Optimizing the Vascular Lab: What Are the Benefits and Drawbacks of Currently Available Database Packages? David L. Dawson, MD, RVT, RPVI

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1 Optimizing the Vascular Lab: What Are the Benefits and Drawbacks of Currently Available Database Packages? David L. Dawson, MD, RVT, RPVI

2 DISCLOSURES David Dawson, MD No relevant financial relationship reported

3 Overview Elements of vascular lab reporting system Comparisons of available systems Institutional experience Recommendations

4 Elements of Modern Vascular Lab Reporting Systems EHR HL7 RIS PACS DICOM SR CVIS

5 Digital Imaging and Communication in Medicine DICOM is both an image format and network protocol Standard implemented by manufacturers Allows interoperability of imaging and information management systems Header metadata and image data stored together Metadata about the patient, machine, and data acquisition settings Image data in processed and unprocessed formats

6 DICOM Structured Reporting DICOM SR is a standard for exchange of structured data and clinical observations (in imaging environment) Structured reporting is an extension of DICOM images Captures measurements, calculations, and other descriptive data in images Data saved in a structured, customizable form Data more accessible compared to traditional text-based reporting Compromises between standardization and interoperability

7 DICOM SR SR documents encoded using DICOM standard elements and transfer via standard protocols for DICOM network services (storage, query/retrieve) DICOM Patient/Study/Series information model (header), plus hierarchical tree of Content Items Uses coded nomenclature May use vocabulary or codes from non-dicom sources

8 Comparison of Vendors? Digisonics Cardiovascular Information System Medstreaming Vascular Information System Consensus Medical Systems VascuPro AS Software, Inc. AS-VASCULAR McKesson Cardiology Echo and Vascular Ultrasound Vidastar Studycast

9

10 Basic Questions to Ask Vascular laboratory the focus or a feature of the product? How will clinical workflow and capabilities be changed? What features are support billing, compliance, billing? Report generation IAC Vascular Testing Vascular Quality Initiative (VQI)

11 Key Performance Indicators (KPI) Examination volume Turnaround time Exam repeat rates Best referral sources Call coverage rates Non-value add work

12 Vascular Lab Automation Typical features of vascular laboratory automation/database systems: Connectivity with lab equipment and hospital environment Technical staff productivity enhanced by time saving features Medical staff reporting efficiency Data security, accessibility (network, web-based)

13 Vascular Lab Automation Some systems may have additional features Reporting macros, migration of patient information (interface engine), auto-generated text Prior study comparisons Vascular Profile: display of patient study results in chart format Tracking individual productivity Trainee procedure log and supervisory feedback Staff messaging Proprietary features

14

15 Looking for New Database History of prior 10 to 15 years Implementation of an EHR (Epic) Conversion of review of studies from videotape (VCR) images to PACS Three changes in RIS Epic Radiant Unsuccessful attempt to implement vascular reporting with vendor that supported cardiac cath lab reporting

16 Priorities Established Vendor track record Demonstrated functionality of product in similar IT environment Product support Customizability Needed more than basic package for reporting on standard normal exams (i.e. carotid, DVT, arterial duplex, and physiologic arterial testing) Capability to report complex exams, abnormal exams, and exams unique to institution Most vendors standard package met less than 30-40% of needs Database functionality Track and report multiple types of data Laboratory metrics Clinical research

17 Product Research Team engagement Presentation by vendors Site visits to other institutions

18

19 Implementation Timeline 2 to 3 months for testing integration and basic functionality in our system 10 months for user customization Technical director committed hours per week Staff involvement Revision of existing templates Customized templates Create custom reporting macros Meetings and conferences calls, individually and in groups: IT, SI, vendor, PACS, EMR team, etc. Troubleshooting

20 Integration Challenges Data field conflicts in EHR Individual US system customization Functionality of tables and graphics Report aesthetics

21 Unrecognized Issues Limitations of ultrasound systems Elaborate calculation packages found to be time consuming to use and of limited value because of what our system sends to database Multiple measurements made in vessel segment, only one goes to database

22 Compromises Comprehensive data collection capabilities Double or triple allotted reporting time if technologists complete all fields Balance with workflow efficiency Selectivity about which data fields to use with with each study

23 Step 1: Vascular Lab Inventory current systems Testing modalities used Standardized by manufacturer? Consider upgrade and replacement Life cycle of systems Changing demands on the lab

24 Step 2: IT Infrastructure Inventory information systems Radiology information system (RIS) Image storage (PACS) Electronic health record (EHR) Assess current and projected capabilities Establish/expand collaboration with institutional IT staff and managers

25 Step 3: Practice Environment Determine scope of vascular lab practice Tests to be performed Single versus multiple sites Nature of practice Reporting requirements and customer expectations

26 Step 4: Establish and Prioritize Goals Efficiency and productivity Comprehensive data acquisition Clinical reporting Research and quality assurance applications Education and training User experience Technologists Medical staff Referring providers

27 Step 5: Planning and Budgeting Determine project budget Timeline for acquisition, integration, customization, and testing User training Customer support

28 Step 6: Reality Check Additional costs Initial decline in productivity Customization Testing Most subset of features and capabilities will be regularly utilized

29 Priority Goals Met Overall increase in productivity More timely reporting Quality assurance enhanced Resident and fellow training tracked

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