Going Paperless in a Cardiac Clinic

The George E. Wahlen Department of Veterans Affairs Medical Center in Salt Lake City, Utah, took an innovative approach to solve a problem that had been plaguing it for years—having stacks and stacks of cardiology device reports pile up waiting to be filed into paper charts. Now with the help of an encrypted flash drive, device reports are seamlessly input into electronic health records (EHRs).

The encrypted flash drive, the LOK-IT Secure Flash Drive (from the Systematic Development Group, Deerfield Beach, Fla.), now allows cardiologists and electrophysiologists to electronically review medical reports for pacemakers and implantable cardioverter defibrillators. “One of these device reps brought it to my attention that these programmers from the different device companies have USB ports, which I was never aware of it since we never used them before,” says Kim Selzman, M.D., an electrophysiologist who headed up the Salt Lake City VA medical center implementation. “So that led us to try to see if there was any way to get the data from the programmer into the electronic medical record in an easier way than printing it all out, and scanning it back in.”

Prior to implementing the encrypted flash drive two months ago, the center’s heart doctors couldn’t securely transfer data from devices that monitor pacemakers or ICDs to the hospital’s EHRs. About 25 patients come to clinic a week and electrophysiologists interrogate their pacemakers and defibrillators to extract a trove of information like how the battery and different components are working, any problems with the device, and any heart arrhythmias that have occurred. The information from the device is either printed on a small paper scroll or the device can be hooked to a printer to print on a standard 8.5” by 11” sheet. For every patient, reports up to 15 pages long were printed out and then had to be hand filed and scanned into the EHR. This would result in stacks of medical records waiting to be filed, which doctors had to sort through to find the relevant report.

Now the VA medical center’s workflow is more streamlined. The flash drive is brought to clinic, and at the end of the day the data is exported to the flash drive by the nurse and then given to the administrator. The administrator uploads the information and sends it to medical records as a PDF to be input into the patient’s EHR.

Out of the three device makers that the VA medical center currently uses, St. Jude’s, Medtronic , and Boston Scientific, only the latter is incompatible with the flash drive; so reports from that device maker are still printed. The encrypted flash drive also helps out with patients that have home monitoring devices that transmit their cardiac reports via landline. Before the reports had to be printed as PDFs from the various device makers websites; but now they can be uploaded on the flash drive. “Even though there are companies’ websites that can store this data, there is something to be said about having a patient’s data in their medical record,” says Selzman.

The VA medical center cannot use standard flash drives because they don’t meet strict government standards for encryption. But the device the VA uses is Federal Information Processing Standards (FIPS)-certified and meets advanced government-level security standards. All users had to be approved to use the flash drive, as well as the administrator’s computer had to be authorized to upload the data. To get information on and off of the flash drive, a 10-digit PIN code must be entered onto the onboard PIN-pad.

“The biggest thing is that is has saved a lot of administrative time,” says Selzman. “Before to take all of these pieces of paper and put it into a paper chart and to file the chart back was incredibly time-consuming, which was why we’d get backed up. So the amount of work to file all this paper has been eliminated.”