Cardiology has always been a complex clinical service with multiple levels of clinical information. Besides imaging, cardiology services must manage other clinical information such as ECG tracings, EP mappings, and hemodynamic data, or the “blood flow, motion and equilibrium under the action of external forces.”
Imaging has been thoughtfully embraced within the Digital Imaging and Communications Standard (DICOM). The other dynamic information has not. The end result is a constant struggle to integrate information from disparate systems, given the lack of any standards.
I am personally involved in one vendor-client situation where the Cardiovascular Information System (CVIS) vendor also has their own hemodynamic solution, but the particular facility has another vendor’s hemodynamic solution. To further complicate things, the hemodynamic system vendor has their own CVIS solution. Naturally, each will argue that the interface between their hemodynamic solution and their CVIS is more robust than one to a competitive system. And, there is likely some truth to this, as each vendor knows all the data elements between systems and can create a custom interface to accommodate them.
One vendor in particular indicated that they do offer an HL7 interface from their Hemodynamic system, but they discourage its use, as it would require the other side of the interface to be constantly updated every time a change is made on the hemodynamic side. In some respects, this is reasonable, as Hemodynamic systems often handle inventory items such as stents, which are managed with bar codes. Because the supply lots of these items change rapidly, it would be a constant struggle to keep these items up to date via an HL7 interface.
The consequence is that many facilities struggle with a work flow that involves printing out the hemodynamic report, and matching it with inventory supply systems to insure proper usage and billing. Oftentimes, this lack of integration results in a dictated cardiac catheterization report, using the hemodynamic report as a reference, instead of making use of available structured reporting tools that would integrate the hemodynamic measurements, and provide greater consistency and efficiency in reporting.
In this age of interoperability and the need for accountability, perhaps it is time for the standards organizations and the vendors to step up and address a standard for hemodynamic communication. I have spoken with several vendors as well as potential standards organizations that could play a role in effecting a standard. To date, this has not been a priority within either vendors or standards groups.
I would argue that based on experience in other areas, developing a hemodynamic standard would be the correct course of action. In the case of radiology, initial image interface initiatives were met with skepticism, and concern for lack of competitive advantage. I would subscribe that the past thirty years have proven that the DICOM standard was worth the effort, and was timely with respect to imaging interoperability for ARRA/MU.
What is needed is for a standards organization to step up and sponsor an initiative to develop a standard for hemodynamic data. I take issue with as one CVIS vendor suggested there is a competitive advantage to a vendor’s tight integration between their hemodynamic and CVIS products. My rationale in rebuttal to the vendor was that I know of no sales situation I have been involved with where the incumbent hemodynamic system influenced the decision to acquire a CVIS!
I offer this initial blog as a challenge to the standards groups and the vendors to come together to initiate an effort for a hemodynamic standard. I intend to continue the dialog with both vendors and standards groups toward this goal. Please feel free to chime in if you concur.