It used to be that referring physicians had to wait two or three days to get a diagnostic report back from the echocardiography lab at Rush-Presbyterian-St. Luke's Medical Center in Chicago. Today they can expect to receive a fax or e-mail within an hour or two after the exam is completed.
It's not that echocardiographers are working more quickly or putting in longer hours. Instead, about a year ago, they began piloting a test version of a cardiology information system built on a powerful Oracle database. One of its features is automatic report generation. As echocardiographers review images, structured data fields are populated either automatically or with a click of a mouse.
The result is a polished report immediately ready for delivery to the referring physician. Although it appears to have been dictated, the report has never been near a transcriptionist.
Soon the entire cardiology department will be on the fast track. In midsummer, Rush-Presbyterian installed a commercial version of the cardiology information system-GE Medical System's Catalyst-in the cardiac catheterization laboratory. By late this year, the center plans to have rolled out the system to the nuclear medicine and electrocardiography labs and to have upgraded the test system in echocardiography to the commercial version. The electrophysiology lab is expected to go online next year.
When it's all done, physicians throughout the cardiology division will no longer have to break a sweat to get diagnostic reports out the door in a timely manner. Even more important, they will have access to a patient-centered medical record that gathers together in one place demographics, clinical history, and information about every cardiology procedure and diagnostic test the patient has undergone, said Dr. Jeffrey Soble, an associate director of the echocardiography lab who directs cardiology information systems for Rush-Presbyterian.
"We were looking for a cross-modality solution that would allow us to handle all of the information needs in each of the laboratories-echo, nuclear, cardiac cath, electrophysiology, ECG, outpatient-but to do it on a common platform, rather than taking a silo approach," he said.
Before all the pieces could fall in place, an interface to the hospital information system had to be built, along with an interface between the nuclear medicine system and IDXrad. An upgrade to the existing GE Marquette MUSE database, used for storing electrocardiographic information, was necessary as well to make it compatible with the division-wide Catalyst system.
Paralleling the implementation of the new information system is the launch of an advanced image management system in the cath lab. As it evolves into a completely digital department, the cath lab is installing Siemens Medical Systems' networked PACS, ACOM.net, and replacing cine film readers with digital workstations.
"We ought to pretty much have the main pieces in place by year's end," Soble said.
For the time being, the Siemens digital review stations will sit side by side with the Catalyst workstations. Eventually, Soble would like to see the two functions merged into one workstation. Exactly when and how that will happen is still undecided.
"Whether we use Catalyst for image review-actually pulling images out of Siemens storage and into Catalyst for image review via DICOM-or whether we run more than one application side by side using interoperability standards, we'll wait and see. We're going to see how the systems evolve down the road," he said.
DATABASES DIDN'T SPEAK
However the systems evolve, they're sure to make life simpler than it was in the past, when each diagnostic laboratory created and managed its own home-grown database. None of the databases shared information with the others or was accessible from elsewhere in the department.
"Like a lot of institutions, we have a history of having built in-house information systems to handle some of our needs, so we actually had a family of Paradox databases being used throughout cardiology," Soble said. "One of our key goals was to get out of the business of building and maintaining our own information systems and to partner with a small number of vendors to put together a comprehensive departmental solution."
Catalyst forms the backbone of that solution, Soble said. In addition to being the primary place information is stored for all the diagnostic labs, the system can pull data directly from imaging and monitoring devices, capturing, for example, measurements and calculations during an echocardiographic study or hemodynamic readings during cardiac catheterization. It can also manage workflow, scheduling, and inventory, and through its structured reporting capability, speed the creation of reports.
Having a single system that maintains all clinical and administrative information on a common platform offers additional benefits as well, by making it easier to do clinical research studies or administrative analyses of the entire patient population across all forms of diagnostic testing and treatment.
"It consolidates what you need to do-administrative reporting, clinical research, clinical functions, report distribution, hospital connections, the database itself-across the modalities and across the departments," Soble said. "It's the biggest step toward becoming a truly digital department, having everything on a common platform."
