A Cloud-Based Approach for Cardiac Image Sharing: Improving Cath Lab Operations

Cloud-based image sharing platforms are increasingly becoming more prevalent in medicine. Cardiac cath labs can turn to this new approach for sending and receiving images to end their previous reliance on physical CDs and shipping. These new solutions come with an assortment of major benefits. Transmitting imaging studies online allows cath labs to reduce costs while improving both the quality of care provided as well as their own ability to attract the right referrals for their facility. Ultimately online image transfer systems allow physicians to build better and deeper referral networks, which in turn means increased volumes and a more open platform for collaboration.

Many cath labs still utilize the archaic method of burning and shipping physical CDs through FedEx or a courier. Most who have operated within this workflow can speak to the inherent inefficiencies of this system. Although many drawbacks can be found, there are key three limitations of this old image sharing method:

1. CD transfers are slow and stagnant. It takes days to ship a CD and once it arrives, it does nothing to facilitate communication and collaboration. There is no movement of ideas, simply a transfer of images.
2. CD transfers limit referral volume and quality. Because it takes days to receive a study, physicians rarely view these images prior to the patient being sent. This creates the potential for unnecessary patient transfers. Additionally, it is the referring center that generally incurs the transfer costs. This means either the small referring centers must pay for the transfer or initiate a separate reimbursement process that comes with its own logistical expenses. All these are barriers to both referral and collaboration in general.
3. CD transfers come with too high of a price. Although the logistics of burning and shipping an image may be a minor expense relative to other hospital spending, there are other costs indirectly associated with CD transfers. As mentioned previously, CD image sharing creates unnecessary patient transfers that come with unnecessary costs. More importantly, these transfers introduce more risk.

Intuitively, it appears as if online image sharing platforms address each of these issues; however, little data is currently available to support these claims. However, a delineation of patient transfer costs using CMS averages can show what cath labs stand to gain, or rather, avoid when switching to web-based sharing systems. In this thought experiment we will assume that a tertiary care center that used the CD method for image transfers would see two patients a month that were transferred to their site unnecessarily, meaning that they were unable to treat that particular patient, for whatever reason. CMS averages say that a one-day stay for cardiac patients costs $5,400. This means that a tertiary care center will spend over $10,000 a month on unnecessary transfers. This is pure cost that returns no revenue. It is impossible to say that web-based image transfer solutions will fully eliminate unnecessary transfers, but it is easy to see how these systems can fill a major role in eliminating these unnecessary patient transfers by allowing physicians access to imaging studies prior to the patient being sent. This is just one way online image sharing can potentially decrease costs.

Additionally, the fact that these systems are web-based means they can be accessed from anywhere with an internet connection. A physician can access studies sent from outside centers while at home or even using mobile technology such as smart phones or iPads. As a result, physicians more available for consults, which in a service industry makes them more effective revenue generators for their hospitals as well as care providers for their patients.

Almost all physicians, cath lab staff, and administrators accept the risks when using physical CDs to transfer patient information. All hospitals tacitly accept the idea that a lost CD means protected health information (PHI) will float somewhere in the ether for anyone to find. However, as with physical CDs, online image transfers come with their own host of concerns. The most prevalent issue revolves around the security of the transfers. Although each provider will have its own security practices, the general concept of online image sharing can and has been made HIPAA-compliant and secure. Many utilize systems similar to those used to protect online banking.

Aside from this technical concern, another major stumbling block is adoption. Many worry that centers will hesitate to send images through online platforms for a number of reasons. The first reason is perhaps the most basic: changing a workflow that has been in place for years. Defeating the “that’s the way it has always been done” attitude can sometimes be challenging and there really is no magic-bullet solution for accomplishing it. The other reason may be security concerns. Even many IT professionals are unfamiliar with the specialized world that online image sharing services operate within. Sites may balk at the idea of sending studies over the internet, because it is an unfamiliar process.

Like with most issues, a way to address these concerns is education. Educating administrators, physicians, and cath lab staff will allow them see the benefits and potential pitfalls of online image sharing. Although many can clearly see that the positives of online image transfer systems outweigh the negatives, it means nothing if the users — hospital personnel — do not yet understand this, generally a function of their unfamiliarity with the technology. Adoption of these systems, in our experience, often requires a person within a hospital system to take the lead in understanding how these platforms work and how secure they truly are. 

Ultimately, it is impossible to predict the speed in which these systems will be adopted. With nearly ubiquitous adoption of EMR/PACs technology, it seems intuitive that an ability to quickly and easily communicate between the discrete networks within which each hospital maintains its records will be an area of interest moving forward.

Case Study: Washington Hospital Center

The cardiac catheterization lab at Washington Hospital Center (WHC) has been a user of a medical image transfer system called ImageShare (Vigilant Medical, Baltimore, Maryland). Dr. Lowell Satler, Director of Coronary Interventions, has been a high-volume user, reviewing hundreds of patients through the ImageShare system. Additionally, Dr. Satler has been instrumental in using ImageShare to triage patients into WHC both for the cath lab specifically as well as the hospital system at large. A specific anecdote encapsulates how ImageShare has made patient care easier to organize as well as better for the patient:

At 6 pm, Dr. Satler received a study from an outside hospital through ImageShare. Dr. Satler quickly accessed the study on the web and determined that the patient needed CABG, not PCI. Unfortunately, Dr. Corso, the available cardiac surgeon, had already left for the day and was driving. However, Dr. Satler was able to push the study to Dr. Corso through ImageShare. Dr. Corso was then able to pull over and open ImageShare’s built-in web viewer on his iPad and review the study. He agreed with Dr. Satler’s assessment and suggested the patient be transferred to WHC immediately. The patient was sent to WHC that night, and Dr. Corso was able to prepare a treatment plan and operate on the patient at 8 am the next morning. The patient went from an on-the-fly consult with Dr. Satler to being treated surgically in less than twelve hours. This is drastically reduced from the two to three days it would have taken to collaborate in this fashion using CDs. Dr. Satler and the team at WHC use ImageShare in this fashion nearly every day, cutting days off of each referral’s length of stay.

Jared Hullett can be contacted at jared@vigilantmedical.net.