IU Health: Using Workflow-centered Cardiology PACS for Improved Care

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Edward A. HarlamertNamed as one of the best US hospitals by US News & World Report for 5 years, Indiana University Health (IU Health), Indianapolis, aims to provide a unified standard of preeminent, patient-centered care in partnership with the Indiana University School of Medicine. Strategies for attaining such a goal include the deployment of increasingly sophisticated imaging and associated reporting technology. Synapse® Cardiovascular 5.0, the most recent iteration of the Synapse Cardiovascular integrated imaging and information system from FUJIFILM Medical Systems USA, Inc, ranks among the newest additions to IU Health’s technology toolbox. The system’s upgraded cardiac-catheterization module was tested for a period of several months, beginning in mid-2012, and is now being used in four IU Health facilities in Indiana: IU Health University Hospital (Indianapolis), IU Health North Hospital (Carmel), IU Health Saxony Hospital (Fishers), and IU Health Tipton Hospital. In addition to supporting significant improvements in cardiac-catheterization workflow efficiencies, advanced, diagram-driven reporting features and other capabilities within the module support enhanced reporting accuracy and better patient care, according to Edward A. Harlamert, MD, MBA, FACC, FAHA, an interventional cardiologist with IU Health and director of IU Health Saxony Hospital. IU Health’s ability to produce cardiac-catheterization reports far more quickly than it could in the past stems partially from harnessing the module’s simple, intuitive graphical user interface when generating diagram content. The original configuration of the module was such that identifying the appropriate diagram components often entailed spending several minutes differentiating among many intricately rendered, monochromatic bars and icons. In contrast, the new edition displays icons that clearly depict the elements to which they correspond—for instance, arteries, stents, and balloons. All buttons are color coded. “The color coding and the artistically appropriate icons save report-production time, not only because they make it easier to determine what and where to click, but also because they direct individual users to the portion of real estate on the screen that corresponds to their role,” Harlamert explains. For example, he elaborates, buttons of one color direct cardiologists and interventionalists to representations of arteries and stents, while buttons with technician-related icons are clustered in a separate location on the visual real estate. Diagram-driven Reporting Other changes to the module’s diagram-driven reporting features play a role here as well, as does a vendor-agnostic interface with hemodynamic systems. Instead of creating basic diagrams by clicking on a grid of buttons that take up valuable real estate00000 Harlamert explains that physicians can click on a vessel and open a comment box, then click on stenosis to choose characteristics (and so on) to generate reports. The diagram content automatically drives report population, selecting the appropriate phrasing from prepopulated elements and creating a base of queryable data; the interface allows information collected by IU Health’s hemodynamic system to be streamed into reports in real time as it is being compiled. “We are no longer spending large chunks of time on dictation or waiting for data from the hemodynamic system to load, so as to close out studies,” Harlamert observes. It’s just as significant, he adds, that IU Health harnesses both the sophisticated, diagram-driven reporting capability and the interface with the hemodynamic system to take report accuracy—and hence, patient care—to a higher level. Diagram-driven reporting renders it difficult for physicians to omit information or include erroneous information unintentionally. Moreover, the data-streaming capabilities afforded by the interface with the hemodynamic system mean that physicians can begin documenting their findings immediately after leaving the cardiac-catheterization laboratory, increasing the likelihood that case documentation will be comprehensive and entirely accurate. “Physicians can walk out of the catheterization laboratory, go to a workstation, open the software to the diagram, and start clicking—when the information is really fresh in their minds,” Harlamert says. “They can do a series of 15 clicks to document all lesions and bypass grafts and their location, without forgetting a lesion. Without the interface, this would not be possible.” Reducing Variability IU Health is also availing itself of the system’s enhanced carry-forward function, through which data and diagrams from prior procedures can be imported into new studies. This particular feature contributes to a better caliber of patient care by ensuring consistency in reporting—from exam to exam and from operator to operator. Without such a capability, Harlamert states, interobserver and intraobserver variability rates could develop at an unacceptable 20% to 25%. “When you can push one button to regenerate the original diagram and then add to it, nothing slips between the cracks—as it often does, if (for example) one physician looks at a lesion at two different times or two physicians assess the same lesion at different intervals, ” Harlamert observes. “Now, we can see whether lesions look the same and not forget that, in addition to a new lesion, there are five preexisting bypass grafts. There is a higher degree of predictability, going forward.” The transparent manner in which the diagrams are generated definitely has the potential to reduce the volume of unnecessary angioplasty procedures, while simultaneously ensuring that patients receive the appropriate treatment for their conditions, Harlamert asserts. To illustrate his point, he notes that a physician might, without advanced reporting tools, estimate the degree of stenosis in a particular patient’s artery as 60% on one date and 40% a week later. In a similar way, a patient’s current physician might call the degree of stenosis 75%, but another physician might call it 50%. In both instances, differences in treatment recommendations might arise. Harlamert anticipates that IU Health will reap additional benefits once it moves from testing to full implementation of the system’s improved invasive peripheral vascular module. Plans call for taking such a step shortly. Harlamert says, “The peripheral vascular component has worked very well for us, in the trial phase.” The enhanced peripheral vascular reporting functions should, based on observations made during the test interval, “prove priceless,” he adds. “The peripheral vessels are longer, there can be a greater number of lesions, the potential for laser equipment needs is higher, and so forth. The more tools like this one we have, the better—now and in the future.” Julie Ritzer Ross is a contributing writer for Radinformatics.com.