I’ve recently been engaged by a client that is looking to improve the way they report cardiac catheterization studies.  They are in the midst of implementing an Electronic Medical Record (EMR) system and they want to improve the way reporting will be done in conjunction with the EMR.  Currently, cardiologists dictate reports into the medical records dictation system, and sign the transcribed report in an existing electronic document management (EDM) system. 

The overwhelming problem they face in terms of creating a systems environment to work with their new EMR is getting the various systems to communicate with one another and avoid replication of data entry.  I have to reflect back to an early blog I did on the difficulties of cardiovascular systems to interface with one another.  Cardiology is much more complicated compared to radiology, as there are many more data types involved. 

In radiology, since images are the primary form of data, the Digital Imaging and Communications (DICOM) standard has been immensely successful in creating an interoperable environment.  Unfortunately, in the case of cardiology, besides images, physicians interact with wave forms, pressure measurements and documentation as part of a procedure.  Heretofore, there has never been a major push to have these systems interoperate, and outside of DICOM extensions for images, there is very little in the way of standards for the other information, outside of the PDF format.

In the case of my client, in terms of considering improvements, there have been a number of issues with creating an interoperable environment that results from a lack of clear standards.  Ideally, documentation of the procedure, including supplies, medications, and the procedure would be accomplished in the hemodynamic system.  This information should flow directly to a cardiovascular information system (CVIS) that would be used to complete the cardiologist’s report.  Upon completion, the CVIS should be able to seamlessly pass the report results to the EMR, correctly populating the medication and supply fields in the EMR. 

Unfortunately, this is not the case!  Depending on vendor, there may be limitations in which information can flow from the hemodynamic system to a CVIS.  Likewise, there may be vendor limitations as to which information fields can be passed from the CVIS to the EMR.  If clear “profiles” existed for cardiology data exchange, similar to the DICOM and Integrating the Healthcare Enterprise (IHE) standards initiatives, it would be a simple task to transfer the necessary data in a seamless manner.

Instead, it may be necessary for the site to enter medications directly into their EMR, skipping the Hemodynamic and CVIS systems altogether!  While this may result in a workable solution for the client, it will mean a more complex work flow than is necessary – all because of the lack of interoperability!  Perhaps it is time for vendors and professional organizations alike to come together similar to the way they have for radiology to create workable profiles and standards for cardiovascular services.  It may not seem to some to be in their best interest, as it may promote “best of breed” acquisitions, instead of a singular vendor.  But I can recall similar arguments in the early days of radiology PACS as well, and look how far radiology has come!

I would welcome some vendor and/or industry organization to step up to the plate and get the ball rolling.  With ARRA/MU looming over imaging services, perhaps it is time!