The intricacy of the business of medicine mandates that leaders pay attention to the smallest details of every aspect of cardiovascular treatment and care. While the articles in this issue span the gamut of cardiovascular imaging, informatics, and management, they have one thing in common: they drill down into the fundamentals of good business practices and sound financial planning.

Gone are the days when vendor reps made deals with fifth-level personnel based on a presumed need to replace a piece of equipment because of its years in service. Today, these decisions are made in concert with high- and mid-level executives, and each decision undergoes intense scrutiny.

As you’ll read in our cover story, hospital CEOs will hold off making some purchasing decisions as long as they can, keeping a watchful eye on evolving technology—such as cardiac CT—even as the bricks and mortar are drying in their new heart centers. Being an early adopter of cutting-edge technology certainly has its advantages—you can be the first in your market to differentiate yourself. But it also has a downside—you can be left with an outdated piece of equipment as the technology evolves. In the case of cardiac CT, there are many more aspects that must be considered and we cover them all.

Choosing the right options to pay for new technology also takes savvy. We explore the pros and cons of various financial arrangements, be they lease versus purchase or joint ventures. Each practice has to choose the right fit for its size, demographics and location.

Information management systems purchases are elevating in frequency, undergoing close scrutiny from the top down. In this issue, you’ll learn some of the finer aspects involved in choosing an electronic health record, as well as how to successfully integrate digital echo images into your image management system.

Finally, while a strong case can be made for the integration of cardiac CT into the cardiology practice, the same cannot be said as forcefully about SPECT/CT. Why? Reimbursement plays a big part, but another concern is the lack of outcomes data. How this will change in the near future remains to be seen. It’s one more aspect for you to be aware of as you sort through the complexities of offering modern cardiovascular care.