Gain enterprise imaging momentum by adding cardiology — the benefits and what functionality to look for

If not already implemented, establishing an enterprise imaging (EI) system for managing medical content is in most healthcare providers’ plans. A common way of reaching the goal of establishing such a foundation is to expand the existing radiology picture archive and communication system (PACS). In doing so, healthcare providers can leverage established electronic medical record (EMR) integrations and PACS infrastructure. In essence, adding additional ologies to an existing platform reduces both cost and complexity since the number of vendors and systems can be minimized.

Adding cardiology as one of the first ologies — ­in addition to radiology — has been a proven recipe for demonstrating early wins. Aside from the financial benefits of cost sharing, this approach has led to reduced turnover times and more satisfied end-users, but only if the system meets the clinical needs of the cardiologists.

But adding cardiology is not without its challenges. The absence of standards, security issues and a lack of enthusiasm are some of the possible hurdles mentioned in a report from Signify Research[1] published in 2019. Showing early wins and addressing these challenges are necessary for a successful implementation.

This article will explain why you should add cardiology as one of the first ologies to your enterprise imaging system, and what functionality the system will need to provide to satisfy user requirements while leveraging platform synergies.

Adding cardiology as one of the first ologies

The aforementioned Signify Research[2] report states that when expanding the radiology PACS to enterprise imaging, it became clear that there was some low-hanging fruit to be had by adding cardiology as one of the first ologies. According to the report, EI project implementation can extend over a period of ten years or more, and that the “lack of early success for EI leads to early stifling of many projects”. Therefore, demonstrating early wins will catalyze further momentum for additional investments and fuel the necessary organizational and cultural change.

The main reason for cardiology being suitable to add early is that the specialty is becoming more image intense and requires support for facilitating tighter collaboration with radiology. Even though the addition of cardiology multimedia to the EI system requires a migration, it quickly pays off in the form of reduced costs and better clinical benefits.

This was, for example, the solution implemented at the University Hospitals of Cleveland in 2015. A study[3] published in 2019 shows the remarkable results achieved by adding cardiology to radiology as a first step toward enterprise imaging. This reduced downtime by 84%, storage costs by 32% and overall IT infrastructure costs by 10–15%.

Post-implementation vs. pre-implementation status of the enterprise imaging system at the University Hospitals health network[3].

The increased use of cardiology imaging

To meet the requirements of cardiology end-users, it is important to have some background information on when and how imaging is used in cardiology.

Cardiovascular diseases (CVDs) are the most common cause of death globally[4]. Cardiac imaging is used in the identification of those at highest risk of CVDs, in diagnosis and in the treatment steps. Technological advancements within cardiology imaging lead to fewer invasive interventions, thereby justifying the use of more cardiology imaging.[5]

Different cardiac imaging techniques and modalities

A variety of clinical symptoms may arouse suspicion of CVDs. Various cardiac imaging techniques are often required in order to establish a diagnosis and proper treatment. From a cardiologist’s perspective, the choice of cardiac imaging modality depends on:

  • The disease being investigated.
  • Individual patient characteristics.
  • The accessibility of tests.

For example, assessing dyspnea and investigating coronary artery disease both require cardiac imaging. And imaging is also common in the diagnosis of cardiomyopathy, and structural or congenital heart disease.[6]

The various modalities used include:

  • Echocardiography
  • Electrocardiography (EKG/ECG)
  • Fluoroscopy in the catheterization laboratory
  • Nuclear myocardial perfusion imaging
  • Cardiac computed tomography (CT)
  • Magnetic resonance imaging (MRI)

All of these have various advantages and disadvantages. Often, at least two of these examination types are required to obtain a comprehensive overview of a patient’s cardiac health.[7] For example, cardiac MRI is used as an adjunct to other imaging modalities when further clarification is warranted. Another example is echocardiography, which can provide the required clinical information without radiation exposure but is often used in combination with other imaging techniques to provide a broader picture.[8]

Also noteworthy is point-of-care ultrasound (POCUS)[9] — one of the fastest growing cardiac imaging techniques. POCUS has during the latest years become an important additional source of revenue and will probably keep growing rapidly in use. These images and videos are often acquired outside of the radiology department.

The list of modalities is long. And an EI system must support all of them to be able to store and enable content for diagnostic review.

Greater need for cardiology–radiology collaboration

Cardiology imaging is producing more content than ever before and this needs to be stored in a cost-efficient and consolidated manner, integrated into clinical workflows. The increase in cardiac imaging has also led to a growing need for collaboration between radiology and cardiology. The common view among cardiologists and radiologists is that this can be a challenge. The problem is exemplified by the fact that only a few successful and truly collaborative radiology–cardiology IT systems exist on the market.[10]

These days, I save five to ten minutes per patient for every ultrasound examination.[11]

Edit Floderer, Senior Physician and Cardiologist at the Cardiology and Intensive Care Unit at Central Hospital of Karlstad

Three different perspectives on the benefit of adding cardiology

The lack of investment in new IT systems may impede the utilization of modern cardiac imaging techniques[12]. Sharing IT costs by utilizing a common enterprise imaging platform offers an opportunity to cut costs and facilitate investment decisions in the long term.

