CVIS and PACS at the Heart of Improving Cardiac Care Workflow

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A nurse sits in a cardiac cath lab control room at Genesis Medical Center.From its humble beginnings in 1869 as one of the first community hospitals west of the Mississippi, Genesis Health System has come a long way to now utilize the latest in healthcare technology. Serving the Quad Cities region of Iowa and Illinois, Genesis includes three medical centers in Davenport and DeWitt, Iowa, and Silvis, Ill., the Heart Institute in Davenport, nursing homes and hospice care.

Currently there are 675 beds between the three locations with patient care provided by 600 physicians and 5,000 staff members. There are two groups of radiologists totaling 27 system-wide that each year perform approximately 210,000 imaging procedures. About 13,000 of those are cardiac. With an annual IT capital expenditure of $5 million to $9 million across the enterprise, Genesis is committed to bringing the best technology to its care, which includes Agfa HealthCare’s IMPAX PACS and Heartlab Cardiovascular Information Management Suite solutions. How Agfa’s technology works in cardiac care is an example of seamless integration across the enterprise.

Leading cardiac care

For more than 29 years, Genesis Medical Center, Davenport has been leading cardiac care services for Genesis Health System. The number of cardiologists has grown to 27 (20 staff) from two in 1988. At the lead facility, there are eight cardiac cath labs, including six interventional labs and two electrophysiology (EP) labs, where in 2006 more than 9,900 cardiac and peripheral vascular procedures were performed. In the echo lab, some 4,800 adult and pediatric procedures are performed annually.

Genesis Medical Center In 2002, the cath lab made the move to a digital image management environment with Agfa IMPAX 4.5 and web-based image distribution solution. Agfa Healthcare’s Heartlab Cardiovascular Information Management Suite was added in November 2005. The Heartlab solution connects cath imaging, echo imaging for adult and pediatrics, results management for echo, and results outbound reporting (via HL7). More upgrades are planned for the second quarter of this year.

Following in the footsteps of the cath lab, the echo lab installed IMPAX and Heartlab in May 2006, doing away with outdated VHS tapes. While the results outbound reporting is in full swing in echo, structured reporting using results management for echo will go live after training is complete this summer.

With digital image management, the enterprise has realized improved patient care, efficiency and workflow, as well as time and cost savings, and reduced archive space. It also has provided a means to easily connect departments and facilities with images and reports ready to review at the physician’s fingertips.

A roundtable discussion on cardiac image management
Providing a look into how cardiac care at Genesis Medical Center has benefitted from integrated Agfa HealthCare IMPAX radiology PACS and Heartlab Cardiology Information and Results Management solutions are three employees whose cumulative experience in radiology and cardiology is more than 70 years: Diane Young, RT, supervisor of implementations, information technology, oversees all IT/PACS for Genesis Health System; Karen Butler, RT, is cardiac cath lab PACS coordinator at Genesis Medical Center in Davenport; and Brenda Brown, RDCS, is an echo tech in the cardiac echo lab at Genesis Medical Center.

 

With the introduction of PACS, what goals were set by Genesis and how have they been met?

Young: The goal for the PACS project was to provide clinical imaging services across all clinical specialties, medical education, and medical research. These services provide quantifiable improvements, which create operational efficiencies and productivity gains, allowing the organization to remain financially viable and competitive. It allows us to serve our patient and clinical customers with systems capable of storing, transporting and displaying all radiology and cardiology images throughout the organization in support of improved patient care. The exams are now readily available for viewing by staff and physicians as needed. Film and film processing costs have been eliminated and in-house storage space has been reduced.

 

Butler: For the cath lab, a primary goal is to establish a more streamlined process for the archiving and retrieval system. The goal has been met with IMPAX [PACS] and Heartlab [CVIS] solutions by reducing the amount of time involved in processing, archiving and retrieving procedures, which in turn offsets some of the cost of implementing IMPAX and provides additional savings going forward.

Brown: The goals for cardiac diagnostics are to store echocardiograms digitally to decrease time for physician review; increase clarity of images; reduce technologist time for completing echo; have a system to readily access echocardiograms; provide the ability to do side-by-side comparison of two studies; and to utilize the system for automatic report distribution. All of these goals continue to be met by IMPAX and Heartlab solutions.

How would you describe your digital image workflow using PACS and CVIS?

