Integrated Cardiac Records Drive Efficiency

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PACS and RIS have helped radiology departments improve efficiency, integration and workflow. Now, those same efforts are going into cardiology departments—a bigger challenge but with, perhaps, even more to gain.

Cardiology is where radiology was about five years ago, says Joseph Marion, an independent consultant and principal of Healthcare Integration Strategies. While PACS was originally viewed as an image management solution, users eventually realized it was really an integration of images into the rest of the workflow. “The same thing is now starting to happen with cardiology, but because there are so many different players and systems, it’s a bit more of a challenge.”

For one thing, cardiology workflow is much different than radiology workflow, he says. Cardiologists have a much more integrative interpretation process that often includes multiple imaging study results. Reliably getting hemodynamic data and associated images into a common viewing and reporting environment is a process still in the works.

Creating a cockpit

Tri-City Medical Center, a 397-bed district hospital in Oceanside, Calif., is in the preliminary stages of accomplishing that by working with McKesson Provider Technologies, says Donald Dawkins, RN, cardiovascular service line administrator. The goal is to eliminate the cumbersome process of viewing separate applications and put all relevant information into a single ”cockpit” (also called a “dashboard”) so that cardiologists have everything they need in front of them.

“As soon as they complete a procedure, the system creates a final report that is faxed directly to the referring physician and into the electronic medical record,” Dawkins says. “We’re moving into a much more automated process to get all of our processes paperless.”

Tri-City’s cardiovascular services growth has been consistent year over year. The facility has one each 64-slice, 8-slice and single-slice CT scanner, two cath labs, two echo rooms, four nuclear cameras and four ultrasound rooms, several interventional radiology suites, two 1.5T MR machines and a strong PET/CT program. The facility is looking at implementing 3T MR and moving into cardiac MR next year and upgrading to a 256-slice or a dual-source CT scanner. “Part of our advantage is that we are so cutting edge and can move rapidly,” Dawkins says. “Administration recognizes the power that our imaging has for referring physicians. They have a clear understanding that they want to keep funding imaging because it really drives volume.”

Cardiovascular services aren’t necessarily in a traditional orders-driven environment, says Steven Young, director of cardiovascular services for Tri-City. “When you want to automate and tie in images, it’s very challenging because there isn’t the infrastructure in the HIS [hospital information system] or RIS [radiology information system] to really drive cardiovascular services through the order process.” He’s leveraged the facility’s RIS to make cardiovascular procedures part of the ordering system. Now everything is structured by date of service, time and results, along with radiology services, and available in one location. Clinicians can see CT, MR, echo and CV reports in one place. “That’s a huge advantage for us,” Young says.

Tri-City has been able to take advantage of the work and expense already devoted to its radiology department’s information systems to link and synch the two systems. The radiology infrastructure already included networking, servers, domains, user groups and more. “We didn’t have to spend any money for this project. It was already built and in place, including the archival piece,” says Dawkins.

Although there are plenty of differences between radiology and cardiology, weekly cardiovascular conferences has served as a forum to highlight the similarities. “The techniques and skill sets of each specialty are starting to come together,” Dawkins says. “The technology is driving that level of communication.” Implementation of 64-slice CT at Tri-City has led the two groups to talk about how to use the technology most effectively and efficiently and the implications for reimbursement and patient selection. The value of the infrastructure and information systems has been particularly apparent through the conferences. It used to take a full hour just to get through two patient cases. Now it takes half that.

The physicians were accustomed to that kind of time waste. “They don’t see it because it’s their daily practice,” says