Cardiology services are cash cows for hospitals. According to Robert Lunt, CEO of the Kansas City-based Lunt Group, cardiovascular (CV) services represents a $300 billion per year industry. “If you have a CV service in your hospital,” says Lunt, “it's driving most of the revenue.”
Add this to the mix: Cardiovascular disease is on the rise. The American Heart Association ranks cardiac disease as the number one killer in the United States. With approximately 1,500 hospitals that have cardiovascular departments in the country, it's clear that cardiac is a booming business for hospitals.
But has IT kept up with the model?
Apparently not. Most experts in the field say that so far, a complete integrated CVIS does not exist. “I've been doing this for 30 years, and this is the first time I can remember that we're ahead of the technology,” says Tom Lonergan, administrative director of the Heart and Vascular Institute at 498-bed Hoag Memorial Hospital in Newport Beach, Calif., and the largest cardiac hospital in Orange County.
Ben Brown, research director at Orem, Utah-based KLAS, agrees. “When we ask providers about who's closest to actually having a CVIS, it's apparent there's a gap between provider expectations and what's available today.”
Though an exact model for CVIS may not exist, most agree that the care model includes a cardiac PACS that ties together clinical areas like cardiac cath, vascular, echo and nuclear cardiology. According a recent KLAS perception study, access to images from these services was the number one requested component in a CVIS, with documentation data a close second.
Though many of the so-called CVISs do tie those services together, even the most advanced cardiac centers do not have a unified PACS solution that goes across cardiology and the rest of the hospital. “In most cases, the CVIS and the enterprise PACS are separate products,” says Brown. He says very few vendors have a single platform. “In theory, they can interface multiple systems to get it, but that's not reality today.”
Documentation and reporting are the other CVIS features hospitals requested after PACS. And in such a high revenue area, reports can have significant impact on a hospital's bottom line. “At the end of the day, what I want is a customized report that tells me how many procedures Dr. Jones did on Tuesday that were women,” says Lonergan. “And I want that to pop up on my screen.”
Most agree that readily available data leads to better management decisions. “If I've got one doctor that takes three times longer to do a case and uses 50 percent more supplies, I want to know that instantly,” he says.
With technology lagging behind, and many core vendors still years away from a complete cardiology solution, CIOs have real decisions to make about how to proceed IT-wise in their cardiac units.
There are solutions, and according to the experts, some of them are very good. Most of the big vendors have been rushing to enter the cardiology game, or upgrade their current offerings. According to KLAS, Siemens, Philips, McKesson and GE all offer cardiology PACS solutions — and are acquiring niche vendors to fill any holes. Cerner is in the early stages of cardiology image management, and Epic is talking about cardiology from the reporting side. Brown says Philips Xcelera is dominant in the field, and on the reporting side, the best of breed Lumedx is the most popular among providers.
With a particularly well-endowed foundation in upscale Orange County, Lonergan has been building a cutting edge CVIS from the ground up at Hoag, and is familiar with everything on the market today. But he says that interfacing multiple systems is still a big stumbling block.
Hoag Memorial uses both Eclipsys Sunrise Clinical and QuadraMed Chartmax in the hospital. Hoag's cardiology PACS is Philips Xcelera, and GE Centricity is used for radiology in the rest of the hospital. “They are two different universes,” says Lonergan. “If I'm a cardiologist in the workstation and I know this patient has had a recent CT scan, I should be able to call it up.”
At Hoag, Lonergan is building his CVIS along the model of a wagon wheel “Each of the spokes are different data elements or modalities: cath lab, echocardiography, EKG, telemetry,” he says.
In addition to those clinical spokes, scheduling, inventory, and regulatory reporting is included as part of the master plan. “We're at a point where we know what we want to do, but so many of the applications aren't there for us yet,” he says. “We may buy the best product on the market, but the problem is we need to take that information and move it somewhere.”
Though he did have a healthy budget, Lonergan found it didn't make a difference. “The problem is you can't go shopping today because there's no one who can give you what you need. There are a lot of vendors who say they have the functionality, but they don't.”
One important consideration for anyone shopping, he says, is DICOM and HL7 capabilities. “We don't want to buy any technologies that are going to put us at a dead end.”
There's another consideration for any CVIS implementation: Who's the boss? Is the CVIS a cardiac or IT project? According to Lonergan, it's the CIO who should be running the show. “The overall process is driven by IT,” he says, “because it requires interfaces on both sides: the application and outbound.”
At Hoag Memorial, he says that CVIS RFPs are a joint effort. “I work with the vendors on the clinical application side, and IT works on the technical side, like interfaces and operating software.”
Brown at KLAS agrees that CIOs are beginning to own the space. He compares today's situation with the early days of radiology PACS. “A lot of the physician groups and radiology directors were heavily involved in PACS implementations, but as it became more mainstream; the CIOs got more involved. We're seeing that happen in cardiology in this idea of a CVIS.”
And as the interfaces become more complex, that may turn out to be another level of responsibility for the CIO — or a headache. “If you've got a $300 million bottom line in a hospital, and two-thirds of that comes from the cardiac administrator, he's going to look at the CIO and say, ‘You better make it work,’” Lunt says.
Should a mid-size hospital without a budget like Hoag's wait for the big steel to play catch up? Most say it depends on each institution's vision, and requires some executive think. “What you've got to do is have a plan,” says Lunt. “You can buy the framework that fits for your hospital, and you don't have to make do with one vendor. But it helps.”
Lonergan has been focusing on integration and interfaces when it comes to his CVIS. He believes that when choosing a system it's important to look at all the possible connections between different vendors, or even the same vendor. “My advice is not only to go on site visits, but to verify and validate the interfaces not only from a modality standpoint, but from cardiology to enterprise ADT or a clinical system that's common. And validate it with multiple sites.”
He says it's also important to consider referring physicians and the accessibility of the cardiac data for primary care physicians. “On the cardiology PACS side, we're seeing the vendors getting better at delivering Web-based or client-server access to doctors, but it still needs to improve,” says Lunt. “It's definitely moving in the right direction.”