OptimizingtheVascularLab:WhatAretheBenefitsandDrawbacksofCurrently

AvailableDatabasePackages?

DavidL.Dawson,MD,RVT,RPVI

DavidDawson,MD• Norelevantfinancialrelationship

reported

DISCLOSURES

Overview

• Elementsofvascularlabreportingsystem• Comparisonsofavailablesystems• Institutionalexperience• Recommendations

ElementsofModernVascularLabReportingSystems

• EHR• HL7• RIS

• PACS• DICOM• SR• CVIS

DigitalImagingandCommunicationinMedicine

• DICOMisbothanimageformatandnetworkprotocol

• Standardimplementedbymanufacturers– Allowsinteroperabilityofimagingandinformationmanagementsystems

• Headermetadataandimagedatastoredtogether– Metadataaboutthepatient,machine,anddataacquisitionsettings

– Imagedatainprocessedandunprocessedformats

DICOMStructuredReporting• DICOMSRisastandardforexchangeofstructureddataandclinicalobservations(inimagingenvironment)– StructuredreportingisanextensionofDICOMimages– Capturesmeasurements,calculations,andotherdescriptivedatainimages

– Datasavedinastructured,customizableform• Datamoreaccessiblecomparedtotraditionaltext-basedreporting

• Compromisesbetweenstandardizationandinteroperability

DICOMSR

• SRdocumentsencodedusingDICOMstandardelementsandtransferviastandardprotocolsforDICOMnetworkservices(storage,query/retrieve)

• DICOMPatient/Study/Seriesinformationmodel(header),plushierarchicaltreeof“ContentItems”– Usescodednomenclature– Mayusevocabularyorcodesfromnon-DICOMsources

ComparisonofVendors?• Digisonics CardiovascularInformationSystem

– http://www.digisonics.com/cardiovascular-solutions/cardiovascular-specialties/vascular/

• Medstreaming VascularInformationSystem– http://www.medstreaming.com/Products/VIS

• ConsensusMedicalSystemsVascuPro– http://consensusmed.com/index.php/consensus/index/1/35/

• ASSoftware,Inc.AS-VASCULAR– http://as-software.com/Vascular.html

• McKessonCardiologyEchoandVascularUltrasound– http://www.mckesson.com/providers/health-systems/department-

solutions/cardiology/mckesson-cardiology-echo-and-vascular-ultrasound/• Vidastar

– http://www.vidistar.com/vascular/#• Studycast

– http://www.corestudycast.com

BasicQuestionstoAsk

• Vascularlaboratorythefocusorafeatureoftheproduct?

• Howwillclinicalworkflowandcapabilitiesbechanged?

• Whatfeaturesaresupportbilling,compliance,billing?

• Reportgeneration– IACVascularTesting– VascularQualityInitiative(VQI)

KeyPerformanceIndicators(KPI)

• Examinationvolume• Turnaroundtime• Examrepeatrates• Bestreferralsources• Callcoveragerates• Non-valueaddwork

VascularLabAutomation

• Typicalfeaturesofvascularlaboratoryautomation/databasesystems:– Connectivitywithlabequipmentandhospitalenvironment

– Technicalstaffproductivityenhancedbytimesavingfeatures

–Medicalstaffreportingefficiency– Datasecurity,accessibility(network,web-based)

VascularLabAutomation

• Somesystemsmayhaveadditionalfeatures– Reportingmacros,migrationofpatientinformation(interfaceengine),auto-generatedtext

– Priorstudycomparisons– VascularProfile:displayofpatientstudyresultsinchartformat

– Trackingindividualproductivity– Traineeprocedurelogandsupervisoryfeedback– Staffmessaging

• Proprietaryfeatures

LookingforNewDatabase

• Historyofprior10to15years– ImplementationofanEHR(Epic)– Conversionofreviewofstudiesfromvideotape(VCR)imagestoPACS

– ThreechangesinRIS• EpicRadiant

– Unsuccessfulattempttoimplementvascularreportingwithvendorthatsupportedcardiaccathlabreporting

PrioritiesEstablished• Vendortrackrecord

– DemonstratedfunctionalityofproductinsimilarITenvironment– Productsupport

• Customizability– Neededmorethan“basic”packageforreportingonstandardnormal

exams(i.e.carotid,DVT,arterialduplex,andphysiologicarterialtesting)

– Capabilitytoreportcomplexexams,abnormalexams,andexamsuniquetoinstitution

– Mostvendors’standardpackagemetlessthan30-40%ofneeds• Databasefunctionality• Trackandreportmultipletypesofdata

– Laboratorymetrics– Clinicalresearch

ProductResearch

• Teamengagement

• Presentationbyvendors

• Sitevisitstootherinstitutions

ImplementationTimeline• 2to3monthsfortestingintegrationandbasicfunctionalityin

oursystem• 10monthsforusercustomization

– Technicaldirectorcommitted15-20hoursperweek– Staffinvolvement– Revisionofexistingtemplates– Customizedtemplates– Createcustomreportingmacros

• Meetingsandconferencescalls,individuallyandingroups:– IT,SI,vendor,PACS,EMRteam,etc.

• Troubleshooting

IntegrationChallenges

• DatafieldconflictsinEHR• IndividualUSsystemcustomization

• Functionalityoftablesandgraphics

• Reportaesthetics

UnrecognizedIssues

• Limitationsofultrasoundsystems– Elaboratecalculationpackagesfoundtobetimeconsumingtouseandoflimitedvaluebecauseofwhatoursystemsendstodatabase

–Multiplemeasurementsmadeinvesselsegment,onlyonegoestodatabase

Compromises

• Comprehensivedatacollectioncapabilities– Doubleortripleallottedreportingtimeiftechnologistscompleteallfields

• Balancewithworkflowefficiency– Selectivityaboutwhichdatafieldstousewithwitheachstudy

Step1:VascularLab

• Inventorycurrentsystems– Testingmodalitiesused– Standardizedbymanufacturer?

• Considerupgradeandreplacement– Lifecycleofsystems– Changingdemandsonthelab

Step2:ITInfrastructure

• Inventoryinformationsystems– Radiologyinformationsystem(RIS)– Imagestorage(PACS)– Electronichealthrecord(EHR)

• Assesscurrentandprojectedcapabilities• Establish/expandcollaborationwithinstitutionalITstaffandmanagers

Step3:PracticeEnvironment

• Determinescopeofvascularlabpractice– Teststobeperformed– Singleversusmultiplesites– Natureofpractice

• Reportingrequirementsandcustomerexpectations

Step4:EstablishandPrioritizeGoals

• Efficiencyandproductivity• Comprehensivedataacquisition• Clinicalreporting• Researchandqualityassuranceapplications• Educationandtraining• Userexperience– Technologists– Medicalstaff– Referringproviders

Step5:PlanningandBudgeting

• Determineprojectbudget• Timelineforacquisition,integration,customization,andtesting

• Usertraining• Customersupport

Step6:RealityCheck

• Additionalcosts• Initialdeclineinproductivity– Customization– Testing

• Mostsubsetoffeaturesandcapabilitieswillberegularlyutilized

PriorityGoalsMet

• Overallincreaseinproductivity• Moretimelyreporting• Qualityassuranceenhanced• Residentandfellowtrainingtracked