Hemodynamic data shown on screens from the Merge Hemo recording system. It is among the newer generation hemodynamic systems for cath labs that are more user friendly and have technologies to speed workflow.
The current generation of hemodynamic monitoring systems can help catheterization labs electronically document the course of an intervention for the procedure report, follow-up care and administrative processes. However, healthcare IT is moving increasingly toward seamless electronic data integration across the enterprise. For this reason, buyers of these systems need to make sure they can play nice and share their data across multiple layers of IT and with various vendors’ software.
Hemo systems that can provide detailed, automated data to avoid the need for manual procedure logs and manual transfer of data into various software systems after a procedure can speed workflow and reduce the staff time used for duplicate data entry. By automating the recording of a patient’s vital signs and data during a cardiac catheterization procedure, cardiologists can expedite charting and final reporting, view reports in real time and query the database for clinical decision support.
Trends in Improving Workflow
“What I am seeing are not entirely new systems, but enhancements to existing systems directed at trying to help clinicians and physicians in their workflow,” said MD Buyline clinical analyst Tom Watson, BS, RCVT, who tracks trends in interventional cardiology. “These changes are helping them capture all the information as it goes through the process without a lot of manual intervention so they are getting full reporting, full reimbursement, and consistent and accurate data. Virtually every hemodynamics system vendor has made changes in that respect, including GE, Philips, Siemens and Merge.”
These improvements include better mapping of how the data should flow from the hemo system into the proper documentation fields in cath lab reports. The systems also auto cross-check to ensure all the data needed to complete a report or registry filing is there.
“It can help get them all of the documentation they need, not only for the patient diagnostics, but also for the reimbursement aspect,” Watson said.
Additionally, he explained hemo systems can help auto-capture data needed not only for diagnostic catheterizations and interventional procedures, but for the more complex percutaneous coronary interventions (PCI) and structural heart procedures now being performed. Oftentimes, these data points need to be sent to various registries, which can be very time-consuming if the data needs to be transferred manually. Notable among today's registry requirements include those for transcatheter aortic valve replacements (TAVR) and left atrial appendage occluders (LAA).
New Hemodynamic Monitoring Technologies
Vendors are looking to improve customer interface and software for high-complexity technology in order to provide more efficient workflow processes. They are doing so by introducing new technology that significantly simplifies the data capture and utilization process with a focus on assisting the clinician in key procedural steps. The need to ensure high-quality, complete data capture and reporting is paramount because this will affect reimbursement. Systems are now automatically populating data fields that previously would have needed to be entered manually. The technology also is cross-checking the values to verify they are falling within acceptable values and ensure the data points are legitimate.
Hemodynamic monitoring vendors showing these improvements at the American College of Cardiology (ACC) 2016 and 2017 annual meetings included GE Healthcare (Mac-Lab), Philips Medical (Xper Flex Cardio) and Siemens (Sensis Vibe). All three vendors have changed and enhanced their solutions to be less labor-intensive and to capture the critical values. This ensures a complete record is captured for accurate diagnosis and complete reimbursement without delays due to missing or incorrect data. Additionally, there is a need to minimize the potential for human error, which can negatively affect the procedure information and the associated reimbursement.
Siemens Healthineers released a new version of its hemodynamic system, the Sensis Vibe, at ACC 2016. The new system completely changed the workflow, platform and the interface to make it much more intuitive and user-friendly. Siemens said the new system offers cath lab staff a hemodynamic system that meets the rising demand for proficient data management and streamlines documentation and reporting. Several new features distinguish it from previous Siemens hemodynamic systems. The biggest of these is an intuitive user interface. It has a component that searches the database for matching entries as soon as the user begins typing, resulting in auto-completion of text. The CaseLog component, which enables the physician to follow the entire course of a procedure at a glance, is a time-stamped overview of all hemodynamic/electrical events and other occurrences recorded or manually captured. CaseLog’s structural data lines, customized display and filter options enable staff to adapt this overview to their preferences. Another feature helps staff verify data entries and measurements automatically in addition to highlighting inconsistencies even before a staff member closes a study.
“All the improvements have really been focused on the data capture and the ability to do that through the case and not have a lot of manual entry to get everything done,” Watson explained.
GE’s Mac-Lab hemodynamic recording system recently added new features and functionality designed to help make the cath lab more productive, remove workflow and data storage obstacles, and enable more procedures per day. It added new technology to capture end-tidal carbon dioxide (ETCO2) so a third-party monitoring device is not necessary. Other features include streamlined multi-path documentation and reporting, which helps the user document cases with few interruptions. Users can start a report anywhere on the network and document on multiple stations simultaneously. Users can now sign their case reports electronically and transfer the data immediately to data storage. Once signed, the report is locked from editing, although further signatures can be added. E-signatures may also help improve documentation compliance and reporting workflow.
