The Integrated Cardiology Enterprise

Cardiology is an increasingly complex imaging and IT-intense specialty. Hospitals are grappling with multiple new demands and challenges. Digital imaging and digital image management have become the mainstay of the 21st century cardiology department. PACS solutions such as Siemens Medical Solutions syngo Dynamics (formerly KinetDx) help cardiologists manage data, increase efficiency and improve patient care.

Alegent Health in Omaha, Neb., has tapped into an array of Siemens imaging and IT solutions to improve operations, workflow and patient care across five of its hospitals and multiple outpatient sites. syngo Dynamics serves as the anchor of the highly integrated cardiac imaging, reporting and distribution systems.

Cardiology image & data management

Alegent Health first deployed syngo Dynamics at Bergan Mercy Medical Center in February 2004. Initially, the project incorporated four workstations. In the last three years, however, it has grown, and now five of the healthcare system’s nine hospitals have deployed syngo Dynamics. Users rely on nearly 30 hospital-based workstations, and the healthcare system plans to add off-campus workstations later this year. One of the health system’s primary cardiology providers — Cardiovascular Specialists — also deployed the same PACS, syngo Dynamics, at its offices. In addition, syngo Dynamics is integrated with Soarian, Siemens’ healthcare process management solution, so results are available via the electronic medical record. Over the last several years, Alegent Health has worked closely with Siemens to optimize its systems and tap into all potential benefits of Siemens solutions including enhanced quality, more efficient workflow and improved patient care.

Alegent Health has employed relatively similar implementation schedules at each syngo Dynamics site. The project is tackled in stages, beginning with echocardiography. The next steps focus on vascular ultrasound and cardiac catheterization. The transition from video to digital has been completely positive, says Steve Brown, manager of Heart and Vascular Institute at Bergan Hospital.

“syngo Dynamics has helped the physicians to become much more efficient,” says Jeff Bro, syngo Dynamics system administrator, “because they can read studies from any campus.” For example, a Lakeside Hospital-based cardiologist can interpret an echo acquired across town at Mercy Hospital. The universal availability of images is a significant benefit particularly with cardiac cath studies, says Brian Halpenny, manager, cardiovascular services at the Heart and Vascular Institute at Lakeside Hospital. “Surgeons can call up studies in the OR [over the web via PACS] after the study has been completed in the cath lab.”

The integrated cardiac system easily facilitates cross-campus consultations between cardiologists and surgeons. It eliminates the time, expense and hassle of copying film studies. If a patient undergoes a catheterization at a site that does not offer cardiac surgery, the cardiologist can phone a colleague at another site to discuss the appropriate intervention as they each view the images on workstations. If the patient is transferred for surgery, all necessary data and images are easily available at the receiving site.

Digital eliminates video tape for echocardiography study review, which yields fairly dramatic gains for cardiologists. “We can do a better job of interpreting studies because we don’t need to rewind and go back and forth with digital studies. In addition, we can complete precise online measurements,” explains Randy Pritza, MD, a cardiologist with Cardiovascular Specialists, an Omaha-based practice that cares for Alegent’s cardiac patients. Prior to PACS, cardiologists could measure structures, but the manual process was more time-consuming and less exact. “Reading a study on video tape takes three times longer than interpreting a digital echocardiogram, leaving cardiologists with more time for patient care and other tasks,” reports Pritza.

syngo Dynamics also makes it much easier for physicians to compare serial studies side by side. What’s more, the system recognizes when a patient has had a prior study. In these cases, PACS recalls the previous echo, which greatly streamlines the comparison process.

PACS also enables multi-modality comparisons. That is, a cardiologist can view echocardiography and catheterization images side by side to determine if the coronary angiography results correspond to echo images — driving more informed clinical decision-making.

Cardiologists also use the syngo Dynamics system for echocardiography and vascular reporting, creating structured reports. Echocardiography report turnaround time has dropped to less than eight hours since deploying syngo, says Bro. In addition, reports are automatically distributed to referring physicians. “It’s practically instantaneous,” notes Bro. Because Alegent Health integrated syngo and Soarian, physicians on the hospital floor can access the report on Soarian. “It’s a major selling point,” states Brown.

The workflow benefits associated with cardiology PACS extend beyond the image interpretation and reporting process. Take for example the Heart and Vascular Institute at Lakeside Hospital. The center completes 1,500 to 2,000 non-invasive studies and 450 cardiac catheterizations annually using an array of Siemens systems such as the Acuson Sequoia 512 echo systems, AXIOM Artis flat-panel angiography systems and a Sensis hemodynamic monitoring system that is interfacing with syngo Dynamics.

The inpatient order process is fluid, says Halpenny. After a provider places an order, the hospital information system generates demographic information onto the angiography system or echo cart, and the tech pulls up the information up with the study list. After the tech completes and downloads the study, he or she sets up a preliminary report in syngo Dynamics. Next, the physician reads the study, and creates and finalizes the report. An electronic copy of the results is sent to Soarian, and results are auto-faxed to referring physicians.

The process is relatively similar for cardiac catheterizations; however, cardiologists dictate reports instead of using the report generating function in syngo Dynamics.

