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Cardiology's Hybrid ... and I don't mean the Chevy Volt!

August 15, 2010
by Joe Marion
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Hybrids are all the buzz these days. If it isn’t a story about the Toyota Prius and unintentional acceleration, it’s the Chevy Volt, the $40,000 car that goes 40 miles. While the auto industry struggles with hybrid technology, so does cardiology technology.

In terms of service areas, cardiology has always been more complex than other services. There are non‑interventional imaging, interventional imaging, and surgical procedures, just to name a few. Procedures involve a lot more than imaging as well. There are wave forms and pressures to capture, as well as procedure documentation of supplies, medications, and events. Typically, many of these devices have evolved as separate, standalone devices due to their unique capabilities.

In a cost-constrained healthcare environment, new emphasis is being placed on how to improve the cost-effectiveness and medical efficacy of cardiology equipment. An area I am running into more frequently these days is the hybrid cardiology room. The hybrid room combines the usual surgical suite used for cardiac surgery with the typical cardiac imaging and interventional suite. Classically, these have been two separate rooms.

Besides the economic benefit of a combined room, in terms of scheduling and staff flexibility, the hybrid room can also improve procedure efficacy. For example, consider the patient that needs open heart bypass surgery. In the typical facility, the patient would have the bypass surgery in a cardiac surgery suite. Once the grafts have been completed, there are occasions when the surgeon needs to check the patency of the grafts to insure the grafts are supplying adequate blood flow. In today’s case, the patient may be taken from the surgical suite to a cardiac catheterization room and a cardiac catheterization procedure is performed.

In this scenario, the surgical case is closed in the surgery suite, and the surgeon prepares his/her report to document the procedure. The case must then be created all over again in the cardiac suite in order to document the catheterization procedure, which is then documented by the cardiologist upon completion of the study. The result? Multiple procedure documentations, multiple reports, unproductive time transporting and setting up the procedure and patient, and potential resource scheduling issues.

In the case of the hybrid room, at the conclusion of the surgical portion of the procedure, should a catheterization be required, the procedure can seamlessly move from a surgical to a catheterization procedure without transporting the patient or re-entering patient demographics and documentation. The reporting process can also be simplified to one continuous report.

While it sounds straightforward enough, what I am finding is that no one yet has figured out how to make all the parts play together! Take the case of procedure documentation. During the surgery, the anesthesiologist is documenting in an anesthesiology system. There may be similar documentation associated with a heart/lung machine if required. And for the cardiac catheterization, documentation is typically done in a hemodynamic system. The challenge? How to either integrate these disparate elements, or better yet, combine them into one documentation.

One prospect for doing so is the emergence of Cardiovascular Information Systems (CVIS). The CVIS becomes the primary repository of acquired information, and has classically been used for cardiac procedure reporting as well as a database for registry reporting and outcomes analysis. If it could be adapted to extend into surgical documentation and reporting, it might present a means of bridging imaging and surgical procedures required in the hybrid room.

It could also open up new possibilities for integrating existing procedures. So, in the same scenario described above, the information captured during the surgical procedure could be forwarded to the CVIS and used to prepare the cardiac catheterization procedure in terms of demographics and preliminary documentation, thereby saving time and resources.

The challenge for the industry is the coordination of system integration across numerous manufacturers, where aside from the DICOM imaging standard, little integration exists! While some vendors may attempt to address the solution by producing completely integrated solutions of their, own, the better alternative would be for them to work out the standards necessary for system interoperability. This was complex enough with the long evolution of the DICOM standard - imagine the complexity of doing it across wave forms, documentation, and other systems!

If we put men on the moon, and can produce hybrid automobiles, we should be able to accomplish it! One can only hope that cardiac service’s clamor for the technology will be enough to make it a reality!

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