0. Cardiac Catheterization Lab Integration Project Frederic Resnic, MD, FACC Brigham and Women’s Hospital Harvard Medical School Boston, MA, USA
I’ld like to talk about Brigham’s experience of taking one a large scale multi-vendor Cath Lab integration project on our own…

1. About Brigham Cath - Statistics
5 Cardiac Catheterization labs
Completely remodeled in 2000
4000 Diagnostic procedures annually
1800 Interventional procedures annually
700 Peripheral procedures annually
March 13, 2006
ACC Scientific Sessions

2. ACC Scientific Sessions
March 13, 2006
ACC Scientific Sessions

3. About Brigham Cath - Systems
Brigham-developed Hospital Information System (HIS) known as “BICS”
Philips Integris Angio Systems
Witt Hemodynamic Systems
Agfa Scheduling and PACS system
LUMEDX ACC NCDR submission system
March 13, 2006
ACC Scientific Sessions

4. ACC Scientific Sessions
March 13, 2006
ACC Scientific Sessions

5. Cath Lab Integration Project Goal
Dramatically change and improve the workflow in the cath lab.
March 13, 2006
ACC Scientific Sessions

6. Cath Lab Integration Project Motivation
Personnel efficiency – entering data (accurately) into multiple lab systems
Determining “status” of exam
Speeding up “lab turn-around” time
“Finding” the patient record in the hemodynamic system (e.g., patient name spelling or patient ID transposed)
“Finding” the images in the digital archive
Expedite charges and billing (centralize and validate information to reduce time lag)
Handle exceptions to basic workflow:
Change rooms during procedure- avoid reentering data all over
Unscheduled/unknown patient -“John Doe” reconciliation
March 13, 2006
ACC Scientific Sessions

7. Cath Lab Integration Project Process
Facilitate discussions between vendors to determine how and what information to communicate (“define the standard”)
Vendors went away to perform implementation
Track vendor implementation status
Try implementations in “live” lab
Find errors, go back to steps 1 or 2
Took a long, long time (2+ years)
March 13, 2006
ACC Scientific Sessions

8. Cath Integration - Pre-procedure
LUMEDX
NCDR
Cath Integration - Pre-procedure
Witt Hemo
Patient, order, and
procedure info
BICS
(HIS)
Agfa
ICIS
Philips Integris
Patient
and order
information
Procedure status
Agfa
PACS
March 13, 2006
ACC Scientific Sessions

9. Cath Integration - Post-procedure
LUMEDX
NCDR
Cath Integration - Post-procedure
NCDR Data
Report
Witt Hemo
Patient, order, and
procedure info
Report
BICS
(HIS)
Agfa
ICIS
Philips Integris
Patient
and order
information
Procedure status
Images
Agfa
PACS
March 13, 2006
ACC Scientific Sessions

10. ACC Scientific Sessions
March 13, 2006
ACC Scientific Sessions

11. ACC Scientific Sessions
Realized Benefits
Accurate and automated patient demographics
Happier technologists (less busy work –typing)
Fewer interruptions for Cath Lab Flow Manager (procedure status and cancellations)
Faster room turn around time
Better communication between cath lab teams
Improved efficiency of billing
Providing data to be able to optimize resource utilization
March 13, 2006
ACC Scientific Sessions

12. Integrating the Healthcare Enterprise (IHE)
Is IHE going to fix this multi-vendor integration problem for us?
Speed of implementation in a hospital?
Technical specification between vendors?
Simplify purchasing process?
Pre-tested/integrated software (not “live in lab”)?
Upgradable/standard software releases (no “one of a kind” software)?
March 13, 2006
ACC Scientific Sessions

13. ACC Scientific Sessions
General Conclusions
End goal was correct and project was successful, but…
Vendor integration process was painful and time consuming
We hope we have avoided potential software upgrade problems in future (specially developed software)
Get to be good friends with software developers from companies
March 13, 2006
ACC Scientific Sessions

14. ACC Scientific Sessions
IHE Conclusions
Our cath lab integration design is very close to IHE Cardiology “Cardiac Catheterization Workflow Profile”. It works.
Next time we intend to specify IHE in our purchasing RFP and avoid the entire design, specification, development, integration, and test phases.
Let IHE do it for us.
March 13, 2006
ACC Scientific Sessions