Time to think about how C-PACS/CVIS fit into hospital-wide EHR

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C.P. Kaiser, Editor

A review of this month's Journal of the American Medical Informatics Association indicates the pervasive use of informatics systems in healthcare, as well as the niche challenges. As cardiology departments refine their cardiology PACS and cardiovascular information systems (CVIS), and integrate them into the larger hospital-wide EMR/EHR, they would be wise to note potential problem areas with informatics implementation and their solutions.

Research by Joseph L.Y. Liu, MSc, and colleagues from the U.K. indicates the growing importance of clinical information systems. Liu et al present the evidence for randomized controlled trials (RCTs) to assess the impact of clinical information systems.

They noted that skeptics of this idea say the RCT is irrelevant in this context because information systems are "fundamentally different from drug interactions."

But Liu and colleagues argued that the "shift to evidence-based policy and the need to demonstrate the cost-effectiveness" of these systems should signal an "urgent need to promote the use of RCTs."

They concluded that RCTs might not be the perfect evaluation method, but they should "form an important part of an evaluator's toolkit."

Dr. Tracy Ann Sykes from Australia, and colleagues from the U.S. emphasized the importance of using a multidisciplinary approach to explain EMR system use and consequent performance among physicians during early stages of its implementation.

Tracy and colleagues used satisfaction surveys from 151 physician and more than 8,000 patients over the course of one year during the implementation of an EMR.

Physicians indicated they were better connected, both directly and indirectly, to other physicians. The researchers found these key factors that predicted EMR system use: social network ties, demographic characteristics (gender and age), three personality characteristics (openness to experience, agreeableness and extroversion) and the perceived usefulness of the technology.

They concluded that these factors that influence a physician's use of EMR systems "can be used to develop interventions and applications that can increase physician buy-in and use of EMR systems."

Finally, Dr. George Hripcsak, from Columbia University Medical Center in New York City, and colleagues found that care providers spend a significant amount of time viewing and authoring notes in the EHR. However, many notes are never read. About three-fourths of healthcare teams included a nurse, an attending and a resident, and those three user groups were the first to write notes during an admission.

Researchers found that users spent between 20 and 103 minutes per day authoring notes and between seven and 56 minutes per day viewing notes, with physicians spending less than 90 minutes per day total.

About 16 percent of attendings' notes, 8 percent of residents' notes, and 38 percent of nurses' notes went unread by other users, and, overall, 16 percent of notes were never read by anyone.

The older the note, the less it was read; however, notes were still read two years out, they found.

As research from IMV Medical Information Division has found, the implementation of C-PACS has grown from about 50 percent four years ago to 80 percent today. Some cardiology departments have C-PACS without CVIS, some have totally integrated systems. While cardiology departments are making strides with its information storage and retrieval, they also have to think of the larger picture: how those systems fit into hospital-wide EMRs/EHRs. In the long run, that will be the game changer.

C.P. Kaiser
Editor of Cardiovascular Business
ckaiser@cardiovascularbusiness.com