Cedara and UCLA collaborate on cardiology workstation

Few specialties draw from as many diverse sources of information as cardiology. Electrophysiology data, echocardiograms, chest x-rays, and angiograms are all assimilated into the discipline. Soon the list will expand, as MR and multislice CT infiltrate this domain, adding wall and valve studies, quantitative measures of function, and new types of angiography to the already extensive data.

A new kind of workstation is being developed to meet the threat of information overload. The workstation is the product of collaboration between the Canadian PACS and workstation vendor Cedara Software and the University of California, Los Angeles. Its function is to collect for cardiologists all the information they need to evaluate a patient and to present those data in one place and in a single format that makes interpretation easy and efficient.

“The information being collected is heavily underused,” said Wido Menhardt, general manager of the cardiology business at Cedara, which is based in Mississauga, ON. “Bringing that information to the person who takes care of the patient has to improve care—it has to make things cheaper and more effective.”

This gathering of data has been long in coming, partly due to the diversity of cardiology’s collection media, but also because of the fragmented industry that serves this discipline. Many vendors provide only a single type of product. With little need to integrate data, these systems have traditionally been isolated from each other. But the push to integrate is coming, according to Harold Wodlinger, business relations manager for cardiology at Cedara Software.

“Doctors want to see an electronic patient file in cardiology,” Wodlinger said. “They want to do a complete review with all the imaging that was done on their patient.”

Trying to do so at present is a chaotic exercise. Chest x-rays are on film; echocardiograms are on VCR tape; angiograms are on cine film; ECGs are on chart paper. But efforts by the cardiology community to adopt standards for data interchange could change all that. DICOM standards have been created not only for different types of imaging modalities but also for electrophysiology equipment. Key to the successful integration of the data, however, will be the functionality of the workstation.

“We want to organize the data in such a way as to tell a story. The trick will be to present the different modalities so they’re understandable and easy to get to,” Wodlinger said.

A driving force behind the project is Dr. Osman Ratib, professor and vice chair of the department of radiological sciences at UCLA. Ratib, who is also an accredited cardiologist, is spearheading the development work on the academic side.

He first worked with Cedara staff when the company furnished components to a PACS system installed at University Hospital in Geneva, Switzerland. When Ratib moved to UCLA, he began exploring the idea of a system that would help physicians consult on cases, and turned to Cedara for help.

“This project is designed to deliver convenient, flexible tools in a customized workstation for cardiology conferencing,” he said.

A prototype of the system has been developed and was shown at the annual meetings of the American Heart Association in November and the American College of Cardiology in March. At UCLA, Ratib and his colleagues are trying to distill the cardiology diagnostic process, then use this knowledge to refine the prototype.

“The trick of getting this right is making sure that workflow issues are taken care of properly,” Wodlinger said. “If it’s difficult for cardiologists to use, then they won’t use it.”

The collaborative project represents a departure for Cedara from its traditional strength, which has been radiology workstations and PACS. Cardiology is viewed as an opportunity for expanding the reach of Cedara products, while allowing the company to build on its core competencies.

“When you look at cardiology closely, you realize that it’s a major chunk of healthcare in terms of procedures and money,” Menhardt said. “What makes this especially interesting to us is that there’s a lot of imaging going on in cardiology and there’s going to be a lot more.”