CVIS, Cardiology PACS Widening Image Access

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Upon first glance, it might appear that the line between a cardiovascular information system (CVIS) and a cardiology PACS is beginning to blur. The cardiology PACS market is moving beyond just image storage and distribution, focusing on gathering relevant patient data to provide more data points to work with and help physicians make better decisions for patient care. But while cardiology PACS and CVIS continue to build momentum toward system integration, the demarcation is still there, due to the capabilities of CVIS in offering additional autonomy and business benefits. One thing the two systems share is the capability to consolidate cross-departmental data, albeit of slightly different natures.

For cardiology PACS, the explosion of cardiac-related advances across imaging modalities has created demand for expanded capabilities beyond simple image storage and distribution, providing physicians with access to patient-specific information related to images and reports within the facility or externally. Meanwhile, with this increased volume of image data, cardiologists also need to have access to more extensive patient data, such as hemodynamic monitoring, EKG and electronic medical record (EMR) information to create structured reports.

Data mining reveals business results

A CVIS does more than just connect cardiologists, patients and administrators, inside and outside the hospital. It arms departments with efficient access to images and reports to inform every decision, while streamlining insurance claims and coding, monitoring inventory levels, enhancing scheduling and structured reporting and facilitating database management.

At the University of Colorado Hospital—where physicians, clinicians and staff are continually striving to provide high-quality patient care—the Cardiac & Vascular Center is realizing the benefits of an integrated CVIS to streamline clinical and administrative workflow for two cath labs, four peripheral vascular interventional (PVI) labs, two electrophysiology (EP) labs, eight echo labs and three surgery suites.

Prior to the implementation of a CVIS, the Cardiac & Vascular Center was operating with a few homegrown databases within the cath lab and EP labs for structured reporting. The information systems team phased in different modules associated with Lumedx’ CVIS, first purchasing the Apollo Advance clinical data repository, CardioSchedule for electronic scheduling and CardioDoc for physician structured reporting. CardioSchedule was deployed in all interventional areas and clinics first, followed by CardioDoc, Apollo modules and interfaces in cath and EP.

CardioSchedule operates in real-time, working to eliminate scheduling conflicts and double-bookings of rooms, equipment and resources, while offering cath, EP and now PVI new levels of stability, consistency and accountability.

Prior to CVIS, getting clinical data out of the labs and into the EMR had become time-consuming—with reports often showing up two to three weeks after an imaging study was completed. Now, the research hospital runs reports and queries with ease.

“The amount of data you can pull out is phenomenal,” says Becky Schultz, systems analyst, Cardiac & Vascular Center. “If physicians come to me and want to see all our CABGs for male patients over 55, I can pull that data out for them right away. And if we were doing dedicated reports, I’d never be able to do that.”

Additionally, the software module broadens access to other departments, such as transplantation, enabling that department to schedule procedures with the center.

The IS team next set its sights on interventional radiology (IR), which had been managing its par levels through a paper-based system. By implementing CardioInventory, IR now has an electronic log of its IR supplies with the capability to see how much is on hand at a given time or what stock was used in a specific procedure. “We can do data analyses that we were not able to do before,” says Schultz. For example, she can analyze why inventory costs increased and determine whether it is due simply to higher volumes or another cause. “I can tell you at any given moment how much inventory is on my shelf and what the cost is of that inventory,” she adds.

Additionally, by using the Apollo module for billing, the Cardiac & Vascular Center has shortened the billing cycle and opened the door to conducting operational and cost analyses, such as comparing CV billing to what the hospital is billing as a whole. Insurance claims and coding have been streamlined as well, although they haven’t yet analyzed associated cost savings. Coders no longer code by hand, which translates into less staff and fewer coding errors. With the electronic coding and claims drop, the billing window of five days, which was a challenge to meet, has been cut to three days.

