Providence Hospital and Medical Centers: The Past, Present and Future: Utilizing technology to adapt new healthcare strategies

Christopher Bissell, Manager, Non-Invasive Cardiology, Jack Cain, Manager, Invasive Cardiology/CIS, Christopher M. Southwick, Administrative Director Providence Heart Institute, Southfield, Michigan
Christopher Bissell, Manager, Non-Invasive Cardiology, Jack Cain, Manager, Invasive Cardiology/CIS, Christopher M. Southwick, Administrative Director Providence Heart Institute, Southfield, Michigan
In October 2003, the first phase of the Providence Heart Institute opened. The Heart Institute now offers complete, centralized cardiac diagnostic services, including echocardiography, nuclear cardiac testing, catheterization labs, electrophysiology, recovery and cardiology support services, in one unit, providing patients, families, staff and physicians a convenient, pleasant environment. Providence Park (nearby in Novi, MI) offers a comprehensive array of outpatient diagnostic services, including echo and nuclear studies. Mission Health Medical Center - Livonia also houses many outpatient diagnostic programs, including cardiac testing. Providence Heart Institute’s Main Campus in Southfield and the two satellite facilities (in Novi and Livonia) are networked via gigabit and T1 networks, respectively. The remote sites and main campus function together as a unified department. This means that images and information acquired at all locations are integrated and shared throughout the entire Heart Institute. Physicians and clinicians responsible for a patient’s care can be anywhere and access images and reports via Medcon's MDWeb (Whippany, NJ). Historical Overview In 2001, Providence installed Medcon’s TCS Symphony. The criteria for choosing the optimal C-PACS and CIS solution included: 1. Ability to create a comprehensive cardiology patient record with integrated cath and echo data. 2. Obtaining seamless connectivity with other systems such as hemodynamic and hospital information systems (HIS) both with current systems and considering future plans for upgrades. 3. Open architecture to simplify interfacing with other systems and smooth transition to an electronic medical record (EMR). 4. A web interface to make cath and echo lab images and information available on the hospital-wide intranet and/or via Internet with secured VPN access. 5 A user-friendly and reliable system with customizable interfaces. Medcon’s TCS Symphony seamlessly integrated with existing cath and echo equipment for both digital and analog acquisition. This was essential, since the schedule for upgrading or replacing capital equipment was determined independently of the selection of an image and information management vendor. Beyond Multi-Modality Imaging: Harnessing the New CVIS Paradigm Since Providence first implemented a cardiac network and archive back in 2001, it has witnessed the shift in demand to a complete workflow solution for the cardiology department. This shift can be summed up as incorporating all image and information into a single cardiac electronic medical record. This is accomplished by providing integration between all cardiac modalities, as well as the ability to access cardiac records throughout the campus without expensive hardware or software. TCS Symphony uses HL7 and DICOM interfaces to automatically transfer patient demographics to TCS Symphony workstations, eliminating duplicate information entry. In the cath lab, integration with Siemens Sensis® hemodynamic system (Siemens Medical Solutions, Malvern, PA) ensures that all measurements, notes, and data fields entered during the case automatically populate the final cath report. Transcription is eliminated and reporting is now one of the least time-consuming parts of the cath lab process, with physicians entering patient summaries and conclusions. Ease of use and timely reporting were critical aspects. The Medcon TCS Symphony unified user interface and single clinical database for Cath, Echo, and Nuclear reporting/image review means physicians can simultaneously and dynamically review multiple studies from cath and echo together, regardless of which station they are logged into. Although Providence did not initially consider adding EP studies to the Medcon TCS Symphony system, the engineers and R&D team from Medcon met with the Medical Director of Electrophysiology, Dr. Christian Machado, to discuss the requirements and needs to import the GE CardioLab report as well as snapshot hemodynamic studies. Once the criteria were established, Medcon completed the task of seamlessly integrating the report/images to the appropriate patient folder, as well as identifying the study as an EP report. With the successful integration of the EP studies, Providence requested an interface with GE’s MUSE. Medcon provided a link to the GE MUSE with a single mouse click via an icon called ECG Link. Physicians and technologists had been spending an exorbitant amount of time pulling up previous studies and/or test results either via paper or via different programs located throughout the Heart Center. Now, Providence physicians review patients’ ECG exams on a universal cardiac workstation with the Medcon TCS Symphony. In the echocardiography lab, all echo measurements and comments are imported to a centralized database, which can be accessed via MDQuery. MDQuery is an SQL query tool, which enables users to define conditions and build queries on the data, as well as save specific queries that are accessed on a periodic basis. MDQuery saves a tremendous amount of time; time that was previously invested in manual retrieval of data for administrative and clinical outcome reports. MDQuery proved a useful tool for preparing data for ICAEL certification. The reporting modules are a great time-saver and one of the physicians’ favorite features. Improved Workflow Workflow has improved markedly as a result