Going Digital on a Grand Scale: Carolinas Healthcare System Selects Medcon for Ambitious 10-Lab, 4-Location Digital Cath Lab A

Carolinas HealthCare System (CHS) comprises fifteen hospitals and is one of the nation’s largest publicly owned hospital systems. Carolinas Medical Center has been named one of America’s Best Hospitals by U.S. News & World Report for the past three years. This facility houses the renowned Carolinas Heart Institute. Given our large-scale operations, the conversion of ten cardiac cath labs located in four separate hospitals into a networked, filmless image management and archival system was an ambitious project. During an eight-month evaluation process, we considered 13 vendors, reviewed products in depth and examined our long- and short-term goals before deciding on the product family from Medcon Telemedicine Technology, Inc. (Whippany, NJ). Ultimately, everyone from physicians to our information technology (IT) specialists was extremely pleased with the results. The project encompassed five labs at Carolinas Medical Center (CMC), three at CMC-Mercy, and one each at CMC-Pineville and CMC-University. Clinical and IT Objectives Certain elements were of primary importance to our clinicians: Maintaining the high quality of images; A user-friendly, easy-to-master interface, Ability to share images among multiple facilities; For physicians outside the cath lab, accessibility to images over the intranet; Ability to view images and prepare reports from locations other than the hospitals; Expansion capability of the system to add other modalities. To accomplish these goals, IT and the future provider had to overcome numerous challenges. First, many labs lacked DICOM export technology. Rather than incurring the high cost of upgrading, we wanted a solution that could translate analog images to digital without compromising quality. Additionally, IT was extremely concerned with the speed of transmitting information-intensive images over the hospital network, given the relatively low bandwidth infrastructure in parts of the cath labs and the significant information traffic involved with transporting images to a remote data center for archival. While willing to upgrade some connections, we sought a vendor that could make the most of our existing infrastructure. To make images available over the hospital network, IT needed a strong browser interface and networking ability. Utilizing images in browser format over the intranet would decrease the costs involved with access to images away from the cath lab. An ordinary browser could be used to access images on any hospital off-the-shelf PC versus some vendors’ requirements that we install higher-end review stations. Open technology that would link seamlessly to our existing information systems, Witt hemodynamic (Melbourne, FL) and PedCath pediatric reporting (Scientific Software Solutions, Charlottesville, VA), and allow for future upgrades and expansions, was critical. Furthermore, to provide all users with a comprehensive list of studies, IT wanted to centralize storage for all four hospitals in the Information Services Data Center. Partnership is Key From a more general perspective, both clinical and IT departments were looking for a vendor flexible enough to work with Carolinas to tailor the system to meet our exact needs and to offer the dedication to customer service and satisfaction that would keep the department running smoothly for years to come. In short, we wanted not just a technologically advanced vendor, but also a genuine partner in our digital success. The Evaluation Process We began by examining RFPs from 13 vendors, ranging from large equipment manufacturers to smaller specialty firms. Based on our extremely comprehensive RFPs, we were able to narrow the field down to seven. In the evaluation process, we demanded much of the contenders, and everyone worked extremely hard to remain in the process. I believe many stayed in through sheer determination and the will to win. No one objected to the lengthy process. As a second step, we asked the seven vendors to come into the hospital and set up their systems for two-hour live demonstrations to showcase their image quality and system features. Following this step, three vendors were selected for full-day demonstrations involving multiple sessions and departments at CMC. Physicians, technologists, administrators and IT staff from all the locations used extensive evaluation forms to rate the contenders. Two finalists were invited for weeklong live product evaluations at Carolinas to showcase their products from the acquisition to storage stage. Because our decision-making team was large, arranging site visits would have been difficult. The evaluation involved not only image viewing in a cath lab at two different sites, but also required the systems be tied into the hospital network, so that we could see images and other information traveling throughout the enterprise. In every respect, Medcon’s TCS system emerged the clear winner. The system was superior in image quality and speed. The conversion of analog images to DICOM was excellent. Clinicians were extremely impressed with the interface, which helped streamline workflow, as well as the transition to a filmless environment. The system is network-friendly, the user interface, very intuitive, and the image quality, outstanding. Our physicians were very satisfied with the technology and functionality of the system. The retrieval time of an image from an archive to a desktop under our current network infrastructure was unbeatable, said Alan Smith, Vice President of Clinical Applications. From an IT viewpoint, the