Cardiology Departments Without Walls: eMedcon Enables Worldwide Cath/Echo Consulting

Lowell Satler, MD, Associate Director, Cardiac Cath Labs, Washington Hospital Center, Washington, D.C. Martin B. Leon, MD, Director and CEO, Cardiovascular Research Foundation, New York, New York
Lowell Satler, MD, Associate Director, Cardiac Cath Labs, Washington Hospital Center, Washington, D.C. Martin B. Leon, MD, Director and CEO, Cardiovascular Research Foundation, New York, New York
Use of eMedcon is focused around a facility-individualized website developed and hosted by Medcon. eMedcon software uploads angiographic and echo images for online access. Users might be referring physicians who wish to send images to tertiary care facilities for consultation, or hospital staff who want to send files to remote users or access these files outside of the department or hospital. With a Microsoft Internet Explorer plug-in, any authorized user can connect to an eMedcon facility website to send and receive cath or echo lab files from anywhere in the world with internet access. The interface is similar to that of most email programs. Medcon’s patent-pending Optimal Data Package (ODP) reduces file size while maintaining clinically important information. Combined with image compression technology, ODP dramatically reduces the size of angiographic X-ray images to make them suitable for Internet transmission, whatever the bandwidth. While eMedcon may be customized based on users’ particular needs, it comes with numerous built-in features. After a physician sets up preferences such as image edge enhancement algorithms, contrast, and brightness, eMedcon remembers them whenever and wherever the user logs on. Software automatically senses bandwidth and adjusts compression accordingly before sending images over the Internet. The built-in DICOM 3.0 viewer can be used to view not only cath and echo images, but also all other modalities, from X-ray to nuclear medicine. Individual websites are customized with the hospital’s logo and promotional copy. They are secure and fully HIPPA compliant. Washington Hospital Center (WHC) Lowell Satler, MD Associate Director, Cardiac Cath Labs, Washington Hospital Center, Washington, D.C. Washington Hospital Center is a 907-bed, private, non-profit teaching hospital, noted for its clinical expertise, innovative medical technology and patient-centered care. Since 1958, it has set the standard for adult tertiary care in the Washington-Baltimore metropolitan region, providing premier specialty services in the area’s largest private teaching and research facility. The Washington Hospital Center’s Invasive Cardiology Services, consolidated under the umbrella of Washington Heart, provides comprehensive, integrated heart care, using the most advanced technologies and maintaining a leading role in cardiovascular research. Internationally respected physicians perform more than 16,000 cath procedures and over 2200 open heart procedures each year, which makes the hospital center the leading provider of invasive cardiovascular services in the area. The Washington Hospital Cardiac Catheterization Laboratory has 10 rooms, an 18-bed holding area and two exam rooms. The invasive cardiology staff includes more than 100 employees. Additionally, some 75 cardiologists with private practices also use the facility. More than 50 cardiologists use it on a regular monthly basis. Our cath labs have been filmless since 2000. The department prides itself on keeping abreast of new developments that will advance patient management as well as streamline and simplify healthcare delivery. Our heart program was recently rated among the best in the nation by U.S. News and World Report. With a large referral base throughout the mid-Atlantic region, over 15,000 heart procedures performed annually, and a desire to further improve our interactions with our referring hospitals and physicians, WHC had long been interested in having cath lab files transmitted electronically for consultation. Rapid transmission of digital cines would eliminate the 24 to 48 hours typically involved in transfer of CD cines by courier and offer multiple benefits. First and foremost, it would improve patient care by facilitating faster treatment. At the same time, it would lower costs for referring hospitals by shortening patient stays. Finally, it would promote closer relationships with referring doctors, streamlining the communications process. Moreover, we had recently embarked on a new program to help other hospitals launch coronary angioplasty programs by monitoring their cath lab procedures and advising in the patient and lesion selection during the first phase of the new program. The ability to send these files to WHC electronically could make a strong contribution to the success of this program. WHC Challenges In order to implement an electronic consulting program, we needed technology that would provide cost-effective communications with an unrestricted number of users on an as-needed basis. We were expanding our referral base, and expected our number of users to grow. Before learning about eMedcon in 2000, we did not know whether the technology we wanted even existed. But we did know that if it did, it would have to be software, rather than hardware-driven, to provide cost-effective access at referring facilities. It likely would involve the Internet to provide universal connectivity and compatibility. And, it would have to be easy for users to set up and learn, since referring physicians, hospitals and staff might be occasional Internet users with no special training. We found eMedcon met our needs. It does not require dedicated hardware on either end or a licensing fee for each site. It can be set up by referring doctors and hospitals and mastered quickly. Any authorized user anywhere can simply log on to our eMedcon website: www.emedcon.com/whc and immediately access everything needed to send the file. We can receive diagnostic quality cath images from anywhere in the world in almost real time. Sending files from our hospital to remote users is equally easy. We began installation of eMedcon in 2001. A preliminary website was constructed by September with full system integration completed in November. At that point, over 15 hospitals that regularly refer cases to us using standard overnight couriers had already switched to eMedcon electronic transfer. Quality and Speed When evaluating eMedcon, image quality was of major importance because the images would be used for lesion assessment and characterization. Clinicians could detect no significant difference when comparing images downloaded from the eMedcon website with the originals. Today, we continue to monitor system performance and image quality. We have never changed our treatment recommendations after comparing the eMedcon image transmission to the patient’s original cine CD. Speed was another key factor