Solutions for Managing Cath Lab Data & Images
Today’s cath labs are repositories of much information that will determine hospital standings in terms of quality, physician performance, and profits and losses. All of this information—from images to inventory to hemodynamic data—must be available in real time within—and outside—the enterprise. Cardiovascular Business asked two health systems—one best-of-breed, one single-source—to discuss their cath lab IT strategy.
The Geisinger Heart Institute, with its 40 cardiologists, seven cardiothoracic surgeons and other cardiovascular professionals, annually performs about 4,000 diagnostic caths, 1,900 interventional and 1,175 major electrophysiology procedures. For cardiac data and image management, Geisinger has tended toward being a best-of-breed organization, says Jeffrey Adams, regional administrative director for the cardiovascular service line.
Here’s how it works. The cath lab uses Xcelera (Philips Healthcare) to manage images, Witt Biomedical (now Philips) to collect hemodynamic data, Q-Sight (OM Solutions) to manage inventory and an EHR (Epic). The newest IT solution, a cardiovascular information system (CVIS) from Lumedx, is the departmental epicenter for all these various data. “The CVIS will receive data from other departmental systems, collect data at the point of care and send discreet data to the EHR, which drives disease management and helps to close care gaps,” Adams shares.
While he admits it might be better to have one system handle all image and data needs, he says it’s difficult to find such a system that provides the flexibility to manage a comprehensive cardiovascular program.
The current EHR allows physicians within the organization to access images and reports, as all of the downstream systems, such as the CVIS, CPACs and EKG reporting systems, feed into the EHR. Referring physicians also are able to access the EHR to obtain patient information.
The new CVIS includes the clinical manager application. The Geisinger team has defined reports that will allow them to turn data into information used to monitor outcomes, other quality metrics and ensure operational excellence. These can include fluoroscopy time, case length, room turnover time and cost by case type/physician.
The CVIS also is designed to provide discrete data that assist to define patient populations that are then reliably managed through the use of bundled care metrics in the EHR. These bundles have been developed/utilized to ensure appropriate patients receive optimal medical care and are rolled into practice globally throughout the health delivery network, including acute care, specialty clinics and community practice.
At present, the image management system handles images from echo and cath. Nuclear medicine and CT images reside on the radiology PACS (Philips iSite). Geisinger currently has three Xcelera systems for its health system, but plans to consolidate to one in tandem with an upgrade scheduled for the third quarter. “We want our radiology and cardiology systems to be connected for better coordinated care,” he says.
The upgrade also will allow cardiologists to do Xcelera Telecardiology solution for outreach sites, “which means we can move images to workstations and physicians can read with low bandwidth between facilities.” This solution also will be evaluated for remote access in emergency situations and for remote interpretation.
Four years ago, Geisinger implemented ProvenCare for elective CABG, which promises the completion of 40 key processes for every patient. The key processes include a pre-admission documentation of the indication for CABG (according to guidelines), operative documentation that the patient received the correct dose of beta-blockers, and post-operative documentation of antibiotic administration for 24 and 48 hours. The program has since expanded to include PCI, while one for ICDs is in the planning stages. Each key process is recorded in the EHR, which can be mined to ensure compliance with the program, Adams says.
From a clinical information perspective, Peninsula Regional has chosen a variety of McKesson products. Within cardiology, the department uses the Horizon Cardiology CVIS (McKesson). “That provides us with both PACS and departmental reporting capability within the cath lab and the echo department,” says CIO Raymond W. Adkins. The capability to store and access nuclear medicine images in the CVIS will soon be available.
The cardiology department is in the planning stages to migrate from the current hemodynamic system to Horizon. The interoperability between the current system and Horizon is functional, but not optimal, Adkins says. “We have talked with facilities and made comparisons with integrated hemodynamic systems versus those that are interfaced like ours. We made the determination there is value from a workflow perspective and operational support perspective to have the integrated hemodynamic system.”
The value of which Adkins speaks is primarily having all cath lab data—including inventory, images and hemodynamics—available immediately as part of the final report. The current interfaced model slows that process down slightly, compared with the integrated model. He expects the migration to be completed by the end of the year. One reason why the implementation will take six to eight months is because it is being done in conjunction with a CVIS upgrade.
“From our view, we have valued the single-source model over best-of-breed model. At each opportunity for change, we evaluate the pros and cons of the systems. But from an enterprise perspective, we’ve tended toward the single-source model,” Adkins says.
Peninsula Regional also uses a portal (through McKesson) by which hospital physicians and staff, as well as outside referring physicians, can access images and data. They can do this through the cardiology PACS or the radiology PACS (Horizon Medical Imaging). Another application allows other facilities to share images with Peninsula Regional. This hosted server (a utility from McKesson) allows providers in outlying facilities to upload images so they can then engage in consultation with physicians from Peninsula Regional. “We are a referral center and these other facilities might need a second opinion from a cardiologist or surgeon before sending a patient to us,” Adkins says.
Cardiology has come a long way regarding its ability to electronically store and retrieve data and images. Gone are the days of silos of information that couldn’t be interconnected. In today’s cath lab, it is imperative to have IT systems in place that can robustly collect data, connect those data with images, and send any or all of it out to other parts of the enterprise or to outlying facilities. The ideal systems, whether best-of-breed or single vendor, should be scalable and able to grow with the organization. They should boost productivity and help maintain quality, for individuals as well as the hospitals at large.
