Last weekend I attended the exhibits at the annual meeting of the American College of Cardiology (ACC). Several trends suggest to me that cardiology is awakening to the changes in healthcare.
Unified View
Cardiology services tend to be fragmented, with varying vendors for different service areas. This has long resulted in a fragmented access to patient study information. For example, an ECG (Electrocardiography) system might be totally independent of other cardiology systems such as an Echo Sonography PACS and reporting system. This has complicated how cardiologists have accessed information about their patient, and made it difficult to get a clear procedure history perspective.
Several companies appear to be doing something about it! Most notably, Philips (http://www.healthcare.philips.com/main/products/healthcare_informatics/products/cardiology_informatics/Intellispace-Cardiovascular/index.wpd) has introduced their IntelliSpace Cardiovascular system that provides a shell over a number of cardiovascular applications, to provide a unified view of a patient’s history on a visual time line. The API (Application Program Interface) nature of the design means that multiple applications can be launched from a common work space. Additionally, PDF documents and reports can be sent to the system and added to the time line, so even if just the report exists, it can be conveniently accessed.
Along similar lines, Agfa Healthcare (http://www.agfahealthcare.com/usa/en/image_management/radiology/products/cardiology/index.jsp) is developing an enterprise image platform across multiple service areas. In the case of cardiovascular services, the core platform presents a common work list of studies and can launch the specific application tool for the selected study. For several aspects of cardiology, Agfa has licensed applications from Tomtec (http://www.tomtec.de/industry_partners.html) that launch directly from Agfa’s core platform.
McKesson (http://www.mckesson.com/providers/health-systems/department-solutions/cardiology/mckesson-cardiology/) is also working on several developments to improve cardiologist productivity, including an enterprise work list that can use rule sets to direct studies to specific cardiologists, as well as to present a complete record of studies done on a specific patient.
Structured Reporting
Cardiovascular reporting has long emphasized the use of structured reporting over other methods such as dictation, largely due to the amount of measurement and documentation data acquired during procedures that must be included in the report. Over the past two years reporting templates have become more sophisticated, first with the implementation of Appropriate Use Criteria (AUC), and more recently guidelines for structured reporting in the cardiac catheterization laboratory (http://networking.americanheart.org/blogs/6/930), known as the ACC/AHA/SCAI 2014 Health Policy Statement on Structured Reporting for the Cardiac Catheterization Laboratory.
It seems that there are no abundance of initiatives to improve the quality of structured reports, and enable them to better meet standardized reporting requirements. Most vendors are aware of the ACC/AHA/SCAI guidelines and are working toward compliance.
Vendor Segmentation
There continues to be a proliferation of vendors offering cardiovascular information systems (CVIS), with little consolidation. Merge Healthcare (http://www.merge.com/Solutions/Cardiology.aspx) did acquire DR Systems (http://www.drsys.com/) recently, and continues to see a market for DR Systems’ cardiology products. Aside from this, there continues to be a number of small, niche vendors providing CVIS solutions.
Vendors seem to fall into three categories: Imaging Equipment; Information Technology; and Specialty vendors. Of these categories, imaging equipment vendors appear to offer the most complete line of products. Of the information technology companies, McKesson and Cerner appear to offer relatively complete product lines with differing strategies. McKesson seems to develop from within, while Cerner seems to partner with multiple vendors. Specialty companies tend to focus on specific service or product areas, such as ECG, or specialty reporting applications.
Mobility
Mobility seems to be slow to CVIS applications. Many vendors offer enterprise solutions, but these typically are limited to viewing and not reporting capabilities. The exception may be McKesson (http://www.mckesson.com/providers/health-systems/department-solutions/cardiology/mckesson-cardiology-ecg-management/) with respect to ECG management. McKesson showed an interactive reporting capability that works on an iPad and an iPhone.
Another mobility aspect is cloud utilization. Lumedx (http://lumedx.com/), long an innovator in CVIS registries, reporting, and analytics, emphasized HealthView as a comprehensive web-enabled CVIS. HealthView’s web enablement allows access to patient studies from the hospital, office or home, providing added flexibility to patient care.
My read on ACC.15 is that it was a year of awakening relative to the CVIS and interoperability as part of the larger healthcare “ecosystem.” By increasing interoperability between cardiovascular and hospital systems, cardiology is finally acknowledging the benefits of integration on a larger scale – a good thing for healthcare!
