In this age of IM’ing (instant messaging), everything is an abbreviation or shortcut. What parent today doesn’t know about BFF, OMG, or P911? And, if they don’t, I suggest a web site such as http://www.webopedia.com/quick_ref/textmessageabbreviations.asp where you can learn about abbreviations.
There have always been a number of acronyms in medical imaging, such as ABD, mA, IVP, PACS, etc., as is true with every industry. In the early days of PACS, everyone kept trying to come up with their own acronym, but the one that seemed to stick was PACS (Picture Archiving and Communications System). And in the end, the description is a fair representation of what it is.
In the case of Cardiology, the term CVIS (Cardiovascular Information System), has become the default descriptor for what is unfortunately, a rapidly changing technology. If one were to research the origins of the term, I would guess that it evolved as a parallel to a Radiology Information System, or RIS. After all, some of the functionality is similar in terms of patient management and reporting capability. Unfortunately for cardiology, the expectation may far exceed the parallel with a RIS.
Certainly, there are the basic functions of ADT interface, orders, scheduling, reporting, etc. But beyond that, there are those in the industry that would argue that it is much more! Following visits to the ACC09 meeting in Orlando earlier this month, and the HIMSS, I am struck with how inadequate the term CVIS really is, and with how confusing it must be for prospective customers to navigate the reality from the messages of multiple vendors.
If one were to truly follow the radiology acronyms, a Cardiology PACS, or CPACS would address images, while a CVIS would address workflow and reporting. Unfortunately, because of the tight coupling of imaging to reporting in cardiology, a CPACS may actually encompass a reporting capability. Conversely, a CVIS usually either encompasses or interfaces to a Hemodynamic system for procedure measurements and documentation that is also crucial to the reporting process.
In a radiology world, the RIS usually only encompass the “transcription” portion of reporting, as most reporting is done via a separate dictation system. In the case of cardiology, a CPACS/CVIS approach has come to embrace the concept of structured reporting, and therefore, a CVIS usually encompasses the reporting module to document a procedure, and may consist of measurements taken during the procedure, diagramming to represent problems (stenosis) and corrections (stent), as well as actual image snapshots.
Where cardiology most significantly deviates from a radiology synonym is in two key areas: department management; and outcomes analysis. In the case of department management, radiology tends to be a singular procedure or service. A patient is referred, one or more studies are performed and reported, and the patient leaves. In the case of cardiology, a patient may be seen by the cardiologist in their office practice, receive several studies, and then be referred to the hospital department. And, upon completion of a procedure (such as a cardiac catheterization), the patient may be involved in a number of ancillary services, such as chest pain management, cardiac rehabilitation services, device management, etc. where the need to continue to document the patient study continues. Having accessibility to such information through the course of diagnosis and treatment is important to good patient care, and needs to be part of the CPACS/CVIS definition.
Outcomes analysis is more important in cardiology in part due to the extended nature of patient care. Having the ability to interact with the collected data is important for both reporting of such information to national and state registries, but also for department management, in knowing exactly what procedures were done, and in knowing what the department’s success ratio for those procedures is. Similarly, the data mining and reporting capability is an important part of a CPACS/CVIS.
In some respects, there are those that would encompass the notion of an EMR (Enterprise Medical Record) within the definition of a CVIS. From the perspective of managing the patient from the beginning of an event through the successful diagnosis and treatment, this would seem appropriate.
So what is my point? When considering the acquisition of CPACS and CVIS, be sure to ask the vendor explicitly what is included. I have recently been involved in a vendor selection situation where initially, the client took an all too radiology view, with the focus primarily on image acquisition and reporting. Subsequent discussions led to an understanding of the more encompassing view, and the realization that they may not be acquiring all the functionality they thought they were! Such an example is a reminder of the need to thoroughly understand requirements up front so that there are no surprises later on. It also enhances the ability to differentiate vendors and rule out those that don’t meet the requirement before getting too far down the selection path.
Would it make sense to redefine the definitions for CPACS/CVIS? I would think so, but like the term “PACS,” we are probably stuck with it. My goal is to make sure everyone understands that there may be a wide variation in its definition.
That’s it for now, so HAND (that’s “have a nice day”).
