New, integrated digital archives, multimodality workstations and online reporting tools are bringing radiology and cardiology departments together (really!) to share the benefits and costs of archiving cath lab and other cardiac images.
Many cardiac cath labs are digital archiving pioneers. Most have bypassed the cine film sneaker-net archive scheme and implemented digital archives. The benefits are undisputed and universal. The lost film plague is a mere memory, and images are readily accessible to a variety of specialists. But archiving technology is a rapidly evolving arena, and cath labs are poised to take advantage of the next-generation archiving solutions.
"The next big step in archiving solutions is the shared radiology-cardiology archive. The next-generation archiving solution will be the central digital archive that stores cine films, x-ray images, ECGs and medical records. In theory, the physician could sit at one workstation to view the patient's last ECG, chest x-ray, cine angiogram and history," explains Tim Fischell, MD, cardiologist with Borgess Medical Center in Kalamazoo, Mich.
The technology to realize Fischell's theory is hitting the market. A number of facilities are deploying solutions to implement an integrated archive and enable a single workstation view of the entire digital cardiac patient record. Some sites tap into the integrated archive as an initial step to the larger goal of the digital cardiac record. Regardless of the ultimate goal, for many sites, the cath lab archive is a work-in-progress that hinges on multiple products and interfaces.
The benefits of the integrated approach include anytime/anywhere access to both cath lab and radiology images and patient data, which leads to improved patient care. Hospitals report other gains as costs are reduced because the expense of an enterprise archive and disaster recovery plan are often less than departmental approaches.
Advice from sites on the cutting edge of the cardiac cath lab archiving solutions falls into a few specific areas:
- Develop a vision for the archive and use that to steer the entire process.
- Reporting tools can yield additional gains and may be considered as part of a new archiving solution.
- Anticipate and research integration and interface issues prior to implementation.
- Ensure that the system can be scaled properly to accommodate both radiology and cardiology images.
- Plan with the future in mind. This may mean adding other 'ologies' to the same system.
The cardiac cath lab typically enters the digital archiving arena to extinguish cine film and the associated film-handling problems. Take for example Borgess Medical Center, which deployed OptiMed's archive in its cath lab four years ago. The cath lab archive runs parallel to the radiology archive; the initial cath lab archive eliminated cine film handling and enabled cardiologists to access cath images at OptiMed workstations located throughout the multi-site facility. A one-gigabyte (GB) network facilitates image transmission from the hospital to off-campus buildings. Fischell anticipates additional gains with a combined radiology-cardiology archive that would provide access for modalities such as cardiac ultrasound and MRI and an integrated computer-based medical record accessible from the cath lab workstation.
Other facilities are moving in a similar direction. Edward Heart Hospital and Edward Cardiovascular Institute began implementing Camtronics Medical Systems Vericis for Cardiology archive in September 2003. Mark Goodwin, MD, director of the cardiac cath lab, says the process is shaped by three goals: to enable physicians to access information anywhere in the building; to facilitate efficient digital reading of echocardiograms; and to streamline data collection with structured reporting.
The hospital has met its initial goals. Camtronics' CardioWorks medical record provides access to cath and echo studies, and an interface with the hospital's Meditech EMR enables similar access in the hospital. Digital echo reading has dropped reading time by 50 to 70 percent, and structured reporting allows the site to query data elements such as patients or procedures. Goodwin's sole piece of advice for a smoother implementation centers on structured reporting. He says sites should implement it concurrently with other changes in workflow processes. Because structured reporting doesn't save physicians much time, they can be resistant to learning a new process