The State of Medical Imaging and the Cardiovascular Information System (CVIS)

Cardiovascular Information Systems StrategyHealthcare diagnostic imaging has historically been one of the fastest growing areas of healthcare. According to the American College of Radiology (ACR) “in 2003, approximately 206 million imaging services were provided to a total of 34.8 million Part B Medicare beneficiaries. By 2006, that number increased 58.4 percent to 326 million services for 35.9 million beneficiaries. In contrast, evaluation and management services, major procedures, and laboratory tests grew 5.1 percent, 16.3 percent, and 14.2 percent during that same period.” But will this growth continue?

Recently, according to ACD, that grown has slowed. “Much of the growth in the utilization of advanced medical imaging during the early part of the last decade occurred simultaneously with rapid technological evolution in CT, MRI, and nuclear medicine. Those advancements led to a great expansion in the diagnostic utility of these services. That evolution continues, but appears to have slowed, which probably explains some of the current plateaus in utilization. Future new technologies (e.g., molecular imaging), however, could once again yield rapid utilization changes if these provide the clinical value that has been attributed to traditional advanced imaging during its recent boom.”

Despite the recent slowdowns in growth, the diagnostic imaging market was valued at over $21 Billion dollars in 2012 and has been on a 2.6% growth curve for the past 5 years. Cardiac imaging pushes these numbers even higher.

It’s not surprising that many types of imaging are popular, as they are an effective and non-invasive tool for clinicians to use when diagnosing patients. Catheterization procedures, as an example, are minimally invasive and produce a wealth of data about the patient’s condition.

Challenges with Current Cardiovascular Information Systems

There are two primary issues affecting diagnostic imaging in the modern healthcare environment. First is the imaging technology used in today’s Radiology and Cardiovascular imaging departments, which has improved tremendously over the past two decades. The second is the supporting computer systems to which the imaging modalities are connected. These modalities connect to a wide array of supporting systems for hemodynamics, image enhancement, interpretation, diagnostics, and reporting. The various types of imaging (X-Ray, CT, MRI, Ultrasound) all have specialized IT systems that support them and store their data and images (PACS, RIS, Hemodynamics monitoring, and various other diagnostic tools).

Unfortunately, these systems historically have not communicated with each other very well, if at all. Add on top of that the move by most healthcare systems to an EMR platform, and you end up with key patient information in silos. Radiology and Cardiology departments have a large number of computer systems to handle their specialties, which at best, must be interfaced with the EMR in order to have a complete patient record. Printed reports from disparate systems combined into a paper chart are no longer an answer for the information silos.

For most organizations, attempts to connect their Radiology or CV systems to their EMR have had mixed results. The effort required to interface the existing systems with an EMR is extensive, which often leads to organizations only interfacing the final report outputs from the Rad/CV system to the EMR. Most of the valuable discreet data points desired by department administrators are therefore trapped inside the information silos, and it is difficult, if not impossible to extract the data in a meaningful way. The reports that are posted to the patients record in the EMR contain all the data necessary for patient care, but do very little for administrators who can’t mine them for valuable statistical data.

The Future for CVIS

Enter the Cardiovascular Information System or ‘CVIS’. There are some vendors who have been in this market space for decades, such as LUMEDX, but many PACS vendors and marketers of other CV products have not paid much attention to this niche until recently.

The push is now on to streamline workflows and to have access to the data across the CV service lines within one system. The benefits to this are clear; a common interface and accessibility to patient data, discreet and reportable data, and a single interface to the enterprise EMR for uploading reports to the patient records. This functionality allows CV leaders improved clinical decision support and improved planning and management of their organizations.

With the new legislative environment after the passing of ARRA and the ACO initiative, this is more important then ever. A leader of a heart and vascular center for a major healthcare system told me “I feel like I’m flying a 747 without any instruments” when I asked him to describe how he felt about the data he receives for operational decision-making in his current environment. No surprise he is very interested in a CVIS.

A comprehensive CVIS is a natural progression given the explosion of healthcare technology and the beginning of a worldwide conversion to EMRs. The challenge will come in integration and compatibility with the EMR — the backbone of the entire healthcare organization. This is a key concern for healthcare CIO and CMIOs, as well as other healthcare leaders. The CVIS market continues to be volatile as leading vendors try to fill this market need with a truly comprehensive CVIS that integrates with other EMRs. As for the EMR vendors themselves, don’t rule them out of this equation, as they are working to create cardiology modules that will fill the CVIS role and are native to their program.