Radiologists Take the Wheel

Ms. PACS: One of the big growth areas for PACS right now is in cardiology PACS. (Don’t cringe – cardiologists can look at images too.) So we at ITN decided to do a Webcast on it - produced by Herman Oosterwijk - entitled: 'Cardiology PACS Integration Can Be Seamless.' With the tagline: ‘Successful Integration is System Critical' - to add a little umph!

We found out that Cardiology PACS is more than just a popular theme, it is a huge undertaking that requires a lot of cooperation between the radiology department, the cardiology department and the IT people.

The way they set it up at The Heart Hospital Baylor Plano is that the RIS is the system where all report generating begins and ends - for both the radiologists and the cardiologists.

One of the problems that the cardiology staff is having with the RIS is: “The cardiology staff was not used to a radiology workflow and we are using a RIS for cardiology, and if you do not follow that process of scheduling, arriving, beginning or completing the exam in RIS, it could cause a break in downstream systems,” said Lori Crissup, RN, Cardiology IT Specialist, The Heart Hospital Baylor Plano.

I thought this was interesting, as it suggests that in the integration of PACS and CVIS, RIS drives the cardiology department's workflow...i.e., the cardiology staff needs to adopt radiology workflow.

“So the orders are placed in the RIS and from the RIS the patient order is brought over on the schedule to the hemodynamic monitors. Once that patient is selected in the schedule on the monitor, we select the case and all of that information populates. All of the hemodynamic data and all of the ACC data is transferred into the DMS servers. Then the cardiologist can go to the workstation in the cath lab and add his or comments and results directly into the report,” explained Richard Sanders RN, Cath Lab Manager, The Heart Hospital Baylor Plano.

Integrating the cath and echo labs, with all of the cardiovascular images, including cath, echo, nuclear cardiology and radiology images like CT, MR and PET- and SPECT-CT – with the rest of the enterprise is not only driving market growth in PACS, but with RIS generating the reports, the cardiology department has to reinvent its workflow…and that puts radiologists in the driver’s seat.

PACSman: When I went to high school my parents made me study French even though I begged and pleaded to study Spanish. Why? Because I could reuse my brother’s French books they invested in. Besides “French is the universal language - everyone speaks French.” Of course that the early 70’s when I had no other choice, but to accept my parents flawed logic. Living in a small white bread community in New Jersey my only exposure to Hispanics was limited to hearing Aurelio Ramos - who was probably the only Hispanic kid in all of Red Bank - yipper yap with his parents…I never did hear anyone speaking French either but by jove I did learn French - or at least enough to understand the words when Lady Marmalade sing her disco hit of the same name in the mid 70’s...

So here I am living in Orlando about 4 hours north of this side of Havana speaking high school French while my 15-year-old son Matt can easily converse with our wonderful Puerto Rican neighbor Jackie in fluent Spanish. Go figure…

So what am I getting at here? While cardiology using a radiology system at Heart Hospital Baylor Plano (HHBP) might work, it’s beyond klugey. That’s like me speaking French in a Hispanic world. The bigger question though is why does cardiology need to “adopt” radiology’s workflow when theirs is different. The ONLY real commonality these two systems have is a central archive- period. The Cardiology Information System (CIS) market is also a $100M+ market in the US alone so why try and make something work with bailing wire and chewing gum when you can have a much smoother system designed specifically for cardiology’s needs?

Looking at the bigger picture does a central archive for radiology and cardiology make sense? Absolutely, and while we are add it let’s add pathology, lab, pharmacy, financial, the HIS, and EMR on it too, provided the facility has a strong disaster recovery solution in place and an even stronger IT infrastructure to support it…Let’s also make sure the archive is truly vendor neutral archive where data migration is not necessary either.

So does using a RIS to take the place of CIS make sense? Not in my book. That’s like Israeli Prime Minister Ehud Olmert being sent an invitation to a Christmas party from the Pope. You have to ask- would he bring a gift? Sing carols? Attend mass? Would the Pope object if Olmert wore his yarmulke in church? Having cardiologist “accept” radiology’s system with “radiologists taking the wheel” was either an act of kindness or a Henry Ford moment to the cardiologists from the hospital (“You can have it in any color as long as it’s black”) The pope might have invited Olmert, but you can rest assured he was only being polite in accepting it and by no means had a “come to Jesus” moment because of it. The same I’m sure holds true for the cardiologists. Saving money by using a RIS in a CIS application may be penny-wise and may even work here, but to me at least the loss in productivity in the single biggest revenue generating department in the hospital seems at least from the surface as being pound foolish…(with apologies to the radiologists who, in this case, are Avis to cardiology’s playing Hertz - “We try harder…”)

Integration is crucial and what is being done at HHBP is a great start. Let’s just make sure though that every department is provided the tools they need to optimize efficiencies. While it is commendable to want to save money by having cardiology use radiology’s RIS, we should never compromise the longer-term vision of a department by focusing on the short-term goals like saving a buck…