Feature | April 30, 2014 | Jen Ireland and Val Kapitula, Ascendian Healthcare Consulting

Essential Elements for New Cardiovascular Information Systems

What to look for when shopping for a new CVIS

CVIS, cardiovascular information system

Cardiovascular operations often suffer from being a hybrid of multiple systems, outdated technology and disparate silos of data. Many healthcare providers are seeking to modernize their cardiovascular departments with a cardiovascular information system (CVIS), allowing transformation across people, process, organization and technology facets. A successfully implemented CVIS solution allows organizations to modernize and optimize the cardiovascular service line. Breaking down the advantages into terms and next steps you can discuss with your executive suite is essential and will allow you to analyze potential vendors’ offerings and organizational gaps as you move from your legacy environment to the “new vision.” Consider the following benefits and features as you develop a comprehensive road map for your future cardiovascular operations and services.
Increased Performance
No matter how fast or how hard staff works in the department to increase productivity and performance, they can only go as fast as their legacy technology allows them. If the technology solution has silos of data/imaging, the staff and cardiologists will always have to physically move to a different workstation or try to query/retrieve this information for another source — taking more essential time. When the procedural information is entered by the user, the silo technology further demands redundancy due to lack of interoperability. That type of workflow is inefficient and no longer acceptable in today’s competitive healthcare environment, which is increasingly demanding greater productivity with fewer resources. 
A fully integrated cardiovascular department with a CVIS enables staff to remain in one area and have complete visibility of a patient’s prior history along with current procedural data/imaging. Most of the market-available solutions have structured reporting modules that have been optimized to improve cardiologists’ reporting workflow with reduced steps of data entry and conventional dictations. Structured templates for echo, pediatrics, peripheral vascular, cath lab and several others are offered by many solutions in the market, and this has truly become a standard practice for increased performance.  
Streamlined Patient Care
How do you streamline patient care without jeopardizing quality? All gaps in the patient’s health record need to be addressed, and patient information has to be accurate and up-to-date. If a patient’s health information is stored in various repositories within a single organization, and among several non-affiliated healthcare providers, the treating physician will have limited visibility to the patient’s medical history to render best-informed decisions. Even worse, the cardiologist may be treating the patient from an outdated data/imaging report; this creates a stack of concerns for patient care.  
Patient care is beginning to evolve outside of a single hospital. Organizations need to consider implementation of technology that not only streamlines workflow within one cardiology department, but creates a continuum of care across multiple departments, systems and organizations. Such technologies as vendor-neutral archives (VNA), coupled with a CVIS, allow organizations to consolidate all of their data/imaging into a single enterprise managing solution and distribute this vital information to all treating physicians; whether you are a cardiologist looking at an ECG, a cardiac electrophysiologist working on retrieving prior ablation data for an electrophysiology study or an emergency department physician viewing a chest X-ray, everyone is treating the patient from one data/imaging source of truth. This type of environment streamlines the treatment process in today’s healthcare and strategically sets the organizations for the value-based reimbursement model. 
Image/Cardiology Asset Accessibility
Cardiologists never seem to treat a patient from a single diagnostic test. Before a patient is treated for angioplasty, they may undergo several noninvasive diagnostic procedures such as a chest X-ray, computed tomography angiogram (CTA), ECG, echocardiogram and several others. Access to this stack of data/imaging could be daunting task, if all this is stored in disparate systems — this is assuming that the patient has been treated in one facility. If a patient has prior studies completed at a different office, it is critical that these studies are made available for comparison and are imported into the system for a complete patient record. Implementation of a well-evaluated enterprise CVIS allows cardiologists and clinical staff to be significantly more efficient in the preparation and post-procedural phases of patient care.
Timely clinical access to patient data/imaging is a critical success factor in any treatment. In addition to clinical needs, today’s healthcare administrators rely on accurate and timely data to optimize their operations. If department managers are not looking to reduce operational costs with their equipment, supplies and staff management, the next few years will be extremely difficult with dropping reimbursement rates. Healthcare organizations will rely on accurate data stored within CVIS, VNAs and other informatics systems to create operational efficiency without jeopardizing clinical outcomes.  
Structured Reporting and Analytics
Structured reporting and analytics are the “buzzwords” in the CVIS market. Almost every CVIS solution offers some sort of structured reporting for all cardiology-related procedures/modalities. The offerings with analytics tools and vendors’ ability to provide data mining have now jumped to the top of the list for healthcare provider requirements.  