system’s ability to interface with the hemodynamic system was superb. Its open architecture would accommodate future changes and expansions. The upgrading of connections proved unnecessary, which resulted in significant cost savings. The Installation The entire installation process for all locations lasted six to eight weeks. Everything went like clockwork, with Medcon’s staff onsite throughout the whole process and beyond. Functioning as if they were our own employees, the Medcon team worked evenings and at times through the night to ensure normal hospital procedures continued uninterrupted. Medcon provided ten TCS analog and digital acquisition systems to outfit cath labs in four hospitals. These were connected to x-ray systems which were mainly from Philips. TCS review stations were installed throughout the enterprise. All facilities have immediate access to current studies. Long-term storage is accomplished with two DVD jukeboxes located at the Data Center. The archive can hold about five years worth of studies. An archived cine run may be retrieved from a jukebox in less than 30 seconds, based on direct read jukebox technology. T-3 lines connect the long-term storage devices with the cath labs. The TCS system design takes advantage of industry standards that enable information-sharing among different health information systems. It acquires or translates all images into a standard DICOM format. An HL7 interface links images to corresponding files from the Witt hemodynamic system. At CMC, this link also pulls in information from our Witt cath lab reporting software (e.g., cardiac tree). At CMC-Mercy, Medcon provided a cath reporting module that automatically integrates cath images and procedural information from the system. Without disrupting workflow, the MD Web module transforms images and reports to standard Windows formats for publication. Once published, this information is immediately accessible over the intranet to doctors in all four locations. A plug-in allows similar image manipulation with a standard Web browser on any PC as available on a dedicated viewing station. Additionally, we are evaluating the installation of eMedcon, the Internet-based communications system that allows authorized physicians anywhere whether referring doctors, staff cardiologists or consulting experts to securely exchange images over the Internet and opens up the possibility of live online consultations. Customization As part of the project, Medcon customized a range of features. For example, the system ensures that a report is attached to every study before permanent storage. It tells us which reports are outstanding. The link to our PedCath pediatric cath reporting system also was a customized feature. The Transition The transition to a filmless system was straightforward. Initially, we had planned to run film for at least a month as we acclimated to the new system. However, one week after installation, our film processors went down and required an extremely costly repair. At that point, we switched completely to the digital system without film and have never looked back. Physician Response Physicians at all facilities have commented enthusiastically about the system. Dr. Charles Simonton, FACC, FSCA&I, noted, The image quality is excellent and the speed of image retrieval has been outstanding. I have also been pleased with the teaching file application for saving images to present at regional and national meetings. We are also eagerly looking forward to the eMedcon application, which will allow us to receive outside studies from our referring physicians directly over the Internet. Dr. B. Hadley Wilson, FACC, added, I enjoy the teaching file option of the system, which allows us to save cases in a teaching format for future conferences. The ability to import outside CDs into our database is another important feature, since we then have instant access to them anywhere in the hospital. The search feature is very expedient also. The availability of the films at multiple workstations for review and documentation makes the workflow better. It truly has been great in that respect, said Dr. Mark K. Reames. Everyone appreciated the easy communication among facilities and the ability to instantaneously share information about cases. The ease of use minimized any learning curve, and customized user interfaces made it fast and convenient to use on an ongoing basis. Cost Savings Carolinas Healthcare System is now enjoying immense benefits elimination of film developing and filing, greater efficiency, improved workflow, decreased room turnover time, and more, due to customizations. Since images are always ready for review, physicians’ workflow has improved. Surgeons can access images while in the operating room, without manually retrieving films. Attending physicians can view a procedure from anywhere in the hospital and immediately discuss it with a patient, instead of waiting for the patient’s cathing doctor to come in for a case review. This improves room turnover dramatically and often eliminates weekend stays. Our four locations are now connected and share information as if they were next door. We estimate that CHS will save almost $200,000 a year in the costs of film and supplies, forecasting an excellent return on investment. Not included in that figure are the economic benefits of the stepped-up caseload we have been able to take on because of increased staff efficiencies. Examining our numbers, we were pleasantly surprised to find that we handled more cases in recent months than ever before, without any increased workload. This is, perhaps, the best testimony to the success of our system conversion.