Change Healthcare’s McKesson hemodynamic monitoring solution provides support for intra-procedure monitoring and charting with integrated fractional flow reserve (FFR) as well as pre- and post-procedure patient charting for the holding area. It can be sold as a standalone system that can be interfaced to a cardiovascular information system (CVIS) or electronic medical record (EMR) for reporting, or integrated with the McKesson CVIS solution. The McKesson CVIS and hemo system use the same database, and thus do not require an interface to connect to each other. The McKesson CVIS can also interface to other hemo solutions.
Merge Healthcare’s Merge Cardio system was named the Best in KLAS by end users for both its CVIS and for cardiology hemodynamic monitoring systems each year between 2011-16. It automates the cath lab process, including data collection, waveform analysis, inventory control and procedural reporting, into a comprehensive digital patient record. The easy-to-use, drag-and-drop functionality enhances efficiency when documenting procedures, while user-defined templates that automatically populate known data fields reduce errors and eliminate duplicate data entry. Merge said its system also improves care delivery with shared information and reduces operational expenses through one central server.
Toshiba offers cath lab and hybrid OR installations centered around its angiography systems. Toshiba has partnered with Merge to provide both CVIS and hemodynamic system integrations as part of its package for new turnkey cath lab installations.
Philips Healthcare’s Xper Flex was released in 2012 and has undergone several improvements in recent years, Watson said. It is equipped with advanced clinical decision support tools to help evaluate a patient’s overall cardio performance. It displays and analyzes invasive blood pressure, surface electrocardiogram (ECG), respiration and other vital signs. The Xper Flex offers several advantages over previous systems, including traditional 12-lead interpretation of the resting ECG in addition to 16-lead analysis, enabling clinicians the freedom to choose which approach is most appropriate for each situation. The additional right chest and posterior leads used in 16-lead ECGs can provide information that may not be apparent on traditional 12-lead ECGs. It also comes equipped with integrated FFR functionality and a DXL ECG Algorithm analysis capability that uses multiple steps to produce precise and consistent ECG measurements to generate interpretive statements. Additionally, the system has Culprit Artery Detection — a technology that provides suggestions on the probable site of an occlusion prior to cath procedure, saving time and assisting with procedure planning — and patented ST Maps that provide a graphical indication of ST elevation.
Integration of Data from Hemo System IT Systems is Critical
Today, interoperability between various systems in hospitals is key as healthcare systems become more integrated electronically. It is critical to have an uninterrupted flow of data from the hemodynamic system into all the software systems that require it, including the cardiovascular information system (CVIS or cardiac picture archiving and communication system [PACS]) and procedural reporting systems. This includes interoperability with the interventional cardiology reporting system and all the other users of the cath lab. This might include reporting systems used by electrophysiology (EP), interventional radiology and vascular surgery. Many hospitals still have a patchwork of subspecialty software systems from various vendors, so hemodynamic systems need to be vendor-neutral.
Outside of the cardiology department, this data might also need to be compatible with the enterprise electronic medical record (EMR) system or analytics software that may be used to data mine the information. Implementation of advanced analytics software has become the next big trend in health IT since the implementation of EMRs. The software is used not only to pull statistics for departmental and hospital management, but also for population health initiatives, clinical research and predictive health analytics. Another use of the big data generated by all hospital systems, including hemodynamics, will be to help train the future generations of artificial intelligence software.
“Data integration is much more important today,” Watson said. “The world has changed tremendously over the past few years and IT has integrated with almost everything in the hospital. With the recent push where everyone has now moved to an electronic medical record, integration has become a big piece of what the clinical systems have to do.
Watson said people need to ask what is required for a vendor’s system to interface with their EMR and other clinical software systems. One of the big things that he has seen in recent years are the issues that often develop when attempting to integrate two different vendors’ systems. He said if vendors do not work together to solve the integration issue, then the physicians and other end users need to push back and demand a solution that delivers the end result they need.
“You really have to have a pretty close and open degree of cooperation and partnership on both sides to end up with a solution that works well, and that can be a difficult challenge,” he said. “I think integration of data, the handling of data and system interoperability are going to be the key words in any conversation.”
Watch the VIDEO “Trends in Cath Lab Hemodynamic Monitoring Technology.” MDbuyline clinical analyst Tom Watson, BS, RCVT, explains the new technology trends he saw on the expo floor at ACC.16. While there were not many new product releases, all technologies are being increasingly integrated into the electronic medical record.
Comparison of Hemodynamic Systems
This article served as an introduction for a hemodynamic systems comparison chart, which can be accessed on the DAIC website at www.dicardiology.com/content/hemodynamic-monitoring-systems. This page requires registration, which is free and only takes a minute to complete. The chart includes technical specifications for all the major cath lab hemodynamic systems on the U.S. market.
Chart participants include:
Change Healthcare (formerly McKesson)
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