Call nights are by far the worst part of being a clinical cardiologist. I love what I do during the day, but on weekends where I am taking clinical calls for my 6-man (one woman) cardiology group, as well as covering weekend echo and TEE for my hospital, the stress can be high.
With the advent of efficient cardiac PACS, however, many of the stressful elements have gone away; in particular, the ability to remotely read and report on cardiac imaging studies has revolutionized my workflow. Now the need to get in my car and drive to the hospital to view studies has been eliminated. Leaving the hospital is no longer dependent on all work being completed.
On a recent Friday evening on a call weekend, my Eternal Fiancée insisted that we go to Oceano for happy hour. Oceano is a Clayton, MO seafood restaurant which has arguably the finest happy hour in the Western World. In the Dark Era preceding EHR and online PACS, this would have been out of the question.
As we were walking out the door, endeavoring to reach Oceano before happy hour ended, the sonographer on call texted me that he was going in to perform a STAT echo on an ICU patient to rule out pericardial effusion. In the Dark Era this would have been devastating. The Oceano visit would have been canceled and I would have had to drive in to the hospital.
When I started at St. Luke’s 10 years ago, our cardiac Cath lab stored their Cath films on ScImage’s PICOM365 Enterprise PACS, and we have subsequently added echo, vascular, ECG, stress and Holter storage and reporting. I can easily access any patient study, no matter the discipline.
The first time I read an on-call STAT echo using PICOM365 Cloud technology on my iPad in a restaurant, my mind was blown. It was as if a heavy weight had been lifted from my call duties.
Now, ten years later, I’m eating Oceano’s delicious Blackened Big Eye Tuna (rolls of ahi tuna filled with radish, shiitake mushrooms, pickled ginger, and scallions with spicy mustard sauce) when the sonographer texts me that the STAT echo is ready and that he is concerned about a pericardial effusion. I had brought my MacBook Pro with me (yes, hospitals have finally figured out that doctors often use Macs), so I logged into PICOM365.
As I pulled up the STAT echo, the loops could be viewed in real-time and I could rapidly step through them to determine that this patient had hyperdynamic LV function, no significant valvular abnormalities, normal Doppler and no pericardial effusion. The echo-free space around the LV was not an effusion, just a prominent fat pad (more properly termed epicardial adipose tissue (EAT)).
An echo and report on this patient from 6 years ago were automatically pulled up and available for me to review and I could see within a few mouse clicks that the prominent epicardial adipose tissue was present in 2012, thus solidifying my diagnosis.
I finished my last bites of ahi tuna appetizer and turned my attention to reporting out the echo. Fortunately, the drudgery and inefficiency of Dark Era telephone dictation is long gone. The true beauty of my current system is how automated and personalized my reports are. One of the joys of working with ScImage is that I have been able to craft templates for our lab’s echo reports that are exactly what I want. In addition, since the vast majority of a report comes from template-generated comments we have created ourselves, the reporting is consistent and complete no matter which of the 15 cardiologists (with wildly varying styles) reads the echo.
Contributing to this standardization of reporting between cardiologists, and to easing the reporting time burden, is something ScImage calls “evidence-based reporting.” In the Dark Era (and in many labs to the present day) cardiologists would make subjective interpretations of the size of the cardiac chamber, the function of the ventricles and the severity of valvular disease. This created huge inconsistencies in interpretation.
In my lab we emphasize precise measurement of these crucial cardiac parameters; using the sonographer-generated measurements, and a range that we specify for each parameter (using ASE guidelines), the report is automatically populated with the corresponding appropriate statement. For example, the echo I was reviewing had a left atrial volume index of 35 (just over the upper limits of normal). “Mild left atrial enlargement” was already present in my report, along with the correct description of LV and RV size and function as well as RA size.
Thus, with a few clicks, I had completed the report between bites of the truffle chicken chanterelle flatbread (beurre fondue, grilled chicken, chanterelle mushrooms, parmesan, truffle oil) the Eternal Fiancée had just ordered.
As we were settling the bill, I received a page: I was being consulted on a 92 year old man (Mr. Card Infarct) in the ER with chest pain and elevated troponins. In the Dark Era, the only information I would have available to me would be what the nurse or ER doctor on the phone told me. If they were ill-informed or English-challenged, a trip to the hospital likely would be necessary.
In 2018, fortunately, while sitting at the Oceano bar, I can review my partner’s office notes on Mr. Infarct and review everything that has been done on him (CABG 2015, stent 2017, ICD 2017) in our hospital’s system. Since our cardiology PACS has all modalities viewable in one list from one log in, it is a very simple matter for me to review Mr. Infarct’s last catheterization, his last echo and compare his prior ECGs to the current one. Within 5 minutes I pretty much am armed with everything I need to know about Mr. Infarct in order to best handle his case. When I call the ER, I can easily process the information the ER doctor gives me about his presenting signs and symptoms and develop a plan.
Life for this on-call cardiologist is good. It’s more normalized here in the Digitally Enlightened Era. I’m no longer shackled to the hospital. And I can enjoy excellent appetizers in a convivial environment without (excess) guilt or anxiety.
Anthony Pearson, M.D.,
is medical director of the echocardiography laboratory at St. Luke’s Hospital in Chesterfield, MO. He blogs about cardiovascular disease at theskepticalcardiologist.com.