To justify investments in new IT, it is necessary to convince each role in the decision-making process of the benefits of adding cardiology to the EI system. These benefits differ depending on the role within the organization and range from reducing IT costs or administration, to improving clinical outcomes. To help you argue the case, we have listed some of the main advantages from three different perspectives when implementing full cardiology support as part of the EI system.

Management perspective

  • Consolidation of IT systems
    Lower total service and license fees, shared hardware and significantly reduced costs due to fewer systems and integrations to maintain.
  • One “throat to choke”
    You can rely on one (rather than multiple) vendor as a counterpart. This results in reduced time spent on administration and time-consuming contract negotiations, while you can rely on one counterpart for functionality and uptime.
  • One image platform
    Aligned with an enterprise imaging strategy to make imaging available across the health system and across several disciplines. This also allows for image acquisition at the point of care to streamline workflows — all the way to patient encounter.

Clinical perspective

  • One system with a shared archive containing all the relevant images, multimedia and reports minimizes the need to request and send patient data between different solutions and departments. It also provides immediate access to prior exams for comparisons without having to request or retrieve these. Overall, one system leads to improved reading efficiency by having all cardiac imaging exams and advanced tools gathered and integrated into a single desktop.
  • Enhanced collaboration between cardiologists and radiologists and with other specialists results in truly integrated diagnostics. This means gaining access to each other’s images and reports, tools for communication, such as instant messaging and link insertion, and one system to use in multidisciplinary team meetings.
  • Enhanced patient satisfaction, as one system can be used to display all images and test results required in the diagnosis and treatment to create a richer patient dialogue. It is also much easier to integrate one system with patient portals, which would otherwise not contain the full imaging history. The use of CDs and USB memory sticks can be reduced to a minimum.
  • Large efficiency gains can be achieved by becoming highly skilled in one system and desktop instead of having to learn multiple applications. This is a benefit that is often vastly overlooked.

IT perspective

The top benefits from an IT perspective can be summarized as follows.

  • Consolidation
    One system to manage all multimedia instead of a portfolio of systems, together with more efficient maintenance of integrations with surrounding IT systems, such as the EMR, lead to a lower total cost for both software and hardware. In addition, one point of contact for support, change requests, upgrades etc. saves considerable time, reduces frustration and leads to increased control of the IT environment.
  • Security
    One platform designed for large enterprises offers higher security and reduces the many points of failure that a highly heterogenous multi-system environment constitutes.
  • Operational efficiency
    More efficient training and improved know-how among staff, since all administrators and engineers are trained in one system. In addition, fewer IT systems reduces complexity and costs for maintenance, handling of upgrades and administration.An additional benefit often overlooked is that investments and resourcing of operational efficiency can be directed to a single system, instead of being thinly spread across many systems. This paves the way for better system updates, enhanced control of security and higher overall operational system performance.

Ensuring that the clinical needs are met

To ensure the successful implementation of EI, it is crucial that the overall system meets the various clinical needs and results in satisfied end-users. In cardiology, these needs range from basic everyday use cases to highly specialized capabilities in the various clinical aspects. A few key requirements to look for are listed below.

  • Make sure the system supports all the various image formats being used within cardiology so that consolidation can be achieved. For example, cardiac CT, cardiac MRI and ECG.
  • All images and multimedia supported by the system should also be able to be viewed from the universal viewer supplied by the vendor.
  • The system should be able to offer tight integrations with the highly advanced clinical tools for cardiology that are required.
  • Embedded third-party tools often provide a better user experience and greater time savings than external launch.
  • The system should support other data types than images used by cardiology, such as ECG, documents and other standards-based reports that the cardiologists use.
  • Make sure the system can integrate with the EMR/CVIS in a manner that enables cardiology-specific findings and image parameters to be directly populated into the report.
  • Give the organization freedom and compatibility using a system that is vendor neutral with regard to modalities — this will reduce the complexity of managing old exams and ensure flexibility in future device purchases, enabling them to be more tailored to the organization as the device industry evolves.


The adoption of enterprise imaging is a long-term transitional change process. If performed correctly, there are multiple benefits, ranging from one point of contact and reduced and shared IT costs, to enhanced patient outcomes. One key to success thus far has been to expand the existing radiology PACS to other ologies. Due to the growing need for imaging within cardiology and large technological advancements requiring new IT infrastructure, cardiology is viewed as one of the first specialties to add in order to demonstrate early wins to further fuel momentum of EI adoption.

Adding cardiology to the EI system will require benefits to be explained to and understood by the various stakeholders. This is necessary to justify the investment in the EI system so that cardiology is also included.

While the benefits and synergies of an EI system for cardiology are clear and visible from an IT and operational perspective, it is also important to ensure that the clinical needs of the cardiologists are met.

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