Children`s Hospital of Philadelphia: Streamlining Operations with Medcon`s Digital Image Archiving and Management TCS Sys

Children’s Hospital of Philadelphia (CHOP) opened its doors in 1855 as the nation’s first children’s hospital. It was named "Best Children’s Hospital in the U.S." by Child Magazine for two years in a row. Our Cardiac Center performs more than 900 pediatric cardiothoracic surgical procedures per year and provides more than 17,000 outpatient cardiac evaluations and treatments. The department treats congenital heart diseases of all age groups. The Center is especially proud of its cardiac cath team of 8 physicians and 12 nurses and technologists who perform some 1,000 procedures annually. They have played pioneering roles in the repair of selected heart defects without surgery and the permanent treatment of abnormal heart rhythms with radio frequency ablation. Our two cath labs have been equipped with Toshiba digital acquisition devices since 1995. However, because of the long runs and large file sizes, the technology to save images digitally had never been incorporated. Instead, we printed cine films and used tape as a back-up. We knew that eventually, of course, we would transition to a filmless environment to keep up with our caseload. Thus, after a thorough search and evaluation of competing products, we purchased a digital cardiac image management and archiving TCS system from Medcon Telemedicine Technology, Inc. (Whippany, NJ). The film canisters have been eliminated. Objectives and the Search for a Solution About two years ago, Jonathan Rome, MD, Director of Cardiac Cath Labs, launched an RFP process to find a cineless system. The clinical team that assisted the process included Dr. Brian Hanna, Dr. Jacqueline Kreutzer, Dr. Paul Weinberg,and myself. The information technology staff, headed by Thomas Spencer, Manager of Ancillary Services, was also actively involved. While the clinical team sourced vendors and tested various systems in clinical environments, the IT team translated CHOP’s infrastructure requirements into an enterprise network plan. Not surprisingly, one of our major objectives was to identify a system that could effectively archive, retrieve and transmit large congenital cath files. In addition, we wanted open standards-based architecture that would allow us to upgrade and expand our system in the future. We needed to capture, archive and display bi-plane images. We wanted a web-based platform that would allow all our cardiac images to flow enterprise-wide over the hospital Intranet, as well as outside the network to remote users, and that would keep up with our complex telecardiology requirements. The comprehensive search process lasted almost two years. Initially, we focused on six vendors and then narrowed the search to three for in-depth examination that included site visits and product demonstrations. We liked the TCS system’s performance in numerous areas. First, the system was extremely fast and reliable, and upon testing it became apparent that it could handle our large files. The interface also appealed to our clinical team. The TCS system could handle bi-plane acquisition and was one of the few solutions with a web publication module. In tests of retrieval time for on-line and off-line studies, Medcon’s DVD archival system was far superior to competing systems. A Clinical and IT Collaboration Today, ten full-featured dedicated review stations are located in the cath lab and key hospital locations. This includes the surgeons’ offices, OR, CICU, and conference room. Recent studies are stored on RAID and can be retrieved instantly. Our deep-storage DVD jukebox contains enough storage for about 10 years of studies. These can be retrieved and delivered to physicians’ desktops in less than 30 seconds. With Medcon’s MDWeb, images can be viewed from any Intranet-enabled PC on our campus or at our specialty centers in other states. Using a simple web browser, our doctors also can review images at home, speeding up procedural planning. Older studies (those recorded before we adopted the TCS system) can be retrieved from the back-up tape and archived to the Medcon DVD. The system is extremely reliable. We have never had a need to fall back on film. Medcon incorporated an application that allows us to e-mail images internally from primary reading stations to doctors’ desktops, enabling image review in any location. The system has streamlined communications between our Pennsylvania cardiology practice and our specialty center in New Jersey. The Verdict We completed the installation in 2002, and the Medcon system’s rapid acceptance by doctors and technologists has already exceeded everyone’s expectations. The clinical staff is pleased with the instant image retrieval and system interfaces. They also like the image quality and feel of the applications. Our telecardiology partners are excited about cath images and diagnostic reports being delivered to them via the MDWeb web publication module. On the administrative side, we have achieved significant time and cost savings through both elimination of film and more efficient deployment of staff. CHOP is a teaching hospital, and digital image display has enhanced our lectures and presentations. The system also has distinct advantages for patients, who can now request their files on self-playing CDs to take to various surgeons for opinions. These CDs can be played on any PC, as there is no need for additional software. CLD Author David Donnelly can be contacted at: donnelly@email.chop.edu

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