because we knew referring physicians would not spend a lot of time waiting for computer image processing. Now that our site has been fine-tuned, uploading and downloading images takes only five to ten minutes. This means we can consult with doctors within 15 minutes of image acquisition a tremendous plus to all involved. WHC’s Custom Features eMedcon met many of our needs right out of the box, and Medcon further customized the installation to address our specific requests, which in large part were designed to enhance ease of use for referring physicians. When unauthorized users access the site for the first time, they register with the site, and then follow simple step-by-step instructions to allow them to download a special 3MB file. Automatically incorporated into Internet Explorer, this file allows users to compress cath files uploading to our website. The program has been customized to provide prompts to guide users through the uploading process. Medcon also created a customized pick list of WHC doctors to be sent files. Once the file is received at the server, the recipient at Washington Hospital Center is automatically e-mailed notification of the transmission. We had our website essentially designed as an electronic courier, transferring images in less than 10 minutes. It does not access information from user archives and does not suggest open solicitation of business as Internet commerce. Users who learn about the site through hospital contacts must first burn their study to a CD, which they upload to our website using the eMedcon software. Although eMedcon has the ability to seamlessly integrate with a digital cath lab system, we wanted the program to be completely freestanding to avoid internal firewall problems. While these could be overcome on a case-by-case basis, we wanted to simplify the process. Today the WHC system is such that anyone who has ever downloaded a file from the Internet can master eMedcon in minutes. Referring Hospitals, Consulting, and In-House Use Referring hospitals are extremely pleased with eMedcon’s ease of use, their own cost reductions (no courier costs), and our quick response time to their clinical problems. We feel that our Internet image exchange abilities enhance WHC’s reputation as a service-oriented facility and that the dramatically improved image turnaround time gives us a real edge in competition for business. We have already significantly enhanced WHC’s referral volume. eMedcon has also proven to be a useful tool for our consulting service for new angioplasty programs. It allows us to function almost as if we were on-site to review images. We feel eMedcon will help the growth of this service. eMedcon also has applications within the hospital. Since any computer with Internet connection has access to our website, eMedcon allows both cardiologists and cardiac surgeons to access images throughout the hospital without running over our hospital intranet. The Cardiology and Cardiovascular Surgery departments also appreciate the access to images at home, at conferences and other remote locations, particularly for referrals that occur during the evening hours as well as on weekends. Lenox Hill Hospital Martin B. Leon, MD Director and CEO, Cardiovascular Research Foundation, New York, New York Recognized internationally for its excellence in comprehensive cardiovascular services, Lenox Hill Hospital houses the Lenox Hill Heart and Vascular Institute of New York, which is an important regional referral center. The Institute has a staff of 50 interventional cardiologists and a total of about 80 technologists and nurses. It performs about 4000 interventional procedures and 1000 cardiac surgeries annually, and our experts consult on cases with healthcare facilities around the globe. Our five cath labs have been filmless for some time. Seeking to Increase Referral Services Lenox Hill wanted to make our clinical expertise available and increase our referral network by providing faster, more convenient consultation services, giving us a competitive edge. The cardiology department became acquainted with eMedcon, and we felt this product might be just the marketing tool we were looking for to open up a new realm of possibilities for our consulting practice. The Lenox Hill Heart and Vascular Institute played a significant role in the decision-making process as well as in efforts to promote eMedon-enabled service to other hospitals following installation. The purchase of eMedcon was an important part of our plan to build referrals, and the decision involved not only cardiology, but also numerous other hospital departments. Clearly, streamlined communications and fast image turnaround time were significant advantages. The entire group felt that offering a cutting-edge service such as Internet“based consultation would only add to our reputation as a technology leader. Moreover, we hoped to use eMedcon to build on our existing international business, enhancing our visibility and reputation around the world. Beginning Installation Of course, to meet these goals, eMedcon had to support the cardiology department’s demanding clinical standards and dedication to the highest quality patient care. Carefully examining the product, clinicians were impressed with eMedcon’s image quality and were convinced it would allow us to consult on even the most difficult cases presented online. Moreover, the enhanced turnaround time due to the elimination of courier services also would improve patient care by facilitating more timely treatment. The Institute began installation in 2001. Both the Lenox Hill clinical team and consulting physicians were extremely pleased with the results, from the streamlined communications with hospitals to the high-quality images. In close consultation with our clinical team, Medcon developed a range of customized features for us. For example, once a referring doctor sends a study to a specific clinician at Lenox Hill, the system defaults back to that doctor for additional consultation until it is specifically changed. To help schedule reading, we requested that both physicians as well as their secretaries receive email notification of a study’s arrival. Medcon also was able to make a number of adaptations to help us streamline workflow. With our large volume of cases, these workflow adaptations had a significant impact. Images Go Directly to the Cath Lab Currently, eMedcon is being customized to send images directly to our Philips dedicated viewing stations in the cath lab control room. This will allow doctors to view images on a high-resolution monitor upon arrival, without leaving the lab. To facilitate this process, eMedcon is being directly interfaced with the hospital archive, where the images will be sent upon arrival. Images will then travel over the hospital Internet to a PC in the cath lab control room. From there, they can be accessed by the dedicated workstation.