverage that information to customize your Cardio Server configuration. Sign up for a complimentary workflow analysis to find out how Epiphany can improve clinical workflow for you.

The U.S. Health Insurance Portability and Accountability Act of 1996 (HIPAA) defined national standards to ensure the privacy of patients’ medical records and personal health information.

Healthcare Data Security

In August 2017, the HIPAA Journal cited measurable breaches in data security for the healthcare industry. Some of the findings revealed:

[B]etween January and June 2017, there have been 233 reported data breaches. Those breaches. . . impacted 3,159,236 patients. The largest reported breach in the first half of the year resulted in the theft of 697,800 records and was caused by a rogue insider, 1 of 96 incidents involving insiders. Out of those 96 incidents, 57 were due to insider error (423,000 records) and 36 incidents due to insider wrongdoing (743,665 records).

This disturbing data implies outside/hacker breaches are less of a threat than non-compliant behavior by your own employees.

Minimizing Risk: Healthcare Security Data Breaches

It is up to your organization’s IT staff to minimize security risks involving equipment that utilizes the latest technology, which includes mobile and off-site access to patient data (such as cardiology and pulmonary diagnostic test results). Epiphany’s engineering team has tested our application and put processes in place to prevent healthcare security data breaches.

What You Can Do

• Apply data encryption to active and inactive data.
• Control and monitor all log-ins; train users to log-off when not using applications.
• Epiphany’s Cardio Server has a customizable, automatic log-off feature to protect PHI.
• Educate employees and make them active participants in your program to reduce security breaches.
• Regular training and awareness regarding security are good, constant reminders to keep guards up and maintain skepticism towards phishing scams (emails or phone calls requesting suspicious information).
• Deploy applications that provide comprehensive HIPAA logs.
• Put firewalls in place to control employees’ access to at-risk websites.
• Use secure application program interface (API) technology with authentication and encryption; all points of entry into the system should be tested and documented.
• Offer secure, remote access to information for physicians.
• Enable secure, single sign-on using Active Directory.

Epiphany and its products align with best practices for today’s security standards. Read our Information Technology FAQs to learn more about ways we can work together to minimize healthcare security breaches.

If speed and efficiency are the name of the game, what is the winning combination? Bidirectional communication.