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Hearts and Minds

September 25, 2008
by Mark Hagland
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When it comes to automating workflow and image management for cardiology, CIOs are finding radiology was a piece of cake

Cindy Eggert, vice president of information systems and CIO at Good Samaritan Hospital in Los Angeles, knew it would be a challenge to bring state-of-the-art cardiology PACS to the 408-bed academic medical center. However, as the volume of cardiologic studies continued to climb, Eggert knew it was a challenge she had to tackle.

For one thing, says Eggert, who has been CIO for over 10 years at the hospital, it had become clear that both cardiologists and radiologists at Good Samaritan needed IT upgrading at the same time. The hospital's radiology department was still film-based in radiology in early 2007, a fact that Eggert acknowledges was both unusual for an urban, academic hospital, and also spoke to the overall focus on cardiology — for several years cardiologists had been working with a standalone electronic imaging system.

Radiology PACS went live in August 2007, while cardiology, echocardiography, and cardiac ultrasound were up with PACS in February of this year. Additionally, in May, the cardiac catheterization lab also went live with the hospital's new system.

For both cardiology and radiology, Good Samaritan is using Alpharetta, Ga.-based McKesson Corporation. Going with a single vendor is the realistic way to achieve a level of interoperability at this point in vendor development, Eggert says.

Joe Biegel

Joe Biegel

The results have been highly successful already, Eggert says, with cardiologists, as well as radiologists, expressing strong satisfaction with the ability to share images, data, and communications across specialties. What's more, the developments fit into a strategic approach that calls for creating an enterprise-wide image management system. Eggert and her colleagues are also about to launch a physician portal to facilitate access to images and data, and inter-clinician communication.

Nationwide, different approaches

Industry experts say that planning and implementing cardiology PACS is turning out to be more of a challenge than anyone had anticipated.

“I think the biggest issue is that cardiology is much more complex than radiology,” says Joseph Marion, principal at Healthcare Integration Strategies, a Waukesha, Wis.-based consulting firm, and an HCI blogger. “That's the primary issue: there are just a lot more data elements to integrate. As a result, they're playing catch-up to radiology in terms of the standardization necessary to integrate all the elements.”

The reality, he adds, is that hospital organizations are turning to single vendors for cardiology image management, as interoperability remains a problem due to insufficient communications standards.

“Cardiology PACS’ evolution has paralleled the evolution of radiology PACS, but has always been behind,” notes Joe Biegel, vice president, product management, for the Medical Imaging Group at McKesson. One very basic reason for the lag in cardiology is the diverse medical technologies, outputs, and clinical workflows involved in the sphere, which encompasses echocardiography, electrocardiography, cardiac catheterization, and angiography/hemodynamic monitoring.

With different medical technologies creating different kinds of outputs, the technological environment in cardiology is far more complex than radiology, Biegel stresses. Therefore, he says, it's not surprising that patient care organizations have difficulty automating workflow processes, image viewing, and image- and data-sharing.

At the moment, “the workflow in hospitals has been shifting from very analog to partially digital, and towards digital,” Biegel continues. But is it the ongoing surge in cardiology volume that is driving the development of cardiology imaging systems?

Indeed, says Robert Tkachyk, a Cleveland-based staff consultant at CSC Corporation (Falls Church, Va.), it is cardiologists themselves who are aggressively pushing CIOs to implement image management systems, as they try to keep up with an increasing volume of activity. Inevitably, individual cardiologists run into bandwidth problems, particularly if they are trying to access images online. “The images in cardiology can be so large that transmitting them reliably over a network can be a very, very significant challenge,” he says.

Roger Hertz

Roger Hertz

So far, he says, the most advanced hospital organizations “have probably partnered with a vendor and come up with a combination of cardiology PACS and a cardiology information system that they may even have worked with the vendor to develop.” Not surprisingly, he notes, the cardiology information systems, analogous to the radiology information systems (RIS), lag behind the needs of today's cardiologists.

Progress in Omaha and Cleveland

At the six-hospital Nebraska Methodist Health System in Omaha, Senior Vice President and CIO Roger Hertz notes, “We've had a strategy of integration since the onset of our journey into the EMR back into the mid-1990s.” For Hertz and his colleague Shawn Wiese, Nebraska Methodist's applications development manager, moving forward on cardiology PACS has been a natural fit with their overall strategy. Methodist Health went live in mid-January with PowerChart ECG, from the Kansas City, Mo.-based Cerner Corporation, in two hospitals, “pushed by the sunsetting of the legacy system we had had,” Wiese notes. Previously, the hospital system had had a standalone ECG product that “required techs to print everything out — it was really only semi-automated, very inefficient,” he recalls.