Structured reporting has completely eliminated the need for conventional dictation. Some CVIS solutions still offer both, but more recent implementation trends have proven that structured reporting yields more accurate and timely results. Similar to early radiology PACS (picture archiving and communication system) conversion days from film to imaging, there is an ongoing challenge with general change and adoption of a new CVIS technology. It is simply a matter of time when cardiologists and clinical teams realize that structured reporting has the ability to maximize efficiency in the reporting workflow, if adopted. 
Today, clinical and business analytics are absolutely critical for healthcare providers. In this demanding industry, measurable clinical outcomes will be the driving force for organizations. Hospitals and integrated delivery networks will have to establish internal benchmarks for clinical and business performance in order to sustain the drop in the ongoing reimbursement rates. Analytics data will need to be accurate, relevant, up-to-date and manageable. Leadership will need to generate periodic reports to see how well they measure against their established benchmarks. Not all CVIS solutions are created equal in this area; however, majority of them do offer built-in data mining and reporting tools. 
Unfortunately, the analytics data is only as good as the incoming source data. If the implemented CVIS utilizes limited integration to all source-delivering devices/systems, the analytics will continue to have gaps. Well-planned procurement of a CVIS and true partnership with its vendor will become more important in the next few years. 
Once an organization is indoctrinated with the key terms and advantages of CVIS, it will then need to drive the initiative, select the supporting technology and implement a successful solution. Vital to success is the assessment of existing infrastructure and the “to-be” vision.  
Strategy and Business Case for Transformation
The major driving factors of purchasing a CVIS solution are reduction in data silos, streamline workflow across the cardiology departments, analytics and the need to have access to data anytime/anywhere. With the implementation of a CVIS, cardiology departments can remain competitive while meeting the demands of their customers. Considering a CVIS solution is a major financial investment and implementing it will have a long-term effect on daily operations and patient care efficiencies. There are a few different purchasing and implementionstrategies that can be used to guarantee the best results:  full replacement, phased approach and a hybrid approach. Determining the strategy will help justify the business case and will avoid unnecessary spending and resource hours.  
Vendor Selection and CVIS Implementation
A robust CVIS solution can provide a foundation for improved patient care and streamlined operations, but systems offer uneven features and functionality. It is important to exercise due diligence in determining which vendor provides the best fit for an organization and dependent on legacy systems, politics, budget, clinical requirements and to-be vision. For years, this process — called a request for proposal (RFP) — has served to provide the best available tool for making an educated decision and alleviating some of the risks associated with selecting the wrong vendor. Requiring multiple vendors to submit responses to an RFP allows for the comparison of each system in order to make an informed decision. 
When the appropriate system is selected based on the needs of the organization, the implementation can be easier. However, implementation of any new system will cause a natural change in the organization. A project plan needs to include a list of possible change risks with mitigation options and contingencies should they occur. Early buy-in from the leadership, physicians and IT will also help in the implementation phase. Leadership needs to be eager for the project before expecting the remaining support staff to believe and adopt.
Assessment for Cardiology Workflow, Organizational Change Management
The most common mistake made is not conducting a review of what current systems exist in the healthcare enterprise. Anybody who has ever done an assessment of the cardiology department cannot believe two things: 1) how different it is from other imaging areas, and 2) how many different devices and systems are used. Understanding current systems and their function will aid in the selection process of interconnectivity and interoperability to future vision. 
A healthcare system should consider other factors such as the volume of procedures, the different modules needed (cath, electrophysiology, echo, pediatric, etc.), its financial resources and in-house technical staffing capability. In addition, it should work with other imaging departments to see if they are moving toward a VNA or other enterprise initiatives. This could decrease cost for back-end storage and while sharing operational costs. 
Editor’s note: Jen Ireland is a senior consultant at Ascendian Healthcare Consulting and is a frequent contributor to publications and a speaker in forums focused on CVIS and enterprise dose management. She can be contacted at [email protected]. Val Kapitula, RT(R), CRT, PMP, is a senior consultant who is a frequent contributor to publications and forums focused on cardiovascular operations, services and HIT innovation. He can be contacted at [email protected], or visit www.ascendian.com. 

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