The Changing Face of the Cath Lab

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  Allura Xper from Philips Healthcare is in use at the brand new Seton Medical Center Williamson in Round Rock, Texas.

Digitized, streamlined information systems in the cardiac catheterization lab drive efficiency, healthcare quality and patient safety. At a time when more and more specialists are using cath lab facilities for a wider range of procedures, electronic data helps facilities get the most out of their equipment investment.

Managing competition

Seton Medical Center Williamson (SMCW) in Round Rock, Texas, just opened in February with technology no one else in town has, according to Julia Davis, RN, a cath lab manager. That includes the Allura Xper FD20/10, the Allura Xper FD10/10 with the Allura 3D-CA interventional tool and Allura 3D-RA interventional tool from Philips Healthcare. The equipment allows for a single contrast injection and rotational images. The ability to view all coronaries with one shot lets the clinicians use less contrast. “Contrast-induced nephropathy is held off greatly. That’s a tremendous aspect,” she says.

Another plus for the new facility is full electronic charting and an Xcelera archiving system that lets any physician pull up any study done within the network. The system is “a great electronic tool,” Davis says, that lets doctors review studies with patients. With ADT and HL7 interfaces, reports for registered patients can be autopopulated, reducing clerical errors and physician time spent creating the report. Those reports interface to the main registration center. Physicians can dictate or write reports on the fly and include images, all of which automatically go into the patient’s medical record.

More and more endovascular work is being performed in the cath lab, Davis says, so “the reality is that everything needs to be kept as one chart—the whole vasculature.” There is less distinction between cardiology and radiology, for example, if the peripheral arteries in the leg are examined. So, the latest systems serve as one big repository for patients’ vasculatory studies.

Integration for enhanced workflow

Stephen Green, MD, associate director of the cardiac catheterization lab at North Shore University Hospital (NSUH) in Manhasset, N.Y., has been using a digital cath lab for the past eight years. Over the years, the facility has continued to install new labs in addition to upgrading old labs with digital technology for a total of eight digital cath labs today. Green uses a selection of Inova large-format, flat-panel x-ray systems for angiographic imaging, Inova 3131 IQ Biplane imaging system and the OEC 9900 Elite, all from GE Healthcare.

Successful cath labs need more than digital imaging systems, he says. “The more you integrate your systems, the easier it is for workflow, and if workflow is enhanced, physicians are more likely to bring their patients.” NSUH performs about 14,000 cath lab procedures a year in the busy geographic area of Long Island, where 3 million residents have nine facilities to choose from. Competition is fierce.

Information systems let users pull demographic, insurance and other key patient and operational information into the labs and move it to report-generating systems. The EMR demographic data from the hospital system is interfaced with Mac-Lab, also from GE,  for the initial demographic data. Further data entry occurs in Mac-Lab throughout the case. The data are downloaded during and after the procedure to GE Centricity, which then has the demographic data from Invision, as well as cath lab data from Mac-Lab. The physician simply completes the final components of the study from pull-down menus. There is ample ability to text additional data in all segments of the report, but generally that is not required. “We can shift data from system to system effortlessly and in the background. It’s a very efficient way of doing things,” Green says.

With 15 hospitals in the NSUH system, each has a different grouping of information systems. The PACS currently are not integrated. “That is something we will be attempting with most of the system hospitals,” he says. All have Mac-Lab and all but one will eventually get Centricity. One community hospital, with their independent hospital IT group, elected to go with McKesson for all of their IS needs. The rest of the hospitals go through a VPN account to view their images.

“It’s harder to integrate 15 hospitals efficiently and cost-effectively. So, going to electronic medical records is our biggest goal right now.” Green