O Pioneers! Cardiovascular Information Systems Workflow & Integration

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Image courtesy of Agfa Heartlab

As a big boom in cardiovascular information system (CVIS) adoption approaches, vendors are gearing up with new offerings, and cardiology departments slightly ahead of the pack install the systems as would-be pioneers in a new frontier.

Like the way of paper charts and VHS tapes for viewing cardiac images, the old way of managing images in a cardiology department are beginning to vanish. But just beginning, for sure.

About “15 to 16 percent of cardiovascular departments have adopted cardiovascular IT systems, if you look at the averages,” says Jeremy Bikman, director, Imaging & Advanced Technology, KLAS Enterprises, which released two CVIS-related market reports in 2005. “That means that they’re storing images electronically and doing documentation electronically,” Bikman adds.

But there can be some confusion as to what exactly they are installing — a cardiology PACS that manages cardiac imaging or a cardiovascular information system that adds tools for patient management and admin tasks. In comparison, radiology PACS adoption rates are much higher — with almost all of large 500+ bed hospitals having shifted to PACS, about half of 200 to 500 bed facilities, and slightly less than half of 200 or less bed hospitals having installed systems.

The adoption gap between cardiology and radiology can be blamed on a number of likely reasons, some of them having to do with the unique culture of cardiology departments which are often much like powerful and influential micro-hospitals themselves. For instance, there are often communications issues between different specialists, and it also comes down to a question of expertise in IT.

“While vendors are struggling to completely live up to their promises, some of it is because cardiologists have not wanted to change the way they’ve done things. We’ve seen the cath lab not really caring or wanting to do what the echo lab guys do,” says Bikman, as an example.

Some departments have to sort out the conflicting approaches and lack of cooperation between each segment of their department in order to move forward with technology. Historically IT has not been that involved in cardiology, and cardiologists themselves do not necessarily have a high level of expertise in IT. The same might not be true of radiologists who are generally pretty IT-savvy.

“Wherein radiology you have people who are somewhat technically savvy, you’ve got radiologic technologists and systems administrators who can become PACS administrators, if needed. In cardiology there really aren’t too many corresponding people within the department” which makes the shift all the more difficult, says Bikman.

A mix of different solutions is another problem. Cardiology departments looking to go digital have to confront the integration of a great number of legacy systems, as well as the struggle of integrating even the newer systems, some of which don’t want to work together either.

“We were surprised by how standalone many cardiology departments are from an IT perspective,” says Bikman. “A lot of the departments were not connected to other systems within the hospital, not even [administration] for patient demographics. They communicate largely by fax or other slower means.”

Yet, despite these hurdles, the cardiovascular information system (CVIS) market is set to boom. KLAS was pressed by a number of organizations and vendors to study the market, which shows the urgency and interest. Meanwhile, large companies are buying up smaller CVIS companies — such as Agfa’s purchase of Heartlab, McKesson’s acquisition of Medcon and Emageon buying Camtronics’ line.

Making it work with few bells and whistles

At the very least, a cardiovascular information system will do a lot to improve a department’s management of digitally acquired images. Comprised of five metro hospitals, and a number of smaller rural facilities, Alegent Health in Nebraska pushes as many as 19,000 cardiology images to its cardiology PACS each year — comprised largely of non-invasive cardiology images such as TEEs (transesophageal echocardiograms), vascular, and x-ray angiography studies, and cine cath lab images.

Since February 2004, they have been gaining many of the advantages from this system that have been seen by countless radiology departments, using Siemens’ KinetDx Cardiology PACS (since renamed syngo Dynamics) to manage images, automate basic reading and reporting of studies, and to allow for enterprise-wide access through a 1 GB network