WVU Medicine Deploys Cloud-Based CVIS to Expand Access throughout West Virginia using PICOM365’s Remote Imaging and Consultation Capabilities
WVU Medicine is Making a Change
West Virginia residents experience disproportionately high instances of cardiovascular disease in comparison to other states, with greater than 40 percent of adults suffering from hypertension and only two out of 10 adults receiving screening for cardiovascular risks. These statistics, coupled with a shortage of healthcare professionals, provide West Virginia with a unique opportunity for innovation and improvement in the detection of latent cardiovascular disease.
“Our goal is to use advanced cardiac visualization and imaging management technologies to detect the early stages of the disease and improve patient care,” said Partho Sengupta, MD, Professor and Chief of Cardiology and Chair of Cardiac Innovation at West Virginia University. “ScImage’s Cloud-based enterprise imaging solution for cardiology is helping us expand access to high-quality cardiovascular care throughout West Virginia. PICOM365’s availability allows remote imaging and consultation so patients can receive services wherever they live.”
WVU Medicine has deployed ScImage’s PICOM365 Enterprise PACS at the Heart and Vascular Institute for integration throughout the entire WVU Medicine infrastructure which is anchored by a 645-bed academic medical center and includes four community hospitals, three critical-access hospitals and a children’s hospital.
ScImage’s PICOM365 is a fully-realized Cloud PACS solution offering a resilient computing infrastructure securely accessible from anywhere utilizing high availability technologies with end-to-end redundancy. Far beyond one instance serving one institution, geo-redundant storage systems with multi-petabyte scalability have the power and flexibility to leverage massive bandwidth for maximum data throughput to simultaneously serve thousands of institutions. PICOM365’s secure end-to-end imaging and reporting workflow feature real-time advanced threat analytics along with data encryption at rest and in transit. Additionally, full IT and medical device regulatory compliance capability eliminates all barriers to entry, allowing full functionality with ease.
“ScImage has an excellent solution to support our non-invasive cardiology needs for a project of this scale (advanced reporting capabilities, remote work and full integration with Epic, etc.). With PICOM365, we can make a remarkably positive impact on patient care in West Virginia,” said Jim Venturella, CIO WVU Medicine.
The Cloud: Disruptive Innovation that Supports a New Age of Caring
PICOM365 delivers secure cardiovascular image management, viewing and reporting capabilities to all cardiology modalities (Cath, Echo, Vascular, Nuclear, Stress, Holter and ECG Management) on a seamless viewing platform, providing WVU Medicine the full benefit of an on-premise solution in a “pure Cloud” offering.
“This comprehensive Cloud solution allows seamless integration of imaging and full workflow customization to meet our specific exam interpretation requirements while empowering physicians to review and report from anywhere. This is a disruptive innovation that supports a new age of caring for patients using automation and speed to provide better and more cost-effective care,” added Dr. Sengupta.
ScImage and WVU Medicine, leaders in forging predictive solutions to improve patient care and increase physician efficiency, have worked to optimize structured reporting, with advanced ASE-evaluated measurements and sectional reporting among other productivity enhancements. ScImage’s inclusion of full Epic integration providing discrete data, image links, encapsulated PDFs and diagnostic view-and-report capability creates a fluid EHR interaction. Added flexibility to control the presentation of the final report, the by-product of the diagnostic procedure, improves the referring clinician experience.
Grace Verzosa, Assistant Director of Cardiovascular Imaging at the Heart and Vascular Institute, stated the ability to customize the workflow was critical. “To enable our physicians to read current and prior studies and report with maximum efficiency, we needed the freedom to develop our workflow recipe, including customizable hanging protocols, tight integration with quantification and visualization software tools in a consistent SR platform across all cardiology disciplines.”
ScImage’s open SQL database maintains the quality of images and patient data in its native format to access, run reports, pull priors and customize pre-fetching rules. Full reporting capabilities via VR, transcription and Macros enables automated report generation; and, as technologists enter measurements from echo exams, PICOM365 auto-populates preliminary reports using the most current ASE guidelines.
“Not only is the reporting process more efficient, but it also reduces the need for fellows to conduct preliminary reads and has reduced our report turnaround times,” said Verzosa. “PICOM365 has also provided many quality enhancements. For example, I can review studies offline at any time and correct inaccurate measurements for the final report. Additionally, the configurable “To-Do List” includes a reporting checklist, which ensures that reports are completely finalized, assuring a more accurate diagnosis and complete billing.”
Making a Difference in Population Health
The WVU Heart Center Innovation Lab is known for pursuing new technology and methods to increase population health. Dr. Sengupta noted, “Advanced imaging and visualization tools have made tremendous strides in improving the diagnostic process. However, inequality in access to these tools remains, and that is where the automation and speed of Cloud-based imaging technology are so important; improved access leads to better patient care and, ultimately, better outcomes.”
Sai Raya, PhD, founder and CEO of ScImage explained, “as Cloud PACS have become more popular, their true definition has become more dubious. With so many companies offering so many Cloud PACS, differentiating between competitors can be difficult, leading to the misconception that simply moving servers from an on-premise cabinet to a commercial data center is a sufficient solution to storing vital data. This is not a solution; this is a single point of failure.” WVU, upon careful consideration of all options, determined a pure Cloud solution to be the most effective pathway to improved health access and outcomes for West Virginians.
“By leveraging Microsoft Azure technologies, ScImage utilizes the industry’s most advanced Cloud security and encryption technologies allowing us to focus on providing the best care through remote imaging and consultation without worrying about security. ScImage brings industry-leading technology to the table as well as the positive outlook necessary to move innovation from ideas to real solutions,” concluded Dr. Sengupta.