Defining CVIS is easier said than done. KLAS wanted to create a simple definition for a CVIS, but they were unable to create an all-encompassing description because of the complexity.

"We have often asked providers their definition of a CVIS, and we thought we would have a broad definition, but it is so complex," Rasband said.

On the KLAS website, there is a general description, but the demands from various subspecialties for reporting and functionality really starts to get divided up, and it is difficult to come up with one solution that fits all the cardiology users' needs. According to Rasband, this often leads to providers using an electronic medical record (EMR) as a basis then picking a primary CVIS, but they still need additional reporting or ancillary systems to create a complete CVIS.

Here are some of the key trends KLAS has observed in CVIS:

1. Increasing use of structured reporting in CVIS

"We are hearing a lot about structured reporting," Rasband said. "This is not necessarily new, because we have been talking about it for some time, but when we were scoping out what we would put into our CVIS annual report, that is where we had the most questions from providers." 

She said in the past couple years, KLAS has seen more structured reporting adoption, and vendors have added additional structured reporting functionality in their reporting systems. 

"Despite the adoption and functionality, structured reporting is still not where it needs to be," Rasband said, based on provider feedback at centers were this technology is used. "Cardiologists work in complex environment and everyone wants more automation." 

2. Remote access to CVIS 

COVID really increased demand for remote access to patient data, reports and imaging. While many of the newer CVIS systems provide remote access, Rasband said providers' feedback showed there is still room for improvement.

"While there was remote access happening, providers said they really needed it to be at a different level," she explained. 

3. AI in cardiology 

KLAS gets a lot of questions from hospitals and health systems about cardiology artificial intelligence (AI) algorithms. Rasband said many providers feel like they are falling behind because they are not using a lot of AI or just looking into their first algorithms. While there is a lot of hype about AI, the reality is that most hospitals across the country are just starting out with the technology.

"We have a lot of people talking about AI in cardiology, but it is still incredibly early," she said. "Cardiologists want to know what will help lighten their workloads, make them more productive and what can they trust with quality. So all of those pieces are on the wish list, but we are not seeing anything that is being delivered quite yet."

4. Concerns about legacy cardiology PACS

Another concern from providers that frequently comes up in discussions with KLAS is the best strategy for replacing older CVIS and cardiac PACS. With large numbers of health system mergers and consolidation, this frequently means a new hospital is acquired, and they need to figure out what to do about a legacy CVIS system used by the merged cardiology department. 

"There are a lot of legacy systems and hardware that need to be updated and refreshed. Those of us that understand the IT side of things [understand] that is not an inexpensive thing to change out," Rasband said. 

5. Movement toward consolidating cardiology into enterprise imaging systems

Enterprise imaging systems use a central archive as a hub that has connecting spokes to data from numerous hospital departments. This model is seeing increasing adoption. These systems help remove barriers from siloed, disparate PACS or reporting systems and consolidates all these elements so any clinician in the healthcare system can access the data. 

In cardiology, health systems often need a CVIS that can consolidate all the detailed reporting for all the subspecialties in cardiology into one system. This can be difficult if a hospital needs reporting beyond ECG, echo and cath reporting to include electrophysiology (EP), cardiac surgery, vascular surgery and pediatric cardiology.

"What we are seeing is that providers definitely want to consolidate. Generally speaking it is not often that they can find one system that is going to fit all their needs," Rasband explained. 

6. Integration of a third-party CVIS with Epic

The Epic EMR system has seen widespread adoption across healthcare, but Rasband said the modules for speciality departments like cardiology often do not have enough depth. This requires most hospitals to use a third-party CVIS that interoperates with Epic's Cupid cardiology module. Other third-party software also needs to integrate, include hemodynamic systems, scheduling and inventory control.

"That is the standard," Rasband said. "And we do see Cupid used differently all over the board. KLAS requires providers to use elements of Cupid's structured reporting, but that does not mean the providers are using it in all areas and each site is very different."

Epic allows reports to be customized at each site, but this requires a build by the IT team that can be very lengthy. Therefore it is not a simple process to modify reports. 

"Often it is not technical challenges to building these reports, it is resource challenges," she said. "Providers have a lot on their plate, and it takes someone with expertise to build out a cardiology report. It can be frustrating, but when we ask providers if they would buy Epic again, they said they absolutely would."

She said providers do rate Cupid and Epic well in cardiology, as long as these elements are supported by other strong, third-party CVIS vendors. And overall, she said there are no major integration issues with Epic reported with the most commonly used third-party CVIS vendors. 

"What is a really positive note is that we have providers on the clinical side that don't really know where Epic starts and stops with their third-party vendors integration. They just know they are viewing it through the EMR," Rasband said. 

7. Implementation of cloud and VNA storage for images and data

There is slow movement toward cloud storage systems and vendor neutral archives (VNA) to replace or augment on-site data storage. These systems can simplify web-based access to data, aid integration of data with EMRs and help outsource data storage off-site to alleviate the need to maintain a server farm onsite and its related maintenance and cybersecurity issues. 

VNAs are often implemented as part of an enterprise imaging system––often starting with radiology, and then adding cardiology because of the large amounts of data these two departments usually generate. Other departments with lighter data demands are usually added after these two are integrated. Rasband said some centers opt to integrate cardiology first just due to the complexity and different data types generated.

Watch the related VIDEO: 6 key trends in PACS and radiology informatics observed by KLAS.