“The vision of the hospital is to consolidate data and get everything into an EMR so that it’s instantaneously available to anyone who needs it,” Schultz says. “The hospital wants to get away from siloed information. Our CVIS helps in that we can easily push our data out to the hospital systems—and we can do it quickly, through interfaces, so that it’s automatic.”

More than just a PACS

If CVIS investments enable anywhere, anytime access to healthcare data, which is critical to improving productivity and workflow, cardiology PACS is stepping it up a notch, providing practitioners with more than just images. Delivering information across departments, giving physicians access to tools to view and reporting on patient studies and giving referring physicians access to patient’s records is an important goal that many cardiology departments are striving to achieve, and St. Luke’s Hospital in Chesterfield, Mo., is no different.

The 493-bed, not-for-profit hospital—which offers care in more than 60 specialty areas including cardiovascular care and surgery, cancer care, neurosurgery and neurology—serves the region from 19 locations across St. Louis and St. Charles counties, including five urgent care centers, three Centers for Diagnostic Imaging and a Vascular Access Center, in addition to a new outpatient center.

Initially, the hospital chose PICOMEnterprise cardiology PACS from ScImage because the software provided a way to acquire, manage, distribute and store cardiac cath studies. However, Scott Holtswarth, director of information services, says they quickly started to expand the system’s utility into other projects within cardiology. They integrated echo and cath lab images to minimize IT workload on the backend, while having information and images in one place on the clinical side.

Instead of having a different application across each subspecialty of cardiology, now IT deals with one single log in, instead of four separate ones. Additionally, ScImage worked with St. Luke’s to develop a web-enabled physician portal, where caregivers can go to gather data regarding their patients’ conditions. More than 70 application interfaces have been written through this portal, WebPINS, tying together data from the hospital information system (HIS), laboratory, cardiology, radiology and transcription.

PICOMEnterprise gathers images, information, demographics and reports from radiology, cardiology or any other department, and stores the data in a web-enabled electronic patient folder. Viewing tools for both static and dynamic images are included along with knowledge-based reporting and links to third-party clinical reporting systems. The C-PACS puts out codes or HL7 messaging to a HIS so that system can complete its billing cycle.

“The impact on my workflow has been a dramatic improvement and I am now able to read studies and go through them in a more efficient and timely fashion—probably three to four times as fast—and am able to create a report in a much more efficient and accurate way,” says Anthony C. Pearson, MD, FACC, director of echocardiographic services at St. Luke’s.

The facility is not the only institution looking to get more out of its cardiology PACS. Sentara Healthcare, which operates seven acute-care hospitals with a total of 1,728 beds, nine outpatient care facilities, seven nursing centers, three assisted-living centers and about 360 primary-care and multi-specialty physicians, quickly realized the need to bring a separate, dedicated cardiology PACS into its IT environment to effectively push images across the enterprise.

After investing in Agfa Impax PACS in 2003, Sentara added ProSolv Cardiovascular to manage images and reports for its echo lab. Over the last two years, the healthcare network has rolled out ProSolv Cardiovascular’s reporting and image management capabilities across vascular as well.

“We have Agfa as enterprise PACS and ProSolv manages cardio images and reports but feeds them to Agfa for deep archive. [The] ProSolv [system] acts as the intermediary,” says Chris Nelson, director, cardiac education & technology, adding that the system has decreased the time from image acquisition to final reports to a few hours, which historically had been a few days.

Within cardiology, there is still the need to be able to integrate different packages and systems. Cardiology PACS technology is continually evolving. What started out as just imaging, is now incorporating more reporting capabilities. Nelson says that the systems that are taking off more quickly than others are those that lend themselves to structured reporting, which is possible with ProSolv. “There is this immediacy now that we didn’t have before,” he adds.

Cardiac patient information and data have grown exponentially, bringing about the need for more sophisticated IT tools such as CVIS and cardiology PACS. Together they help to harness data and resources across cardiology’s departmental silos to better and more efficiently distribute it throughout the healthcare enterprise to enable caregivers to treat patients and streamline business operations.