Cardiovascular Information Systems Expand Departmental Capabilities
Savvy cardiology departments tap into CVIS to engineer cost-savings, streamline workflow and deliver better patient care.

The push by healthcare to become paper-free is timely as the increased healthcare needs of the ever-aging and chronically ill population of the U.S. puts many strains on cardiology departments. Yet many departments function in a paper-based silo mode that fails to provide anytime/anywhere access to patient data.

Some cardiology departments have found a solution. Next-generation cardiovascular information systems (CVIS) serve as the cornerstone of a massive re-engineering program characterized by streamlined access to patient images and information. South Shore Hospital in Weymouth, Mass., for example, surveyed the demographics of its large catchment area and realized the hospital needed to overhaul its cardiovascular department. The hospital built a new center based on the “hospital-within-a-hospital” approach. All cardiovascular services, from EKG to cardiac ultrasound, cardiac catheterization and rehabilitation, and all providers are located in the one-stop center—which is just steps from the front door of the hospital for easy access.

The new center offered the opportunity to rebuild operations and employ a single-vendor CVIS solution rather than multi-vendor departmental systems, says Bill Burke, director of cardiovascular medicine. Burke and colleagues chose Centricity Cardiology from GE Healthcare, which serves as a single database that tracks data across multiple systems. “With one click, we can mine data into meaningful trends like volume by procedure, physician or time of day, which allows us to make amazing practice management decisions,” says Burke. In addition, clinicians and referring physicians can access all clinical data and images from a single user interface.

The new CVIS allows South Shore Hospital to automate other critical functions including scheduling and patient tracking, billing and supply management, and it simplifies coding. In a traditional department, technologists and nurses share partial responsibility for coding, checking off CPT codes on a paper-based system before sending the data to the billing department. The new system merges documentation and coding workflows, extracting coding data from nursing documentation. Since deploying the CVIS and implementing processes to analyze inappropriate billing, South Shore’s cardiovascular center has realized a $45,000 net increase in monthly charges because bills are more accurate than under the previous system.

IT builds a seamless enterprise

A few years ago, MedCentral-Mansfield Hospital, a 250-bed community hospital in Mansfield, Ohio, was a typical 20th century enterprise, characterized by departmental, paper-based silos of information that talked poorly to each other. That all changed  when Gregory Eaton, MD, director of cardiovascular medicine, spearheaded a plan to create an integrated backbone of data. The task, says Eaton, is mission critical. “All hospitals need to use IT to its full potential to provide care in an efficient, cost-effective manner to improve patient outcomes.” The core of MedCentral’s strategy is the Soarian Suite of IT solutions from Siemens Healthcare.

The IT-based approach removed silos of data, allowing the hospital to increase efficiency, standardize patient care and review outcomes. Before the hospital deployed the system, it was very difficult for physicians to obtain prior EKGs. In many cases, treatment started without key pieces of data. That doesn’t happen today with the new system, says Eaton. The CVIS also provides a structure for report generation, pushing physicians to add key elements that influence outcomes. Researchers can search the key elements or variables to connect the dots between variables and patient outcomes.

Northridge Hospital Medical Center in Northridge, Calif., operates in an ultra-competitive medical neighborhood. The 450-bed hospital is shoehorned among six hospitals in an eight-mile radius. “We have to stay ahead of the curve,” says Ed Lopez, service line director for cardiovascular and respiratory services. A few years ago, the hospital upgraded from a first-generation cardiology PACS to a fully integrated CVIS solution by deploying Horizon Cardiology (McKesson Corporation). The three-phase project started with a cardiology PACS upgrade. Prior to the new system, cardiologists were tied to a single PACS workstation in the cath lab. Horizon Cardiology, a web-based system, provides access to cath lab and echo images in the cath lab, throughout the hospital, in physicians’ offices and at home. The hospital ensured speed by adding a separate 2 gigabyte (GB) network and new network drops in the cath lab, echo suite and in physician review areas.

Phase two centered on hemodynamic monitoring and nurse charting. “This is the age of quality. We wanted everything captured for American College of Cardiology reporting,” says Lopez. The new CVIS captures essential data and populates the physician report with it, which links with the final phase of the project: physician reporting. Documentation is more complete and consistent, he says. For example, consider the patient with a small myocardial infarction. The new CVIS ensures that physicians document the length of the lesion and stent.

Transforming cardiology

CVIS can serve as the framework for true departmental re-engineering. Sites that implement CVIS as the backbone of an integrated data-access project realize critical advantages beginning with comprehensive access to patient images and data and including linkages between systems to reduce duplicative data entry, minimize errors, boost efficiency, cut costs and enhance quality control and patient safety. With CVIS-initiated improvements, the department is transformed into a provider of efficient, cost effective, data-driven, high-quality patient care. 

PACS: Meeting the Image Integration Challenge Across Various Business Models
Marshfield Clinic in Marshfield, Wis., a large group practice, operating 50 clinics and employing 750 physicians across northern Wisconsin, is moving toward a single repository for all DICOM and non-DICOM images. “Image silos are very difficult to manage from an IT standpoint, and they are very costly,” says CIO Carl Christensen.

A sufficiently open repository provides vendor-independence, that is, images can be easily shared among diverse PACS. At Marshfield Clinic, the common repository combines TeraMedica’s Evercore Clinical Enterprise Suite and internally-developed software for image management and smart DICOM routing. When Evercore receives a study, it applies routing and storage rules. If a physician needs to review an image from PACS X on workstation Y, Evercore coerces a DICOM header that integrates into the disparate PACS workflow.

Independent imaging centers face a unique set of challenges and intense competition. Many sites are beginning to hear the same request from referring physician offices. Referrers want to view reports in the EHR, which represents a tremendous integration challenge for the practice faced with dozens of EHR systems.

Epic Imaging in Portland, Ore., has tackled the challenge, tapping into NeoTool’s NeoIntegrate interface engine to reduce the cost and improve the process of interface development. “It’s costly to develop a RIS interface for each provider’s EHR,” says John Griffith, operations director and CIO, who estimates the price tag per interface at $20,000 to $25,000. NeoIntegrate reduces the cost to about $5,000 per interface. The HL7 integration engine takes standard RIS feeds and builds outbound messages that conform to each EMR’s requirements.