A Quick Look at Cardiovascular Information and Imaging Systems (CVIS)

I must have been sleeping at the switch. Outside of my lab/LIS world, a new category of integrated clinical information systems has arisen -- the CVIS or cardiovascular imaging and information system. McKesson provides a CVIS web site promoting the McKesson product. Listed below and copied from the " comparing solutions" tab of this web site is a summary of the functionality of their system:

• Reporting: (1) Real-time reporting; (2) Remote report creation and signing; and (3) Automated rules-based report distribution
• A single, coordinated image display, to view all medical images
• Single sign-on for clinicians to access multiple systems
• Patient-centric workflow
• Robust digital archiving (efficient access to historical images and data, including echocardiograms, and ECGs and hemodynamic waveforms)
• Web access for clinicians and referring physicians

Readers of this blog will undoubtedly be familiar with the major "ancillary" information systems: LISs, RISs, and pharmacy information systems. In addition, we now have the PACS variants in both radiology and pathology. They are used for archiving the digital images acquired in both departments. The CVIS is a very interesting variant on this theme of specialty-oriented systems because, it combines workflow, reporting, and digital archiving similar to LISs, RISs, and PACSs. Note the reference above to a "single sign-on for clinicians to access multiple systems." Cardiologists, the major users of CVISs, obviously need access to the hospital EMR to integrate various streams of clinical data such as current medications and nursing progress notes.

I have suggested in previous notes that hospital EMRs are not adequately designed to hold the text and image files generated in diagnostic departments such as the clinical labs, pathology, radiology, and cardiology. Here are two quotes from a previous note discussing the superiority of "ancillary department automation" over EMRs and the goals of EMR vendors (see: EMR Failures and a Recipe for Their Avoidance in the Future ):

• .... Mr. HIStalk's proposed solution [for managing hospital information systems]: stick with ancillary department task automation. I will take his definition of ancillary information systems to primarily involve LISs, RISs, PACs, and pharmacy information systems. Unfortunately, few CIOs and CMIOs have in-depth knowledge about the lab, radiology, or pharmacy systems. They are managed by the knowledge and process domain experts in the specific hospital departments, frequently with hosting by the central IT departments.

• For their part, EMR vendors continue to pursue their short-term strategy of selling inadequate and poorly designed systems that that are difficult to install, don't scale up, or perform inadequately. CIOs and CMIOs keep buying inadequate EMRs, despite the long  history of failure of these systems, because they are paid to deploy "modern" systems and there are few if any in the market that respond to their wish lists. You have two sets of players that are pursuing a flawed business model in concert.

So what is the take-home lesson from all of this. Pretty simple, really. The "departmental diagnostic systems" continue to evolve, frequently integrating images with reporting information. Moreover, they also manage patient and physician mission-critical workflow for the various specialties. This is in contrast to hospital EMRs that more frequently serve as data repositories relating to clinical care. The LISs, RISs, radiology/pathology PACS, and now CVISs are thus on a different development trajectory than EMRs. I am not exactly sure of the future relationship of the EMRs to these ancillary systems but the "integration" challenges will be formidable.