Managing Images & Information Cardiology Style

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When cardiology departments headed toward the digital age with images and patient information in the last decade, following the examples of the other image-intensive department - radiology - seemed like a logical step as the benchmark for how to proceed with cardiology information systems (CIS).

Radiology departments progressed to picture archiving and communications systems (PACS) to store and archive digital images and supplemented the control of workflow within the department - scheduling patients and tracking films and reports within the facility - with radiology information systems (RIS).

What cardiology departments unfortunately found in the early development of image storage, archiving and transmission technology was that cardiologists and caregivers were dealing with cine images with file sizes of 500 megabytes, compared with radiology images in the range of 5 megabytes.

"The biggest thing that is different with cardiology is that the heart is a moving organ," says Tom Feigenbaum, president of CIS vendor Problem Solving Concepts Inc. (ProSolv). "You have moving images, where as in radiology, most of the images - if not all - are still-frame images. There may be many still-frame images, but they are not cine loops or moving images. To determine function, you have to see the heart in motion and that leads to larger file sizes for the captured images."

By 2000, technology began to catch up with cardiology's needs. Computers advanced from 200 megahertz PCs to gigahertz PCs and computer memory (RAM) increased from 128 to 512 megabytes. Standard networks grew to 10 megabytes and then to 100 megabytes to offer more image and data transfer capabilities. All of which converged to help handle cardiology images more efficiently.

"Even in the late '90s, people were asking the question: 'Why can't I just store my cardiology images on my PACS with all the rest of my images?'" recalls Harry Chesnut, cardiology segment manager for Agfa Healthcare. "It just wasn't do-able. Now it is both do-able and feasible."

MARKET OVERVIEW

Cardiology is not only more dynamic and represents a distinctly different patient care model than radiology. But it is newer territory for image and information-based technologies.

"Radiology has been doing this for a while, so it has had time to mature in the market," says Shawn Gibbons, product line manager of image management for IDX Systems Corp.'s ImageCast division. "Cardiology has been doing it, but there are more data sources to input - ECG cards, inventory systems, HIS, procedural medicine systems - and traditionally they have not all been aligned together with communication standards."

In its July 2003 report, market research firm Frost & Sullivan noted that the markets for cardiac catheterization lab and echocardiography PACS are "more developed than the markets for cardiology-wide PACS solutions," with the majority of images generated in cardiology coming from cath lab and echocardiography studies. Because cath labs began converting to digital imaging almost 10 years ago, cath labs, the report adds, "represent a more mature market than echocardiography." Eighty to 90 percent of the cath lab installed base now is digital, with some 10 to 15 percent still using film.

Frost & Sullivan estimates revenues for echocardiography and cath lab PACS in the United States at approximately $118 million in 2002, with projected revenues of $430 million in 2009. Cath lab PACS contributed $72.3 million to the 2002 total, while echocardiography PACS accounted for $45.6 million.

Increasing cardiac imaging procedure volumes and proven benefits of digital imaging are the two primary forces expected to drive growth over the next five years. Cardiologists, the report notes, also have come to realize the operational and economic benefits of digital technology and how the "management of physical CD and videotape libraries is a major cost center for most cardiology departments."

WHY A CIS?

Cardiology is amongst the fastest growing (and cost-generating) departments within a healthcare facility, in terms of new technology and equipment and the creation of larger data sets. Thus, greater capabilities and expanded features of CIS are more in demand.

"The complexity of the [cardiology information] systems has grown tremendously over the last couple of years and the vendors are making a push to have broad cardiology systems with image management as a component and not just an end piece," says Thomas E. Kennedy, PhD, vice