New cardiac cath lab embraces enterprise imaging

• For the communities in and around Moreno Valley, Calif., having an academic-affiliated cath lab close to home means counting on fast access to topnotch care for heart and neurovascular conditions such as stroke and acute coronary syndrome.
• For invasive, non-invasive and interventional cardiologists, using the RUHS-MC cath lab means no longer dashing to another facility for diagnosing or treating patients suffering life- threatening heart problems like ST-segment elevation myocardial infarction (STEMI), a severe type of heart attack.
• For RUHS-MC as an institution, successfully running a state-of-the-art cardiovascular service line means taking a major step toward elevating its trauma-center designation from level 2 to level 1.

And for clinical support staff, working in and with the new cath lab means riding heart care’s leading edge for the benefit of all the stakeholders above. Enterprise imaging for cardiology is playing a role too in facilitating excellent quality of care by now managing cardiovascular images within the same Sectra PACS they’ve used for 21-plus years in radiology. They also benefit from full integration with their Epic EMR as well as systems for structured reporting and automated echo measurements.

“From my perspective, the opening of the cath lab has been the biggest development at RUHS since I joined the organization almost four years ago,” explains Edward Garcia, a respiratory therapist with 29 years of experience who manages RUHS’s cardiopulmonary services. “It’s fantastic to have the technological and human resources we need to provide safe and effective patient care.”

Reuben Butler, director of nursing services in the cardiac cath lab at RUHS-MC, agrees with that assessment.

“I’ve been in healthcare for 20 years and consider myself a patient advocate,” Butler says. “That has been one of my driving forces in being a nurse. With the cath lab we’re getting good outcomes and doing good things for the people of Riverside County and the surrounding counties of Moreno Valley. That makes me happy.”

Inauspicious beginnings

For all their unshakable focus on the patient, Garcia and Butler are quick to express their appreciation for high-tech toolkits without which they wouldn’t be providing the best care—even though much modern medical technology “runs in the background”, invisible to most patients.

Take for example Sectra’s Enterprise Imaging for Cardiology. The vendor-neutral platform for managing cardiology image data integrates clinical and analytics tools within physicians’ individual workflows. Its hallmark is displaying cardiovascular image data for cardiologists and other clinicians who demand crisp views delivered with ultrahigh efficiency.

Garcia and Butler say all members of their heart team have come to rely on the solution.

However, interestingly, both point out that they were initially skeptical. They knew their colleagues in RUHS-MC’s radiology division had been happy with Sectra products and services for years. But they didn’t fully buy in until a series of unfortunate events made it clear Sectra offered a fitting way forward.

“We had recently upgraded everything—a new echocardiography machine plus updated image- management software from the echo OEM,” recalls Garcia. “And then, long story short, we were not able to send echo image and video files over to pediatric cardiologists at a hospital we share an Epic instance with.”

The problem was that despite the OEM’s software upgrades and pre-installation promises, its legacy PACS for handling echo image data couldn’t be made to work with its otherwise highly capable new echo machine.

“It was then that someone suggested we try Sectra for sending echo image files to physicians,” Garcia recalls.

Skeptics won over

Both Garcia and Butler balked at the suggestion and did not think a vendor who had historically focused on radiology could make a group of demanding cardiologists happy.

Despite their skepticism, both could see the strategic sense in having Sectra expand its know-how to their department. They also realized the system was an enterprise imaging solution cross-trained on cardiovascular imaging, not just a radiology PACS. Building on RUHS-MC’s existing relationship with Sectra “might give us the ability to have a little bit of a stopgap” against the failing of the legacy cardiology PACS, Garcia recalls thinking. “It could help us continue providing safe patient care.”

So Garcia and Butler embraced the decision when RUHS-MC’s cardiology PACS purchasing team— which was led from the C-suite and included Garcia and Butler—arrived at a consensus on Sectra Enterprise Imaging for Cardiology.

In retrospect, the two agree, it was the right thing to do all along. The system went live without a hitch the third week of October 2019. And the early signs suggest a pleased population of physicians and staff.

Not least among the clues is a pleasant lack of complaints from physicians: If any were unhappy, Garcia and Butler say, the two would have heard about it by now.

“What I really like about this Sectra product is the way it puts everything right there for you,” Garcia says. “You’re able to look at your patients’ information, see the studies, complete the report and have the report go straight into Epic.”

That capability alone has taken away 15 to 20 minutes per exam, he adds. The time savings “translates to better access for patients.”

“It’s huge that the doctors don’t have any complaints,” says Butler. “But it’s also huge that the staff understands the doctors’ workflows and are comfortable supporting them. And the staff members don’t have any complaints, either. So it’s all working really well so far.”

Quick and capable

Garcia and Butler also like the seamlessness of the integration connecting Sectra Enterprise Imaging for Cardiology with Sectra partners TomTec for automated echo measurements and ASCEND for structured reporting.

“Everything went live at the same time, so it’s all in use now, although we’re still fine-tuning the structured reporting piece,” Garcia says. “All in all, the technology does make a difference. The physician is able to go in and identify any cardiology issues in children much more quickly than before.”

He’s referring to the 30- to 45-minute drive through traffic that pediatric cardiologists used to have to make from their facility 12 miles away in Loma Linda. The Sectra cardiology solution allows them to view studies remotely.

Meanwhile, Garcia adds, the solution’s interface with Epic is configured so that any doctor who has access to Epic charting also has access to the echo studies.

“If a patient needs cardiac surgery, we can share that patient’s information with the outside group,” Garcia continues. “They can quickly get an understanding of what’s going on with the coronary testing, where the lesions are and what needs to be done. It helps them better diagnose the issue and decide on the best care path.”

Productive partnership

Thinking back to the period leading up to the October go-live with Sectra Enterprise Imaging for Cardiology, Garcia and Butler recall the weeks their department spent planning and preparing as key to the success they’re seeing today.

“There was a lot of testing,” Garcia says. “There was a lot of integration involving Epic, and Sectra had to be very involved with our Epic builders to make sure the interface ended up easy to use for the end-users.”

Sectra’s subject matter experts played a key role, he says, adding that they led discussions on what each participant needed to do from the standpoints of IT, training and integration.

“Without Sectra’s support, none of those discussions would have happened,” Garcia says. “Or if they had, they wouldn’t have been as productive as we needed them to be.”

Garcia was pleased to find Sectra’s technical support staff making themselves present or readily available over the phone, via remote access to the department’s digital systems and, occasionally, in person at RUHS-MC.

“When we went live, they were onsite for the entire week,” Garcia says. “That was very helpful to our super users and technologists as well as our physicians. Having that Sectra resource here with us really made us feel comfortable about moving forward.”

A rewarding new beginning

Garcia and Butler conclude by reiterating their patient-centric viewpoint on technology.

“As a clinician who started at the bedside, my first inclination is always to provide the best care to get to the best outcomes with the safest method possible to get that patient in and out of the hospital,” he says “Being able to implement new technology in partnership with great vendors like Sectra—and with our great colleagues in RUHS-MC’s radiology department—enables us to do that.”

“Things are going well, and I believe we’re all happy with the direction we took,” adds Butler. “The fact that we’re getting good outcomes is our reward.”