When Worlds Collide: Integrating Radiology and Cardiology Imaging

On August 24, 2008, Good Samaritan Hospital, Vincennes, Ind, became the first site in the country to go live with integration between the Synapse PACS from FUJIFILM Medical Systems USA Inc, Stamford, Conn, and the cardiovascular image and information system (CVIIS) from FUJIFILM's subsidiary, ProSolv Cardiovascular, Indianapolis. FUJIFILM first announced the availability of integration between the two systems at last year's RSNA meeting.

"We've had the Synapse PACS in place for several years, and we implemented the cardiovascular system about two years ago, before Fuji had purchased ProSolv. We didn't know then that the two were going to meet at the end of the road." -Julie Thomas, director of cardiology Good Samaritan Hospital, Vincennes, Ind

Good Samaritan initially implemented the ProSolv CVIIS to bring its echo/vascular exams online; until then, they were still being viewed, distributed, and stored on VHS tape. Over the next two years, however, the cardiology department would gradually begin to bring most of its major modalities onto the cardiovascular system. “We knew we needed a product that could serve as a long-term storage solution for cardiac catheterization, echocardiography, peripheral vascular disease, ECGs, and stress tests,” Thomas explains. Meanwhile, the radiology department, by this time experienced at digital image viewing and storage, began wondering what additional clinical efficiencies could be achieved via integration between its PACS and the cardiology department’s CVIIS. “The radiologists began to imagine what the benefits could be,” Chris Vieke, Good Samaritan’s project coordinator and a supervisor in the cardiology department, recalls. “After an abnormal carotid scan, if the radiologists then did a CT or an MR angiography, they wanted to be able to pull up the cardiologists’ images to compare.” The benefits of integrating the two systems, however, extended beyond the clinical. Faster turnaround times would help Good Samaritan remain competitive in the Southern Indiana market, and the ability to transmit both cardiology and radiology images seamlessly would allow easier communication with both physicians and other hospitals throughout the state. “When we started down this road, we were doing everything with paper and transcription services,” Thomas notes. “Now that all of our systems are digital, images and numbers are immediately transferred to reporting stations, reviewed, electronically signed, and then sent to our patient medical record. It’s an enormous efficiency gain.” Once the integration was initiated, tying the two systems together was a fairly simple process. “We mainly worked after hours, so we wouldn’t interrupt the day shift,” Vieke says. “It was all software—just the two applications querying each other. No additional hardware was required.” At the end of just three days, Good Samaritan was ready to go live with its PACS/CVIIS integration. “What’s really remarkable is that we were able to complete the integration without our radiologists or cardiologists spending any time being trained,” Thomas says. “All the work was done by the support people from FUJFILM and our staff. They made it easy on the clinicians.” Responses have been largely positive. Whenever a clinician is working with an image in either application, the study list from both applications is available, allowing him or her to toggle back and forth between the two at will. The list of clinical efficiencies achieved through the integration is quite extensive. “Our chief radiologist loves having the side-by-side review,” Thomas says, “and in the cath lab, during any cardiac cath or percutaneous coronary intervention, the cardiologists can actually bring up any images from Synapse or ProSolv CardioVascular. It’s a huge enhancement in the procedure room. Efficiency and speeding up workflow are key.” Vieke says, “It helps the radiologists answer questions about their films.” He adds that the integration doesn’t just help the cardiologists and radiologists—it also yields benefits for supervisors and administrators. “A big benefit, for me, is that when I do quality assurance of our studies, I can look at the cardiovascular and Synapse images side by side,” he says. “It’s been a real time saver.” IT Efficiencies From an IT perspective, according to Chuck Christian, director of information services and CIO at Good Samaritan, the primary efficiency achieved is intangible, but not to be discounted. “What’s in it for us is the fact that we now have one less vendor to deal with,” he says. “Having one partner to work with instead of two helps us achieve a more singular focus on imaging.” Thomas concurs. “The benefit for the hospital is that we, wisely, separately chose vendors who married each other,” she says. “As we move into the future, we’re all traveling down the same road together.” Other clinicians in the hospital are also reaping the rewards of having an integrated system, and none of them more so than the specialists. “We do have doctors who will go in and look at their own films, like the open heart surgeons, who look in both Synapse and the cardiovascular application,” Thomas says. Because the system now supplies images from both the PACS and CVIIS when a patient’s name is entered, any clinician accessing the application sees efficiencies. “The primary care physicians are mostly interested in the reports, but the specialists are able to get both reports and images at once,” Thomas says. “They’re definitely getting the most bang for their buck.” That’s not to say that the first-of-its-kind implementation went off without a hitch, of course. In upgrading the ProSolv CardioVascular application to the Web-based 4.0 version, Vieke notes that some minor issues arose that the vendor is addressing. For the most part, though, her team is happy. “This is a group that will definitely let you know when something’s wrong,” she says, “so to have heard so few issues over the course of ten weeks is great.” The next step, for the cardiology department, is to bring its ECGs online; that’s when the primary care physicians truly will become invested in the integration, Thomas thinks. “We feel really good about bringing on our next application,” she says. “That’s where we will really touch many of our physicians, because they do look at their own ECGs.” Having the right support from a single vendor makes Thomas confident that further integration within the hospital will go smoothly. “I think we’ve really put ourselves in league with a good partner,” she says. “We didn’t have as much experience with it as our radiology department had, but we’ve been very happy with it. We have a lot of opportunities ahead of us to make a lot of people happy.”