Imagine the backstage of a high school symphonic band concert, ten minutes before the start. This is how imaging modalities are playing together in many cardiology departments today. Interestingly, the larger the institution, the greater the fragmentation and chaos. Your experience sitting in the audience once the concert starts is much different. This is how radiology departments are organized. And in this case, the bigger the institution, the more organized it appears. Why is this and how does one handle the situation from a big picture IT perspective?
Historically, invasive cardiology, for variety of reasons, has claimed the privileged seat at the table. Physicians, nurses and techs have developed a nice workflow centered around Cath Lab imaging and Hemodynamics systems. Manufacturers of these systems have fused required image/info components call this a “CVIS.” Echocardiography claimed the second seat at the table with its huge datasets, abundant measurements and complex reporting statements that are triggered by measurements. Nuclear cardiology claimed the third seat with its own specialized procedures, workstations and reporting. ECG was never given a real seat at the imaging table and they got comfortable in their own little silo. Modalities like Holter monitoring were not even invited to the discussion. Meanwhile multi-modality procedures such as Stress Echo and Nuclear Stress were forced to go into “whatever is available” mode. Vascular Echo shows up sporadically within the cardiology domain. Pediatric echo, congenital heart reporting and such, demand specialized advanced reporting tools. CTA and MRA take us to a totally new discussion on department silos. Instead of sharing the budget, they broke the budget and built their own silos for the right clinical efficacy reasons. Over time, the workflow in cardiology became so fragmented that now no one wants to touch it for concern over making the physicians using these systems unhappy.
With an EMR company there are charges for each HL7 feed on the inbound (Orders or ADT) and for each image pointer and report feed on the outbound. Typically, radiology interfaces require one of each these for a total of four interfaces. Cardiology is much worse because of all the silos. Add professional services fees for implementation and yearly support contracts for these interfaces and then ponder the costs involved in managing different archive destinations and their disaster recovery mechanisms. Consider stability issues with all these moving parts. What if it were possible to consolidate all this without losing clinical efficacy and without making physicians unhappy?
An easy way out is to invite your big iron vendor (or the so called CVIS vendor) to extend their solution to the entire department. They will happily patch together a solution using different products from various acquired companies. The result will be an eloquently sold system that is bulky and inefficient on the inside and nicely dressed on the outside. Financially you are consolidated but technically you are exactly where you stared, with different silos.
Let’s rethink the cardiology imaging and pick a solid foundation (not a patched solution) that has most of what you want and then add the last few missing pieces.
Pick a foundation that can:
- manage all imaging and waveform exams.
- provide single point archive and offsite disaster recovery
- provide complete diagnostic viewing tools accessible from anywhere
- do the job without multiple interfaces for the same info.
- provide Modality Work List for DICOM and non-DICOM modalities
- provide concurrent licenses that are not bolted down to individual workstations
- capture all measurements from Hemodynamics to echo to vascular to ECG
- can provide structured reporting for all your exam types
- can send discrete data to your EMR for Meaningful Use
- seamlessly support external specialty reporting applications
- natively support universal viewing on all device types from anywhere
- support Cath Lab information and inventory management either natively or via third party
- support Registry and accreditation modules
- support 3D echo visualization either natively or via third party
- provide deep integration with quantitative nuclear cardiac software
- provide end to end ECG management natively available
- handle multiple modalities within an exam such as Cath-IVUS, stress echo, nuclear stress
- handle new cardiac modalities such as cardiac CT, CTA and MRA.
- provide a single database to harvest all data points and provide an open platform for Analytics.
Look around. Research what is available and don’t forget to take a look at PICOM365 by ScImage.
We are very confident you will end up with the right imaging strategy for your cardiology department.