Butler: The cath lab workflow is easy from the point the patient information is entered into the HIS to when a cardiologist reviews the procedure. When an order is placed for a cath lab procedure, the patient worklist populates and the tech is able to select the exam from the worklist, and the exam is automatically sent from the modality to the IMPAX archive server and then to Heartlab. If a patient has been here since PACS was implemented, the tech can easily retrieve the patient’s prior exams at the modality workstation in the exam room. The study is retrieved from PACS, including if necessary, studies from the cath lab at the Illini campus. Procedures performed before IMPAX was implemented are kept for a minimum of seven years and will either be on film or a CD. If it is on the latter, I am able to download the study into IMPAX and destroy that CD. In other words, we have been able to archive retroactively. If a prior procedure is on film, it must be located in an archive storage area in our basement. When a procedure is complete, the cardiologist can review and dictate the procedure immediately post-procedure and often will show highlights of the procedure to immediate family members.  

 

Brown: Workflow is greatly simplified for echo techs. When an echo is ordered in our hospital information system, it generates a requisition and places the order on a worklist on the echo machine. The tech selects the order off the worklist on the echo machine which automatically downloads the patient’s data, which is 100 percent accurate since this comes from the hospital information system. The study is downloaded via data ports (which are located in multiple areas throughout the two campuses and the outreach site). The study downloads in IMPAX within two to three minutes, thus ready for physician review immediately. 

Can you describe improvements in efficiency and accuracy that PACS has enabled?

Butler: The cath lab has seen a dramatic decrease in the number of lost archived procedures. If a procedure needs to be sent to another facility, it is quickly copied and we no longer have to worry about it being returned. It is much easier for physicians to review any related procedures the patient may have had, such as an echocardiogram, nuclear stress test, or CT scan and chest x-ray. Planning the patient’s care is more comprehensive because it can all be done from one computer, and it’s literally always at the doctor’s fingertips when needed on one system enterprise-wide.

 

William Witcik, MD, cardiologist, and Brenda Brown, echo tech, review a patient's echocardiogram on the Heartlab echo review station at Genesis Medical Center in Davenport, Iowa. Brown: The echo lab also has seen the turn-around time for the interpretation of the studies decrease significantly since physicians now review studies in a fraction of the time prior to PACS. Physicians can access previous studies without requesting the echo staff to retrieve a VCR tape from storage. Patient requests for copies of CDs of their echocardiograms can be done within less than three minutes versus 30 minutes to copy a VHS tape. With the increased efficiency, the echo lab is able to perform four echos in three hours, versus four before PACS.

Another benefit is the superior image quality. With crisper and clearer images, the physician is able to determine the left ventricular wall motion to report an ejection fraction. The physician can determine if the morphology of the valves is normal with crisper images. The physician can access abnormalities on the valves with clearer images. With digital images, the physician can see the color flow through the valves to determine abnormal blood flow or leakage of valves.

What PACS and CVIS features do you find to be particularly helpful in cardiac care?

Butler: I would have to say it is the accessibility of a patient’s procedures, whether it is a previous cardiac catheterization, a cardiac echo, nuclear stress test or a chest x-ray. The tools and the ease of making copies as needed are great, but being able to access current and older studies quickly and all from one location is the best feature.

 

Brown: CVIS allows echo techs to re-calculate measurements once they have been downloaded into PACS. The structured report mechanism is a fantastic feature, which we will be implementing at the end of summer.  Management reports are easily acquired to provide statistics for accreditation purposes. The structured report provides the referring physician with a standardized report which includes all measurements. The report is readily available in the hospital information system once the physician creates and signs the report, thus allowing physicians to treat patients promptly according to their cardiac findings. The CVIS system provides physician access to all digital studies stored throughout Genesis such as from the cath lab, ultrasound studies in radiology, and reports from those areas for a complete assessment of the patient. Studies can be reviewed by a single frame or multiple frames at time. Also workstations with two monitors allow all icons on one screen and single frames on the other. The touch screen is an awesome feature used for reviewing instead of using the mouse. 

For community hospitals considering building a digital workflow, what recommendations do you have?

Young: When selecting vendors, make sure that the company can work with vendors of other modalities, that they are well established and have PACS enterprise experience. Consider the cost and time that is entailed in going live, maintenance needs, and future upgrades.

 

Butler: Getting buy-in from participants is important. Involve physicians early in the process and provide continuing education.

Brown: Develop detailed workflows prior to implementing PACS and future workflows after the PACS installation and look for gaps. Understand the role PACS will play in other areas such as surgery, ER and ICUs. It is very important that your site visits are of comparable size of your own organization (same number of echo machines, staff, and volumes).