The ARRA/HITECH Act has made electronic medical records a front burner issue, and many believe that EMRs will make departmental systems redundant. Some cardiologists beg to differ, arguing that cardiovascular information systems are deeply clinical and essential to the cardiovascular workflow. Here’s a look at the evolution of CVIS, EMR, and their roles as the healthcare landscape is being transformed by meaningful use.
Today a lot of attention is focused on addressing electronic medical record (EMR) systems to meet the needs of American Recovery and Reinvestment Act (ARRA) and meaningful use legislation. In the words of some EMR vendors, the EMR will act as the aggregator of necessary clinical and operational information, enabling the physician, in one system, to access all relevant patient information across a number of clinical services.
No doubt this is true. The approach has its supporters and its detractors. Robert Cecil, Ph.D., a staff member with The Cleveland Clinic Foundation in Ohio, believes the EMR is the right environment to manage patients, making departmental systems redundant. He believes that the EMR will evolve to fill this role, as the aggregator of patient information. This will leave departmental systems to focus on what is important, which is acquisition and reporting. Dean Cheatham, enterprise manager of cardiovascular technology at PeaceHealth, Bellevue, Wash., echoes this sentiment. He considers a cardiovascular information system (CVIS) to be “another data silo laid flat across the cardiovascular service line,” and not a “clinical-facing” system.
Not everyone feels that strongly about the EMR. Tom Lonergan, executive operations director, Hoag Heart and Vascular Institute, Newport Beach, Calif., feels that “EMRs are still evolving, and they are not all-encompassing at this time, so there is still a place for a CVIS. An EMR is not disease or department-specific in the way it presents information—both important to a cardiovascular physician.” For James E. Tcheng, M.D., professor of medicine and professor of community and family medicine at Duke University Health System in Durham, N.C., the EMR’s focus is on patient management and not procedure management, and therefore the EMR is not specific enough for the cardiovascular workflow.
PROPOSED DEFINITION FRAMEWORK
Understanding the differences between an EMR and a CVIS can be simplified by means of a framework as proposed in Figure 1. Initially, departments focused on what can be referred to as cardiology picture archive and communications system (CPACS) to address image acquisition. Cardiac catheterization lab images from the fluoroscopic X-ray system and cardiac ultrasound images from the ultrasound cart are captured and stored in a central viewing and archival system.
Cath lab procedures involve case documentation of supplies and medications, as well as a record of the procedure, while study parameters and measurements are captured on a cardiac ultrasound cart. In early CPACS, such documentation was usually printed out and used along with the images from the CPACS to produce a dictated report.
Subsequently, CPACS vendors expanded their offerings to include structured reporting tools that enabled the cardiologist to produce a report directly from the CPACS while viewing images. Interfaces to hemodynamic and ultrasound systems enable directly capturing the documentation and measurement information into the structured report.
Unlike radiology, where reports are usually dictated, a cardiovascular report would require a significant amount of dictation effort to include documentation and measurements—hence the benefit of structured reporting. Capturing information directly from the hemodynamic system or ultrasound cart eliminates the need to manually transfer the information into the report and prevents possible typing errors. Thus CPACS evolved into an image management and reporting solution.
Over time, cardiovascular departments realized that their workflow could be simplified if additional administrative and study management functions could be automated. Directly capturing information for registries from the reporting database could speed reporting to the National Cardiovascular Data Registry (NCDR), patient demographic consistency could be improved by passing order work lists to supported imaging equipment, inventory/billing accuracy could be enhanced through tighter integration with documentation equipment, and department management could be enhanced by management reports.
These functions emerged into CVIS. Note that depending on vendor and development evolution, there is an overlap between CPACS and CVIS in the area of study documentation and reporting. Some vendors encompass both CPACS and CVIS functionality in one product, while others offer distinctly separate products.