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ACC 2016 and CVIS Trends

March 29, 2016
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This coming weekend marks the opening of ACC16 (American College of Cardiology – in Chicago.  The ACC’s annual meeting is a great place to assess the trends in cardiovascular information systems (CVIS), similar to the way the Radiological Society of North America (RSNA – is for assessing trends in radiology.

In anticipation of the meeting, I have identified a few topics that will be relevant to my discussions with CVIS vendors:

CPACS/CVIS Deconstruction

Within radiology, a hot topic of discussion is the “deconstruction” of PACS, primarily driven by the advent of Vendor Neutral Archives (VNA) and Universal Viewers (UV).  The notion is that the viewing and management of images is shifting to an enterprise level, as it can embrace many imaging needs around the enterprise in conjunction with an Electronic Medical Record (EMR), rather than individual archive and viewing technologies in each individual imaging service area. 

The question is: have cardiology services reached the point where they are sensitive to similar needs and wish to “deconstruct” the CVIS as well?  If so, how are vendors responding?  Do cardiology operations perceive there is much benefit to improved access to cardiology study access, as well as the ability to access other service areas such as radiology within cardiovascular services?

With the trend for absorption of cardiologist practices into healthcare providers and healthcare provider consolidation, there are likely more opportunities for study sharing across facilities.  Deconstructed PACS may be a means for improvement of image sharing.

Analytics and Decision Support

There has long been an interest in accumulating information from cardiovascular systems and CVIS for use in managing cardiovascular services.  For example, in the case of cardiac catheterization operations, there is a statistic known as “door to balloon time,” or a measure of the efficiency in processing a patient’s arrival in the ER, assessing the need for a cardiac catheterization procedure, and initiating the catheterization procedure.  Similarly, cardiologists typically like to follow the Ejection Fraction (EF) for a patient across multiple exams and potentially across different procedure types.  These are but the tip of the ice berg in terms of useful information that can be captured and utilized analytically to improve operations. 

Oftentimes analytics applications have been standalone, but many are now capitalizing on the CVIS application to acquire and present analytical information.  I will be interested in how various vendors manage such analytics, as well as how they view such capabilities in light of similar trends in terms of EMR’s and separate facility data warehousing initiatives.

Another key trend is the expansion of decision support capabilities.  Clinical Decision Support (CDS) applications can quickly determine how well a patient meets ACC (American College of Cardiology), AHA (American Hospital Association) appropriate use criteria for imaging (  In one sense, CDS is like the glass being half-empty or half-full.  Some view CDS as an intrusion on how to practice medicine, while others see it as a means for identifying appropriate use, and reducing costs by avoiding unnecessary tests.  However one views it, CDS is becoming more prevalent, and intertwined with EMR’s and CVIS.  CDS can be related to appropriate use criteria (AUC), that can be used to categorize patients undergoing PCI (Percutaneous coronary intervention).  Vendors are building such criteria into their CVIS to improve procedural efficacy. 


FHIR, or Fast Healthcare Interoperability Resources ( is a new standards framework created by HL7.  It combines the best features of the HL7 and CDA standards, makes use of the latest web standards, and focuses on interoperability.  FHIR focuses on fast and easy implementation and is free to use with no restrictions.  FHIR offers a simple framework for extending and adapting existing resources to improve interoperability. 

Given the large number of separate cardiovascular applications (Echo, ECG, Cath, Hemodynamics, Etc.), it would seem reasonable that FHIR might be useful to improving interoperability.  I have previously blogged on the need for greater interoperability with respect to hemodynamic data (, and perhaps FHIR will be helpful in achieving it, as well as addressing other areas such as analytics, data warehousing, and decision support.

These are but a few of the areas that will be interesting topics for the ACC.  I look forward to a productive weekend in Chicago!