Enterprise Imaging Facilitates Replacement of Departmental Cardiology PACS

In recent years, there’s been a lot of focus directed at the radiology department, especially with regard to improvements to a rapidly aging and inadequate PACS infrastructure. Today, this is taking the form of replacing PACS with Enterprise Imaging (EI), “a set of strategies, initiatives, and workflows implemented across a healthcare enterprise to consistently and optimally capture, index, manage, store, distribute, view, exchange, and analyze all clinical imaging and multimedia content to enhance the electronic health record.”(1) This represents a fundamental shift in how healthcare organizations operate and how patient outcomes are delivered, and as radiology is still the #1 producer of images in the healthcare world, it has been a natural starting point for the shift to EI. However, we would also like to show how EI is helping to transform the way Cardiology departments implement workflow and standardize on enterprise systems instead of departmental PACS.

Like radiologists, cardiologists have relied on PACS for many years to store and manage patient images. However, cardiologists have a unique workflow and leverage structured reporting and quantitative analysis in their interpretation much more than Radiology. In larger organizations that are geographically dispersed, individual departmental PACS would be implemented at each facility since cardiology has larger datasets and remote reading was not conveniently supported by clinical applications. These limitations were being felt by one of our customers, but rather than replace their existing system with another cardiology PACS, they decided there was a better way.

This customer was implementing the Mach7 Enterprise Imaging Platform (EIP), including the Mach7 Enterprise Worklist, VNA, and eUnity diagnostic zero footprint viewer, to replace their aging radiology PACS. For context, they have a volume of more than 1 million studies per year across 11 hospitals and many clinics and outpatient centers. In the midst of their radiology EI transition, they realized they also needed to replace their aging cardiology PACS that was no longer meeting their needs. In addition to workflow and end-of-life storage infrastructure, they were having issues with archive management, integrating storage, department-specific archives, and an expensive tape-based archive backup. As they analyzed Cardiology’s needs, it became apparent what they really wanted was a similar enterprise-focused solution that would let them leverage the best tools to meet the organizational and clinical demands. Specifically, the organization was looking to leverage their Epic investment and wanted to embrace the features of the Epic Cupid worklist and structured reporting solution. However, Epic’s implementation had some integration roadblocks, and they were unable to find a single enterprise Cardiology solution that met all their needs.

The organization, which had decided to standardize on the TOMTEC Viewer and Invia’s 4DM Flow, had a problem integrating the Cupid worklist with multiple viewers when it only supported calling one external application. The Mach7 Integration Manager, one component of the Mach7 EIP, was able to integrate these solutions and enable the needed workflow. As configured for this customer, the workflow is as follows:

  1. A cardiologist initiates diagnostic workflow by selecting an exam to view from the Cupid worklist.
  2. The worklist notifies the Integration Manager of both the exam and the end user’s credentials to ensure they have the proper clearance to view the exam.
  3. The Integration Manager queries the Mach7 VNA for the exam and all relevant priors.
  4. The Mach7 Platform audits the request to view the images. This audit trail, which is logged and stored in the Platform, allows for improved security and accountability.
  5. The Integration Manager launches the TOMTEC viewer or 4DM Flow based on the type of exam, passing the user credentials, and provides a list for the viewer to display, including the current exam and relevant priors identified by the system.
  6. Using this information, the viewer streams the images directly from the Mach7-VNA-managed storage (Isilon).
  7. Diagnostic artifacts generated during the session, such as image annotations, are ingested using the Mach7 Platform and are archived with the associated exam. Measurements for diagnostic reporting are stored back into Epic Cupid.

From the perspective of the clinical user, this process is simple and easy: they click on the study they want to view in the worklist, and, provided they have the appropriate permissions, the correct viewer opens and the current study, as well as related priors, is presented. Ease-of-use is one of the key design considerations behind the Mach7 Platform. The easier it is for clinical users to learn and use, whether it’s cardiologists, radiologists, or other users, the more efficient they can be. Greater efficiency means less stress for the clinical user and a greater quantity of work output, which can ultimately have a positive impact on the patient’s outcomes.

The benefits of the Mach7 EIP even go beyond radiology and cardiology. Enterprise Imaging is designed to incorporate all the clinical departments in a healthcare organization. Exchanging information is critical to the future deliver of effective patient care, as more information gives care providers a more complete view of the patient’s health and allows for a more effective treatment plan to be designed. If you want to learn more about Enterprise Imaging, we have a great two-part white paper on the subject. Be sure to check it out! Maybe you want to speak to us about how we can help your organization? Contact us to join the conversation today!

(1) https://siim.org./page/enterprise_imaging