Embracing Technology:Montefiore Einstein Heart Center Goes Digital With Medcon`s TCS System

The Heart Center brings together all aspects of cardiac services, from screening and preventative care to advanced patient treatment and resident and medical student education. The Heart Center has innovated significant advances in administrative efficiency, responsiveness and information management in order to improve patient care. Heart Center facilities are housed on two separate campuses the Henry and Lucy Moses Division, and the Jack D. Weiler Hospital of the Albert Einstein College of Medicine, which are about five miles apart. The cath labs at both sites perform a broad range of procedures, from coronary angiography and myocardial biopsy to balloon septostomy. Long a leader in pediatric cardiology, including pioneering an implementation of pacemakers in children, the Center boasts one of the first pediatric cath labs ever established. The Heart Center has four full-time attending specialists, six voluntary attendings, one pediatric cath attending, nine technologists and twenty nursing staff. It performs 5,200 cath procedures annually. Upgrading Our Digital Equipment At the time of the digital upgrade project, the Moses Division had three cath labs, two with legacy GE analog acquisition (Waukesha, WI) and one with digital technology. It also had several echo-stress labs in the main facility and one in the Medical Arts Pavilion, a separate building across the street. Our goal was to connect all Moses cath and echo labs to the new digital management and archiving system. The Heart Center at Weiler had been introduced to digital about two years previously with a conversion that proved limited in capabilities. In 2000, the Heart Center decided to undergo a full-scale conversion. Full conversion to a filmless environment was expected to speed up patient care because films were being stored off-site and retrieving them often took several days. Digital technology was also intended to reduce the time technologists spent developing film and coordinating storage and retrieval. Our sizeable selection team provided diverse expertise. Team members included myself and the following members: Nancy Fish, VP Clinical Services; Mark Greenberg, MD, Director, Cardiac Cath Lab, Chief Cardiology (Acting), Moses Division; Mark Menegus, MD, Assistant Director CCU, Moses Division; Garet Gordon, MD, Director, Echo Lab, Moses Division; Jamshid Shirani, MD, Director, Non-Invasive Lab, Weiler Division; Dmitriy Layvand, Administrative Manager, Heart Center IT; Courtney Thomas, Technical Supervisor, Cardiac Cath Lab, Moses Division; Denise D’Amore, Lead X-Ray Tech, Cardiac Cath Lab, Moses Division. The team worked in cooperation with the Montefiore Medical Center Materials Management team to specify and generate a list of requirements, review proposals from vendors, select the final vendor, and handle product acquisition. The evaluation process took over 18 months. Project Goals Early on, the team identified key goals for the system. 1. First and foremost, our clinicians desired high quality images and a simple, friendly interface to minimize the learning curve in the transition to a filmless environment. 2. They also wanted a multi-modality system that integrated cath and echo under one application and user interface, while offering a work environment for each modality. 3. From an IT perspective, the Heart Center required a system characterized by open architecture, flexibility and modularity. This would allow us to easily adapt the system to our growing needs and to expand upon it in the future. 4. We were hoping to find a vendor that would eliminate the need to purchase digital acquisition and could cost-effectively convert our existing analog cath output without significant hardware add-ons. 5. We preferred to keep costs down by using off-the-shelf, rather than proprietary, hardware. 6. An extremely important goal was to find a vendor with a patient-centric database, one that would integrate existing and new modalities into a single central database organized by patient. 7. To facilitate hospital-wide image communication as well as telecardiology and remote reading, we wanted a Web interface to move images quickly over Intranet and Internet connections. 8. It had to be an extremely reliable system with significant redundancy. 9. Most importantly, everyone on the team was looking for a technologically advanced, flexible vendor willing to devote significant effort to customizing our expansive solution and to integrating existing software across platforms. We ultimately chose the Medcon TCS system (Whippany, New Jersey). Installation began in March 2002 and was complete within several weeks. After Installation In the analog rooms, the analog acquisition station grabs frames and transforms images to digital DICOM output. Information flows 24/7 throughout the department and beyond. RAID permits fast access to 200-250 recent cath images and 300“500 echo images. A 3TB DVD jukebox handles long-term storage and offers instant retrieval of many years worth of archived cases. In addition, together with Medcon, we developed a disaster recovery solution for off-site storage. The patient database is backed up to the image server to ensure total recovery. A nice TCS standard feature is the ability of each room to automatically function locally until the system resumes in case of server failure. Five dedicated TCS review stations located throughout the department allow for image viewing, processing and analysis of cath, echo and related files on the system. Integration of Systems Although Medcon could provide fully integrated cath and echo reporting in the TCS system and database, the Heart Center decided not to exploit Medcon’s reporting capabilities directly, because of its extensive prior investment in its Apollo clinical information system. Instead, Medcon developed a custom link from TCS patient files to feed the corresponding Apollo echo reports with data. They employed optical character recognition (OCR), measurements and other annotations on the images to automatically populate the TCS patient record, saving significant duplicate data input. The off-site echo lab, which had to be connected to the system through our hospital network, presented a particular problem because of slow image transfer speed. This was addressed in part with a special router and gateway. With the new system, a CD burner allows voluntary attendings and others who use the hospital part-time to take images with them, and provides opportunities to easily provide patients with their own files. Among the other useful features built into our system and that other hospitals might want to consider are: Image format conversion, including JPEG and TIFF for importing images into teaching files and other presentations and papers; Auto-population of the cath and echo database with patient demographic information from the hospital clinical information systems (CIS); Streamlined importing of files with DICOM query/retrieve from an existing digital cath system in our case Weiler’s cath system to a new system; The ability to upload other modalities not on the system as needed, such as IVUS to the database. Physicians have immediate access to images without waiting for film development or manual retrieval of cases. Finding and accessing studies in digital format is significantly faster and the possibility of lost films has been eliminated. The integrated cath and echo application quickly brings most of the information clinicians need. Its flexibility allows fast access to both modalities in a work environment specifically designed for each. Cath reporting is handled by the TCS system, stored in the same patient-centric database, and is accessible from the same application. The hospital Intranet is put to good use. The MD Web interface speeds data over the hospital Intranet for viewing throughout any facility on off-the-shelf PC monitors. Physicians appreciate having the cath images available on the Medical Center’s Intranet, since it allows review and consultation from any of the workstations across our multi-campus facility, and allows us to utilize actual case studies in teaching situations. Surgeons can have immediate access to images in the operating room while the patient is on the table. In the future, radiologists and physicians will be able to access images at home or in remote locations for opinions and consultations. Using this technology, our echo attendings at Weiler now read images at Moses as they are acquired. This access may prove to be an important marketing tool as more and more referring physicians connect by modem into our network to review patient images. With the TCS system up and running for some time, we are launching the digital conversion of the echo labs at the Weiler campus. Weiler will add additional echo rooms for a total of five, which will all run on the TCS system and be archived through a T-1 connection at Moses campus.

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