Geisinger Health System
Geisinger Health System is an integrated health services organization widely recognized for its innovative use of the EHR and the development and implementation of innovative care models. The system serves more than 2.6 million residents throughout 42 counties in central and northeastern Pennsylvania.The Geisinger Heart Institute, with its 40 cardiologists, seven cardiothoracic surgeons and other cardiovascular professionals, annually performs about 4,000 diagnostic caths, 1,900 interventional and 1,175 major electrophysiology procedures. For cardiac data and image management, Geisinger has tended toward being a best-of-breed organization, says Jeffrey Adams, regional administrative director for the cardiovascular service line.
Here’s how it works. The cath lab uses Xcelera (Philips Healthcare) to manage images, Witt Biomedical (now Philips) to collect hemodynamic data, Q-Sight (OM Solutions) to manage inventory and an EHR (Epic). The newest IT solution, a cardiovascular information system (CVIS) from Lumedx, is the departmental epicenter for all these various data. “The CVIS will receive data from other departmental systems, collect data at the point of care and send discreet data to the EHR, which drives disease management and helps to close care gaps,” Adams shares.
While he admits it might be better to have one system handle all image and data needs, he says it’s difficult to find such a system that provides the flexibility to manage a comprehensive cardiovascular program.
The current EHR allows physicians within the organization to access images and reports, as all of the downstream systems, such as the CVIS, CPACs and EKG reporting systems, feed into the EHR. Referring physicians also are able to access the EHR to obtain patient information.
The new CVIS includes the clinical manager application. The Geisinger team has defined reports that will allow them to turn data into information used to monitor outcomes, other quality metrics and ensure operational excellence. These can include fluoroscopy time, case length, room turnover time and cost by case type/physician.
The CVIS also is designed to provide discrete data that assist to define patient populations that are then reliably managed through the use of bundled care metrics in the EHR. These bundles have been developed/utilized to ensure appropriate patients receive optimal medical care and are rolled into practice globally throughout the health delivery network, including acute care, specialty clinics and community practice.
At present, the image management system handles images from echo and cath. Nuclear medicine and CT images reside on the radiology PACS (Philips iSite). Geisinger currently has three Xcelera systems for its health system, but plans to consolidate to one in tandem with an upgrade scheduled for the third quarter. “We want our radiology and cardiology systems to be connected for better coordinated care,” he says.
The upgrade also will allow cardiologists to do Xcelera Telecardiology solution for outreach sites, “which means we can move images to workstations and physicians can read with low bandwidth between facilities.” This solution also will be evaluated for remote access in emergency situations and for remote interpretation.
Four years ago, Geisinger implemented ProvenCare for elective CABG, which promises the completion of 40 key processes for every patient. The key processes include a pre-admission documentation of the indication for CABG (according to guidelines), operative documentation that the patient received the correct dose of beta-blockers, and post-operative documentation of antibiotic administration for 24 and 48 hours. The program has since expanded to include PCI, while one for ICDs is in the planning stages. Each key process is recorded in the EHR, which can be mined to ensure compliance with the program, Adams says.
Peninsula Regional Medical Center
On the other end of the spectrum is Peninsula Regional Medical Center in Salisbury, Md., which relies almost solely on a single-vendor solution for cardiovascular department image and information management. Peninsula Regional is a 360-bed tertiary care facility serving the Delmarva Peninsula, which comprises parts of Delaware, Maryland and Virginia. The cath lab averages about 3,000 diagnostic and interventional procedures a year. There are 20-plus cardiologists serving the Guerrieri Heart and Vascular Institute.From a clinical information perspective, Peninsula Regional has chosen a variety of McKesson products. Within cardiology, the department uses the Horizon Cardiology CVIS (McKesson). “That provides us with both PACS and departmental reporting capability within the cath lab and the echo department,” says CIO Raymond W. Adkins. The capability to store and access nuclear medicine images in the CVIS will soon be available.
The cardiology department is in the planning stages to migrate from the current hemodynamic system to Horizon. The interoperability between the current system and Horizon is functional, but not optimal, Adkins says. “We have talked with facilities and made comparisons with integrated hemodynamic systems versus those that are interfaced like ours. We made the determination there is value from a workflow perspective and operational support perspective to have the integrated hemodynamic system.”
The value of which Adkins speaks is primarily having all cath lab data—including inventory, images and hemodynamics—available immediately as part of the final report. The current interfaced model slows that process down slightly, compared with the integrated model. He expects the migration to be completed by the end of the year. One reason why the implementation will take six to eight months is because it is being done in conjunction with a CVIS upgrade.
“From our view, we have valued the single-source model over best-of-breed model. At each opportunity for change, we evaluate the pros and cons of the systems. But from an enterprise perspective, we’ve tended toward the single-source model,” Adkins says.
Peninsula Regional also uses a portal (through McKesson) by which hospital physicians and staff, as well as outside referring physicians, can access images and data. They can do this through the cardiology PACS or the radiology PACS (Horizon Medical Imaging). Another application allows other facilities to share images with Peninsula Regional. This hosted server (a utility from McKesson) allows providers in outlying facilities to upload images so they can then engage in consultation with physicians from Peninsula Regional. “We are a referral center and these other facilities might need a second opinion from a cardiologist or surgeon before sending a patient to us,” Adkins says.
Cardiology has come a long way regarding its ability to electronically store and retrieve data and images. Gone are the days of silos of information that couldn’t be interconnected. In today’s cath lab, it is imperative to have IT systems in place that can robustly collect data, connect those data with images, and send any or all of it out to other parts of the enterprise or to outlying facilities. The ideal systems, whether best-of-breed or single vendor, should be scalable and able to grow with the organization. They should boost productivity and help maintain quality, for individuals as well as the hospitals at large.