of information accessibility throughout the hospital. Physicians can review cases any time, anywhere inside the enterprise and even outside utilizing telecardiology and web features. In particular, the ability to read cases right in the CCU, emergency room, and other patient care units has greatly improved efficiency. Since the design criterion for Medcon’s TCS Symphony was to create a single web-based view, it allows physicians and clinicians to access the complete cardiac patient record whenever and wherever they may need it. Physicians have commented on the important benefits to their communication with families. Family members can now view images on computers in patient areas and see test results firsthand. Telecardiology also enables image exchange between Novi, Livonia, and the main Southfield Campus, as well as centralizing the archiving function. As a teaching facility, Providence has a cardiovascular residency program, which has reaped significant benefits from the project. Cases are now available for immediate review, allowing for more efficient use of time. Also, procedures to be presented during a conference or for future education purposes can be linked to teaching folders. When the file is accessed via the user-defined teaching folder, patient demographic data is removed from the file for HIPAA compliancy and patient privacy protection. Web Publication Providence relies on a web interface for sharing cardiac images and reports throughout the hospital. The information is available to any authorized user on the ProvNet portal or the Internet via a web browser. Studies performed today, two months or even two years ago are readily accessible for review with Medcon’s MDWeb, which offers the same image tools (i.e. zoom, brightness/contrast/gamma, speed control) as on Medcon’s full multimodality workstations. MDWeb also provides the ability to perform onscreen measurements by querying the diagnostic DICOM image. Providence has succeeded in implementing a comprehensive CVIS solution with significant benefits that include: Increased efficiency and organization by staff Improved documentation and quicker access to clinical data for physicians and staff Elimination of transcription/ dictation costs and related turnaround delays User-friendly and universal functionality across the cardiac continuum Overall improvement in quality and in patient and physician satisfaction The Ultimate Proof of Concept: Moving Sites Without a Hitch When Providence opened a new Heart Center in October 2003, the four cath lab procedure rooms were equipped with new flat panel high-resolution digital labs x-ray equipment, as well as new hemodynamic systems. Moving into a new facility and changing equipment at the same time as modifying the department’s workflow environment was quite an undertaking. Needless to say, there was a lot of trepidation about the transfer of existing equipment and software systems to the new center, but the transfer actually took place during a single weekend. On Friday, the old labs were in use and by Monday, cases were done in the new center, with the network and archive up and running. Since the cardiologists had been performing automated cath reporting since 2001, Medcon also had to insure that the new hemodynamic system’s data was integrated with the cath report module. From the start, physicians were finalizing their electronic reports without a hitch. Even though Providence did not replace its Philips Sonos 5500 ultrasound units, Medcon implemented network drops, IP addresses and systems within the new area in order to provide seamless workflow for the noninvasive department. Looking Toward the Future The Emergence of New Technologies Plans are underway for the Providence Heart Institute to expand its services by adding Cardiac CT and MR angiography. The multi-slice images will be accessible at any Medcon workstation and will provide the physicians image enhancement tools specific to these non-invasive testing modalities for cardiovascular diagnosis. Providence has been able to evaluate systems without limitations by establishing the criterion that the system must integrate with the Medcon TCS Symphony system. Future plans also include the migration of records from the DVD platform to an Enterprise SAN. Providence has also partnered with Medcon to expand integration of its existing noninvasive studies (i.e. Holter, treadmill stress, 12-lead ECG) to complete the electronic patient record for cardiology and to provide a single clinical repository. Effective Business Model Expands Heart Services Providence Heart Institute, together with its primary cardiology groups, participated in a joint venture, The Cardiovascular Institute of Novi, which opened its doors in December 2004. By aligning the working relationship between the medical center and its physicians, Providence has been able to improve collaborative efforts and unify interests towards long-term commitment for its cardiac program success. Medcon provided the seamless, integrated image and information workflow required for the new facility, interfacing a new Siemens nuclear camera as well as 2 existing Philips ultrasound systems. Recently, Providence announced plans to build a new $224- to $259- million facility, which would be a 400,000-square-foot expansion of the present 300,000-square-foot medical office building on the Providence Park campus. The scheduled completion date is 2008. The new 200-bed hospital will include acuity adaptable beds as well as a full line of diagnostic imaging services within its integrated heart center, including four new interventional labs performing cardiac, vascular and EP studies. Vast changes are occurring in the field of cardiovascular technology. Providence continues to design its program with flexibility in mind. The authors have nothing to disclose and can be contacted at: Christopher.Bissell@providence-stjohnhealth.org