Put to the Test: Cath Lab Reporting Systems

At a time when the electronic health record has taken a pivotal role in healthcare delivery, cath lab team members are under mounting pressure to supply high-quality health records even while streamlining procedural reporting. To accomplish this, cath labs must rely on modern and effective software.  

However, by some estimates, 30% of the current cath reporting products have reached their end-of-life, as vendors abandon support for aging software. This puts cath labs at risk of system failure, leaving no alternative but to rip out and replace existing systems. In these cases, evaluation of replacement solutions becomes an urgent necessity, and new software may be needed as a quick-fix to replace outdated, unsupported products. The urgency of the replacement can limit the opportunity to thoughtfully evaluate the strategic consequences of the available choices.  

Whether your role is selecting, using, recommending, or implementing cath lab reporting solutions, understanding the tactical and strategic criteria for product and vendor selection will help your team avert costly mistakes and establish a sustainable path forward.

How did we get here?

Cardiology requirements have always been more complex than those of other medical domains. Cardiology is about simple lab tests, but it is also about day-long trips to an invasive laboratory with a whole team of healthcare providers. It is about measurements and image analysis and procedural narrative. It is about the introduction of technology and technique at a breathtaking pace. Mostly it is about clinical judgment when all these elements are synthesized.  

It is no surprise that cardiology needed to invent its own approach to software — cardiovascular information systems (CVIS) came online when healthcare information systems (HIS), picture archiving and communication systems (PACS), radiology information systems (RIS), and lab management software had not the slightest chance of meeting cardiology needs.  

But in today’s environment, traditional CVIS systems have become unwelcome information islands when the hospital’s primary information ecosystem supports easier access to integrated health information. So the natural evolution must be toward interoperability. With the declining pressure for isolated CVIS software, major CVIS vendors have found their products too expensive to maintain and advance. Their market is ready to be consumed by commodity PACS and enterprise HIS solutions. Cath procedural reporting has been left out in the cold as an essential vestige stuck in a dying CVIS market sector.

To be sure, CVIS systems have suffered from technical shortcomings. Systems have relied on customizations to create content they did not have. Heavily customized systems cannot be moved forward, and become orphans when the standard of practice changes. Systems allowed core fundamental properties to be changed without documentation, leaving data corrupt and useless. Systems have failed to keep data internally consistent. In most cases, these were predictable consequences of immature system architecture. And now vendors know that the next step may be starting over.  

How can we move forward?

Very simply, we must reverse all the mistakes. All the old requirements are still there — cardiology hasn’t grown simpler. However, we must recognize that systems missed implicit requirements: data integrity, upgradability despite site configuration, and just plain usability. Laboratory workflow is the paramount requirement, and every specific feature request must be secondary to that workflow. Lastly, we must recognize that the consumers of the data — the physician and patient — must ultimately define how technology moves cardiology information.

A new set of requirements within the cath lab

As a result, today’s cath lab reporting will have a different set of requirements than in the past, requiring a strategic approach to vendor and product selection, and a well thought-out implementation strategy for a more complex healthcare environment.  

Interoperability has become the holy grail of healthcare. Disparate systems across a facility, region, or entire nation should work as if they were one. Interoperability makes it possible to blend enterprise and cardiology-specific data, and ensure data consistency. Clinical professionals should express the same findings in a compatible way, regardless of the source of the findings. Treating information as coded data, and taking advantage of the benefits of analyzing that data, can wait no longer. 

Dr. James Tcheng, Professor of Medicine at Duke University Health System, Co-chairman of the American College of Cardiology’s Catheterization Structured Reporting committee, and a national advocate for clinical cardiovascular standards, wrote: “I’m not a formally trained informaticist, but it’s where it’s at in our profession. If we want to become more efficient and improve patient care and processes, we need to roll up our sleeves and get the informatics parts of this right.” 

There is no better time to embrace the age-old 80/20 rule. We need not code everything, but we need to code the data we need as data, and find a natural way to describe the rest.

Core software requirements are these: 

• Configurability must be rich, but must not imperil data integrity.
• Interoperability must obviate the need for data reentry. 
• Systems must meet local needs without closing off an upgrade path for the software, as clinical practice evolves.
• Systems must use coded data to help clinicians with reminders, consistency cross checks, and logical analysis to guarantee the best result for the patient. 

A new set of requirements for the hospital

The Accountable Care Act sets forth mechanisms for cost savings, so that clinicians can provide high-quality, evidence-based care that also contributes to organizational profitability. Health information technology that collects, organizes, compiles, and reports both clinical and financial data provides the essential infrastructure for accountable care by facilitating communication and cooperation among departments and across the care continuum.

Population health management is another strategic mandate that depends upon the interoperability of systems, making it possible to aggregate and analyze relevant clinical, financial and demographic data of patient populations.  

A strategic, platform-based approach gets the informatics part “right” by bringing unique value to the entire cardiology enterprise with solutions that effectively address documentation, data, and workflow demands across the spectrum of care. Using this approach, cath lab professionals, administrators, and cardiologists would gain a comprehensive, interoperable solution that serves as an accelerator for rapid improvements, rather than a “kludge” of systems that hold back success.  

Such an approach “future proofs” investments in cardiovascular IT, and enables effective patient and data management throughout the entire continuum of care. 

About the authors: 

Lisa Braunreuther has more than 25 years of combined industry and clinical experience in cardiology, radiology, and healthcare IT. She is vice president of sales and marketing at ASCEND, a provider of healthcare information technology solutions for cardiology.

Richard W. Samsel, MD, has been working in computers in healthcare and research for over 20 years, and is vice president for informatics at ASCEND.

More information at ASCEND's website.