EMR cardiology model vs. third-party CVIS

As electronic medical record (EMR) systems add specialty modules for the various subspecialties like cardiology, there is a question as to the role these EMR modules play. Many cardiology departments feel these modules do not have enough granular detail in their reports or interfaces with monitoring, testing or procedural systems. One example she mentioned was Epic's Cupid Module. 

Thompson said many hospitals have decided to integrate third-party CVIS into Epic, sometimes incorporating Cupid as well.  

"Cardiology has the additional complexity with its procedural nature, and the experience and sheer volume of data, the reporting mechanisms and the decades of experience that these cardiology IT vendors bring a wealth of knowledge. So trying to replicate that is proving difficult and it requires a lot of investment on an ongoing basis," she said.

From a cost effective and IT management side, some hospitals have decided to eliminate the third-party CVIS and just go with Cupid because it is easier and less expensive. 

"But for hospitals where cardiology is still very present in that decision making, the battle is still weighted into the favor of those best-of-breed products from the imaging IT vendors," Thompson explained.

Structured reporting aids with registry data interfaces

Another big area of activity in CVIS has been integration of structured reporting to enable more efficient transfer of data to various cardiology registries. Transferring procedural data to registries like those for transcatheter valve replacement (TAVR), left atrial appendage occlusion (LAAO), percutaneous coronary interventions (PCI) and electrophysiology (EP) can be very labor intensive, and some hospitals have full-time positions dedicated to this. To make this easier, CVIS structured reporting can help capture all the fields of data needed for the registry, rather than a nurse or other staff needing to find data elements in a written report or monitoring from the procedure for manual entry. There are several of these registries in the U.S., and there are also reporting requirements for the National Health Service (NHS) in the U.K. 

"The procedural nature of cardiology and the larger volume of data lends itself better to structured content," Thompson said. "If you are going to be doing something so repetitively, the ability to use technology to automate that transfer of data as much as feasible helps, because you don't want to spend your cardiologists' time manually transferring it to create these reports."

She said this structured reporting to help automate of some reporting functions gives third-party CVIS vendors an edge and may help justify the additional costs of these systems when calculating staff involved if this automation was not available. 

Consolidating the cardiovascular service line onto a single IT system

Enterprise imaging systems have become a buzz term in recent years. This is where a central data archive is created that all departments can share to store their data. This makes it easier to access images and reports from anywhere across the health system, allows easier web access for remote working, sharing the data to referring physicians and integration of all departments into a central EMR. This appears to be the direction many hospitals, especially larger health systems, are headed. This system eliminates siloes of data in each department, which often creates interface issues sharing data easily between IT systems.

The integration of departments into enterprise imaging systems usually starts with radiology and cardiology. But before that consolidation can happen, cardiology departments need to integrate their own subspecialties into a unified system. Some centers still have separate IT systems for cardiac imaging PACS, the cath lab, cardiac surgery, hemodynamics, EP, ECG and inventory management. This can be further complicated if there is a need for integrating interventional radiology (IR) and vascular surgery into the cardiology department IT systems, because they share resources or are integrated into the service line. 

Thompson said this consolidation into a department-wide IT system helps facilitate the creation of care pathways that allow patient care to flow much more smoothly.

"Cardiology departments need to look at how they can provide care pathway solutions that centralize and unify the multiple, different workflows that are within a department," Thompson explained. "Adding in analytics and dashboards to help feed performance metrics can help understand the efficiency of the department."

She said all subspecialty departments are going through this type of consolidation phase for better unification and streamlining of data, and lowering the total cost of ownership. 

"We are hearing stories of providers are still running four or five CVIS or cardiac PACS systems to manage different subspecialty data, so even taking that first step in unifying data into a singular platform is a great stride toward that efficiency, cost savings and quality of care that comes with it," Thomson explained. 

That consolidation also enables much easier integration into an enterprise-wide system that includes numerous departments.  

She said Signify is seeing an increasing number of health system contracts with IT vendors to combine cardiology and radiology systems in efforts to achieve this unification of data. 

Increasing use of CVIS by ambulatory surgical centers

Along with this consolidation trend, IT vendors said they are seeing health systems wanting to integrate ambulatory surgical centers (ASC) into their enterprise imaging systems. These ASC include outpatient interventional vascular procedures. The business model has seen a lot of traction in recent years because less involved, same-day cath lab procedures can be more cost effective if performed outside of hospitals.   

Thompson said this has been a big growth area for CVIS because hospitals are starting to build their own ASCs, or are partnering with established ASCs.  

"Like outpatient radiology imaging centers, ambulatory surgical centers shifting the dynamic where patients can have their care," Thomson said. 

COVID-19 made many people anti-hospital, and the easy of access of small outpatient centers appeals to many patients. ACSs have seen additional reimbursement, which has helped drive growth. These centers are seeing a lot of business now, as they help with the procedural backlog of cases that were put off during the pandemic. 

In Europe, funding has increased for these types of outpatient diagnostic centers, which include cardiology, to help with the backlog.