Greenville Hospital System integrates cardiology and radiology departments with a single solution from Agfa

Greenville Hospital System (GHS) is a not-for-profit health organization affiliated with Medical University of South Carolina and University of South Carolina Medical School. The hospital has more than 1,180 beds and 1,000 staff physicians located on five campuses throughout Greenville County, South Carolina.

GHS is involved in a statewide collaboration with the University of South Carolina (USC), the Medical University of South Carolina (MUSC), and Palmetto Health. The purpose of the South Carolina Health Sciences Collaborative is to improve health sciences research and education, the economic environment, and public health in South Carolina. As a result of this ongoing effort, GHS attained university medical center status in 2004.

Technology strategy based on logical units

Another feather in GHS's cap - it was recently named one of the "100 Most Wired Hospitals" and "25 Most Wireless Hospitals" by the American Hospital Association's Hospitals and Health Networks magazine. According to Doran Dunaway, Vice President and Chief Information Officer for GHS, the hospital has a four-pronged technology strategy. "First, we're committed to developing a computing infrastructure that improves patient safety by providing a patient's complete medical history," he explains. "In addition, we want to improve access to clinical results, enhance process automation for care providers, and eliminate the constraints of film- and paper-based records by having digital access to all information."

The long-term result of GHS's technology strategy and its participation in the SC Health Sciences Collaborative will be a cross-collaborative system that provides integrated access to all hospital records, systems, and clinical data. To achieve these lofty goals, GHS developed an IT philosophy that categorized various IT functions into "logical units." According to Doran Dunaway, "We grouped IT applications into logical units and tried to work with a single vendor and single interface for each unit."

For example, Doran Dunaway continues, the hospital's Picture Archiving and Communications System (PACS) from Agfa HealthCare is the core of a logical unit that includes radiology, cardiology, orthopaedics, and eventually, women's services. "Agfa is on the forefront of clustering applications so that all of the information is in a single database," he explains. "This allows us to look longitudinally at patient information and see data from across the organization."

Our staff members now have the ability to see the cath, echo, and vascular images at the same time, without having to go to another PC in another department.
Cindy Coffey, Manager of Non-Invasive Cardiovascular Services

Cardiology imaging and reporting: on a mission to make it better

The GHS Heart Institute is well-known for its innovative and comprehensive cardiac care, and has the largest vascular disease program in the state. Annually, more than 10,000 patients choose GHS as their partner in the prevention, diagnosis, and treatment of cardiac and vascular diseases. Patients have access to a variety of invasive and non-invasive catheterization and echocardiology procedures at the Chest Pain Center and physicians use the latest ultrasound technology to perform more than 17,000 non-invasive vascular exams each year in the hospital's state-of-the-art vascular labs.

Upgrading its current cardiology imaging system was a critical part of GHS's long-term vision, but it was also purely practical. "We needed an improvement to the systems we had," says Cindy Coffey, Manager of Non-Invasive Cardiovascular Services. "Primarily, we wanted our systems to be integrated."

Cindy Coffey explains that the Cath department used a different system than the Echo and Vascular departments, and the systems were not interoperable. Due to limitations in the system used by the Echo and Vascular departments, it was impossible to view more than one modality from a single workstation. Cindy Coffey says, "If a patient had cath, echo, and vascular studies, we had to view every study from a different workstation."

In addition, the Echo and Vascular staff also wanted to access cardiology reports and images from the hospital's existing Agfa radiology PACS. "With our previous cardiology imaging system, we didn't have the capability to view images stored in the radiology PACS on a cardiology workstation," says Cindy Coffey. "Our staff did a lot of going back and forth between departments."

According to Cindy Coffey, also at issue was the previous system's limited ability to provide standardized reporting. "It wasn't able to implement standardized reporting to the PACS," she explains. "We were frustrated with the lack of progress in enabling reporting."

A practical solution for integrated imaging and standardized reporting

Cindy Coffey and her colleagues in the Echo and Vascular departments were able to find a better solution when the hospital began looking for a cardiology imaging system. GHS selected Agfa because its Heartlab cardiovascular image and information management system integrated seamlessly with the hospital's existing Agfa radiology PACS.

The Echo and Vascular departments at GHS quickly became interested in the Heartlab system. The Heartlab system is a single solution that supports multiple modalities, including all of the hospital's cardiology sub-specialties and its radiology PACS. Now, GHS is working with Agfa to implement Heartlab imaging and reporting in its cath, echo, and vascular labs. Currently, imaging has been deployed in all three labs, and structured reporting is available for echo and is in progress in the vascular lab.

Agfa is on the forefront of clustering applications so that all of the information is in a single database.
Doran Dunaway, Vice President and Chief Information Officer for GHS

With the Agfa solution clinical staff at GHS can review cardiology and radiology images and reports from the same workstation. As far as Cindy Coffey is concerned, that's the best feature of the fully integrated systems. "Our staff members now have the ability to see the cath, echo, and vascular images at the same time, without having to go to another PC in another department," she explains. "And, we can see a patient's radiology studies - chest X-rays and reports for example - that aren't even on the Heartlab system. It's all transparent to the users and that's invaluable."

Cindy Coffey says that the Heartlab system was critical in helping the Echo and Vascular departments earn accreditation from the Intersocietal Commission for the Accreditation of Vascular Laboratories (ICAVL). Standardized reporting is a requirement for ICAVL accreditation. "Before we had the Heartlab system, we had a workflow list posted at all the reading stations and we asked physicians to follow the protocol when they were reading and dictating," she explains. "But because the process was not consistently followed, reporting was never completely standardized."

"Now that the Heartlab system is in place, physicians can read studies in any order," she continues. "The Heartlab system organizes all the reports in the same way so that they're uniform and standardized."
Coffey says that standardized reporting is helpful for resident physicians. "Physicians who haven't been reading studies for a long time benefit from the system, because it reminds them of the things that need to be included in a report. A standardized report helps them," she says. "It's another way to keep everything a little more uniform in the department."

Conclusion

When the deployment is completed, GHS will be the first U.S. facility to have a fully integrated Agfa imaging and reporting solution that spans radiology and cardiology vascular, echo, and cath labs. "Being able to view images and standardized reports for all cardiology and radiology modalities from a single workstation will dramatically improve workflow," says Cindy Coffey.