I’ve just returned from San Francisco and the American College of Cardiology’s (www.ACC.org) annual meeting, ACC13. In past years I have commented on the apparent lack of attention to integrating cardiovascular services into the enterprise. This year, I am starting to see that vendors are finally starting to prioritize integration!
Here are my initial findings on why I believe cardiovascular information systems are finally improving.
Increasing CVIS Functionality
Vendors are paying more attention to cardiovascular information system (CVIS) functionality, beyond just report generation. There was greater emphasis on interfaces with an EMR for order and scheduling integration. Fuji is adapting similar functionality from their Radiology Information System (RIS) for cardiovascular needs. Merge offers tight integration with both Cerner and Epic. And most work lists now show the status of the exam, and track status through filtered work lists. Vendors such as Lumedx continue to address benchmarking and dashboard applications for improved management of cardiovascular services. Overall, it appears vendors have a better understanding of the necessity of interoperability with the EMR in light of ARRA/MU.
Mobility
Mobility is all the rage in radiology, and it seems many vendors are extending similar capabilities to cardiovascular products. This represents a tougher challenge, as most radiology images are static, whereas cardiovascular imaging requires dynamic image display.
Most likely driven by the changing healthcare environment, another key factor is the ability to read remotely. In the past, this has meant having similar workstation and network connectivity to support the usual “thick client” workstation. The trend is toward web services clients that can be accessed on any PC that can connect to the internet, and image review performance and functionality are equivalent to local workstations.
Agfa, GE, Philips, Digisonics, Lumedx, Merge and Infinitt all referenced some form of mobile device, whether it was a web-based application or a non-diagnostic mobile device application. It is clear that the technology and healthcare reform are having an impact on cardiovascular mobility!
Comparison and Collaboration
Several vendors showed interesting developments in terms of improving the overall reporting process. Fuji and Digisonics emphasized the ability to compare the current and prior cases side-by-side, while Siemens presented quite a different twist – the ability of multiple physicians to collaborate on a report. Siemens demonstrated both the ability for serial collaboration, where one physician might start a report and another might finish it, as well as interactive in the sense of inviting multiple physicians to collaborate on a report. In the case of Siemens, this was part of a larger emphasis on enterprise applications across multiple healthcare facilities – something of emerging importance in an ACO (Accountable Care Organization) environment, and where cardiologist practices are merging into healthcare providers.
Last year McKesson acquired peerVue, a company that emphasizes workflow to expedite communications for improved quality and efficiency, and to support customer efforts to improve patient safety. The initial application has become widely deployed for radiology services, but it had not yet been extended to other service areas. McKesson demonstrated an extension of peerVue for cardiology services to improve the communication between physicians collaborating on cardiovascular cases.
Advanced Reporting Tools
Following a trend shown by a few vendors over the past few years, “what you see is what you get” or WYSIWYG is becoming more popular as a reporting method. Instead of having the user check a number of boxes on a form, or go through multiple levels of a decision tree, WYSIWYG provides an interactive view of the final report, and changes can easily be made by clicking on a particular section of the report.
Dynamic population of the report template with hemodynamic measurements was another popular improvement. Some vendors have extended this to automatically annotate the tree diagrams, thereby saving the physician the effort of illustrating the diagram. Fuji and Digisonics in particular illustrated this capability.
Vendors are also progressing in terms of interoperability with imaging devices, particularly in the area of Echocardiography. More vendors are making greater use of DICOM SR (Structured Reporting) in their ability to pull data directly into the report template. Agfa and Digisonics highlighted this capability in particular. Evidence-based reporting is increasingly important, where the language generated is predicated on guidelines such as SNOMED (Systematized Nomenclature of Medicine) terminology, thereby improving the quality and analytical search capability of reports. Conversely, several vendors (Merge and AscendHIT most notably) were demonstrating the ability to use speech recognition directly into the report template for those that choose to dictate conclusions or make additional comments. Merge was also demonstrating Voice Recognition in terms of the ability to use the voice commands to invoke various functions or macros.
The ability to annotate an image from the case and include it in the report was demonstrated by several vendors, who indicated that many users like this capability over annotation of the tree diagram, as it is more representative of the diagnosis and treatment.
Interoperability
Vendors appear to be addressing interoperability more aggressively. Several vendors are moving toward greater integration between radiology and cardiovascular products, specifically image storage, where Fuji, GE, and McKesson are all speaking to common image management infrastructures.
EEG is another area with greater emphasis on integration, particularly advancements from Philips and Epiphany. Philips spoke to greater integration of stress and holter with their TraceMaster EEG system, while Epiphany spoke to open architecture, the number of vendors they interoperate with, and their integration with Epic.
Medstreaming spoke to a level of integration with perioperative systems – a major dilemma for those considering hybrid rooms, in that patient and procedure information can be shared between systems rather than unproductively entering common information into both systems.
Summary
In summary, ACC13 represented a major stride forward in terms of advancing the state of cardiovascular information systems. It seems that vendors are paying more attention to how CVIS interoperate with the rest of the enterprise – more than likely a result of changing healthcare policies! If not by coincidence, ACC14 will be held in Washington, DC – further recognition of the importance of cardiovascular technology to the changing healthcare landscape!