Bro points to other benefits of modality worklist. Techs receive study orders pre-populated with patient demographic data, so they don’t need to enter data by hand. “Modality worklist labels studies automatically, which dramatically reduces human error,” notes Bro. “It keeps patient demographic data clean and saves time for technologists.”

Beyond the integrated enterprise

The integration process at Bergan Mercy Medical Center is relatively young, but the hospital has moved rapidly into the digital era. The Heart and Vascular Institute is comprised of four distinct business units: cardiac catheterization, congestive heart failure, non-invasive diagnostic imaging and cardiac and pulmonary rehabilitation. One of the three cardiac cath suites is equipped with Siemens AXIOM Artis bi-plane angiography system, and images are digitally archived on syngo Dynamics. The non-invasive diagnostic imaging department is equipped with Acuson Sequoia ultrasound systems; images are stored on syngo Dynamics. Additional ultrasound and x-ray equipment completes the imaging inventory.

“It’s a relatively new development in the cardiac cath lab,” says Tim Nelson, RRT, MBA, operations director, Heart and Vascular Institute, Bergan Mercy Medical Center. Prior to syngo Dynamics, Bergan had deployed a stand-alone cath lab archive. Although digital storage did deliver some gains, physicians could access images only at specific workstations. syngo Dynamics improves upon the digital storage model. Physicians can access images throughout all of the hospitals either on Soarian or through web-based enabled PACS. And since Cardiovascular Specialists equipped its offices with syngo Dynamics, the reach of the system is multiplied. Cardiologists can view studies from all sites, and when a patient undergoes an echocardiogram in the office, images are stored in syngo Dynamics and available across the Alegent Health enterprise.

siemens1aKwin Moran, RN, works in the control room of the Siemens Axiom Artis cath lab at Bergan Mercy Medical Center, one of Alegent's nine hospitals. The syngo Dynamics deployment at Bergan Mercy Medical Center has benefited clinical business units as well. Take for example the congestive heart failure unit. The hospital must obtain a left ventricular ejection fraction on each patient to meet Centers for Medicare and Medicaid Service (CMS) and Joint Commission on Accreditation of Healthcare Organizations (JCAHO) core measure requirements. The hospital can use a recent echo to provide the measure; techs can easily gather the results from syngo Dynamics and add them to the patient chart. “The process is streamlined. We can avoid the time and expense of an additional study in some cases,” explains Nelson.

Alegent Health has tapped into additional quality improvements via PACS. The system streamlines data mining, says Pritza. For example, the practice might pull up all aortic stenosis cases in one month. During a monthly meeting with staff and physicians, the team reviews the cases and re-educates staff. Similarly, the practice might examine all positive stress echos and compare findings with cath lab results to determine if results correlate. The next step, says Pritza, is quality improvement on false positive and false negative stress echo studies.

Other results center on costs. For example, the hospital saves approximately $35,000 on annual film printing expenses in the vascular lab with syngo Dynamics. “The system saves time for techs and cardiologists,” reports Nelson.

A foundation for success

Implementing digital cardiology workflow processes delivers significant benefits in multiple areas including quality and patient care. It is, however, a complex, multi-faceted project. Alegent Health shares its experiences with others embarking on the process.

The physician is a key player. Involve physicians in the process, says Nelson. “They have to feel comfortable with the product and the user interface.” A physician champion is essential, adds Bro.
Expect the report template design process to take time. Alegent Health uses report templates for echo and vascular studies. The structured reporting process boosts workflow and delivers standardized results, but there is a hefty upfront time commitment. It takes some time for cardiologists to agree on terminology for standard reports. According to Nelson, the design process took about four months at Bergan Mercy Medical Center. Sites can ease the process by beginning template design prior to implementation, says Bro.
Evaluate imaging systems and IT-readiness. Modalities must be DICOM-compliant to interact with syngo Dynamics. Alegent Health decided to leave one cath lab non-DICOM because the cost of the upgrade outweighed the benefits. Don’t overlook the archive and network as they play a critical role in the speed and reliability of the project.
Determine a reporting process. If it relies on HIS integration, evaluate the system to ensure that it meets the site’s needs.
Invest in a test server. A test server has been key to the project’s success at Alegent Health, says Nelson. The enterprise invested in a test server that is used to test software, upgrades and interfaces before going live.
“Determine site needs and goals, and communicate them with the vendor to ensure that all participants are on the same page,” concludes Brown.

Future directions

The collaboration between Alegent Health and Siemens Medical Solutions is an ongoing process.

The Alegent Health enterprise envisions deeper integration between radiology and cardiology, too. The healthcare system is laying the foundation for this endeavor via the strategic alliance with Siemens, deployment of syngo Imaging and syngo Dynamics and unified back-end archive via EMC Corporation’s CLARiiON networked storage system. Alegent Health hopes to deploy the one-stop shop approach in cardiac reporting too, and use syngo Dynamics for cardiac cath lab reporting.

Power in integration

Integrated digital solutions can pack a powerful punch across cardiac care. Well-deployed and integrated solutions boost efficiency and workflow, improve quality and patient care and trim costs. Sites can maximize the benefits of a project by analyzing their needs and infrastructure and evaluating various vendors. Opting for a collaboration approach carries additional benefits as a collaborator can help guide the strategic direction of the project.

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Lisa Fratt