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CLINICAL EVENTS CALENDAR

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    Oct 22,2008
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    The Joint Commission Presents Laboratories: Accreditation Essentials (Beginner: 10/22; Advanced 10/23)
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    Oct 23,2008
    Introduction To Cardiovascular Cath Lab
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    Oct 25,2008
    Cath Lab Basics ‘08 with Dr. Morton Kern and Dr. Michael Lim
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    Oct 30,2008
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    Oct 30,2008
    Introduction To Cardiovascular Cath Lab
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Shore Memorial Hospital: Faster and More Efficient Workflow

VOLUME: 12 PUBLICATION DATE: Sep 01 2004

A Case Does That Does the Heart Good

The ultimate reward when implementing a new system is witnessing its contribution to a positive outcome in a life-threatening situation.

Mr. Brown* is a 78-year-old man who experienced chest pain, particularly when working in his yard. He thought it was heartburn and not cardiac-related.

Mr. Brown was scheduled as an outpatient on April 12, 2004. When he arrived at the CardioVascular Institute, all demographic information was duly recorded on the hospital information system. The interventional cardiologist evaluated Mr. Brown and immediately determined that he required a diagnostic cardiac cath.

An order for a left and right heart cardiac cath was entered into the HIS. From this point on, the transmission of demographic information for Mr. Brown through the system was automatic and transparent. Using HL7 standards, the HIS sent Mr. Brown’s name, the procedure ordered and other related information to the Medcon Modality Worklist application. The Modality Worklist parsed the incoming information and stored it in the central TCS Symphony database. The modalities in CVI queried the central database and received the updated schedule for a cath procedure in DICOM format.

Meanwhile, Mr. Brown arrived at the cath lab to undergo his diagnostic procedure.

“By the time we saw the third image, we knew we had a major blockage,” describes Kathy Pugliese RN, CVI Nurse Manager. “There was more than 70% stenosis on the LAD and 80% on the LMCA. There was no question that Mr. Brown required an urgent coronary artery bypass.”

The cath team decided to transfer Mr. Brown to The University of Pennsylvania Medical Center-Presbyterian for emergency surgery. Using the Cath Reporting application, a complete final report of the cath procedure was generated and saved on a CD along with the cath images, in time to leave with the patient. CVI called for a helicopter and Mr. Brown was airlifted together with his self-playing CD, which contained all the relevant patient data, a complete final cath report and the images.

Dr. Waxman said, “The time it took from the moment we decided to transfer Mr. Brown until he was admitted to surgery, with the cath lab report and all the images, was only 90 minutes, and that included the 25-minute helicopter ride!”

Today, Mr. Brown is fully recovered, and is able to continue his yard work.

*The patient's name has been changed to protect his privacy.

Issue Number: 
9
author: 

Gina Preston, MHR, RD

Shore Memorial is the only local hospital offering a clinical affiliation with the University of Pennsylvania Health System. Through this affiliation, cardiologists from PENN Cardiac Care at University of Pennsylvania Medical Center-Presbyterian provide diagnostic catheterization services on-site in Shore Memorial™s recently opened CardioVascular Institute (CVI).
The CVI is located on the hospital™s second floor. An $8.5 million Institute, it includes some of the most advanced technology available and a team of nurses, technologists, cardiologists, radiologists and vascular surgeons selected for their specific experience and expertise in cardiac care.

The vast majority of the Institute™s patients come for stress tests, echocardiograms and electrocardiograms, although the Institute also performs cardiac catheterizations. Harvey Waxman, MD, Presbyterian™s Chief of Cardiology, serves as medical director for the Institute™s low-risk cardiac catheterization laboratory, and Gina Preston is administrative director.
Gina notes, It was very important to us to introduce a system that would smoothly integrate with non-invasive cardiac studies. Since we had just purchased a Siemens PACS system, integration between that radiology system and the new system for cardiology and vascular studies was another determining factor.

Shore Memorial installed a complete suite of clinical information system (CIS) components, including Medcon™s Cath Report, Echo Report and Vascular Report. TCS Symphony reporting tools have what™s called On-Image Reporting, where physicians and technologists point and click their diagnostics directly on the image. Shore Memorial also installed MDWeb to enable physicians to review cases from remote locations over the Internet. The hospital™s future plans include full reporting over the web, further supporting a paperless workflow.

With the new system, orders data is automatically sent to modalities, eliminating duplicate data entry on the modality. HemoLink, an inbound hemodynamics data interface, includes a data mapping engine that auto-populates most of the final cath report when requested. MDEchoLink imports all echo and vascular measurements performed on ultrasound machines. The outbound results interface allows final reports to be exported back to the Cerner HIS for inclusion in the central Electronic Medical Record (EMR). This feature ensures access to all patient data from one central location, using any workstation running the HIS.

Pre-set customized queries can also be applied to the TCS Symphony database to facilitate administrative operations and clinical research. Queries are built with a visual query builder. Data is exported into formatted reports or Excel spreadsheets for statistical processing.

The integration between cardiology studies and the HIS is a tremendous benefit for referring and consulting cardiologists, says Kathy Pugliese RN, CVI Nurse Manager. The perfect example is when a patient arrives at the emergency room at 2 am with chest pain. The cath lab report created six months earlier is immediately pulled up and the attending physician has on-the-spot access to all the relevant data.

Gina Preston can be reached at GPreston@shorememorial.org

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CME Showcase

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Time: 6:00 pm ET
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This activity is sponsored by the North American Center for Continuing Medical Education.

LUMEN 2009 - THE SYMPOSIUM ON OPTIMAL TREATMENTS FOR ACUTE MI

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Location: Loews Miami Beach Hotel
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Release Date: June 19, 2008
Expiration Date: June 19, 2009
Target Audience: This activity has been developed for physicians, nurses, and technologists.
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