Methods Inf Med 2007; 46(03): 344-351
DOI: 10.1160/ME0371
paper
Schattauer GmbH

Optimizing the Interventional Cardiology Facility: Services Integration in Routine Workflow

L. Gortzis
1   Telemedicine Unit, Department of Medical Physics, University of Patras Medical School, Patras, Greece
,
A. Kalogeropoulos
2   Department of Cardiology, University of Patras Medical School, Patras, Greece
,
D. Alexopoulos
2   Department of Cardiology, University of Patras Medical School, Patras, Greece
,
G. Nikiforidis
1   Telemedicine Unit, Department of Medical Physics, University of Patras Medical School, Patras, Greece
› Institutsangaben
Weitere Informationen

Publikationsverlauf

Publikationsdatum:
20. Januar 2018 (online)

Summary

Objectives: Integration of administrative and clinical data, imaging, and expert services, although challenging, is a key requirement in contemporary interventional cardiology facilities (ICF). We propose a workflow-oriented hybrid system to support the ICF and investigate its feasibility and effectiveness in a referral medical center.

Methods: We have developed a Java-powered hybrid system (NetCARDIO), able to support over web synchronous and asynchronous data management, realtime multimedia data telemonitoring and continuous telementoring. Data regarding procedural rates, treatment planning and radiation exposure were collected over a two-year period of routine NetCARDIO implementation (July 2002 to June 2004) and compared with data from an immediately preceding period of equal duration (January 2000 to December 2001).

Results: During the NetCARDIO period, 163 ±11 coronary procedures per month were performed vs. 77 ±15 during the control period (p <0.001). Percutaneous coronary intervention was delivered ‘ad hoc’ in 88% of eligible patients vs. 45% (p <0.001). Mean fluoroscopy time per coronary lesion treated decreased from 594 ± 82sto 540 ±94s (p < 0.001). Annual radiation exposure of expert interventionistswas decreased by 22%. Electronic storage significantly reduced archiving costs.

Conclusions: Real-time multimodal services sharing combined with powerful database capabilities is feasible through a web-based structure, significantly enhancing performance and cost-effectiveness of ICF. Further research is needed to promote integration of additional data sources and services.

 
  • References

  • 1 Togni M, Balmer F, Pfiffner D. et al. Percutaneous coronary interventions in Europe 1992-2001. Eur Heart J 2004; 25: 1208-13.
  • 2 Zavala-Alarcon E, Cecena F, Ashar R. et al. Safety of elective – including “high risk” – percutaneous coronary interventions without on-site cardiac surgery. Am Heart J 2004; 148: 676-83.
  • 3 Le Feuvre C, Helft G, Beygui F. et al. Safety, efficacy, and cost advantages of combined coronary angiography and angioplasty. J Interv Cardiol 2003; 16: 195-9.
  • 4 Tsapaki V, Kottou S, Vano E. et al. Occupational dose constraints in interventional cardiology procedures: the DIMOND approach. Phys Med Biol 2004; 49: 997-1005.
  • 5 Crowe B, Hailey D. Cardiac picture archiving and communication systems and telecardiology – technologies awaiting adoption. J Telemed Telecare 2002; 08 (Suppl. 03) 9-11.
  • 6 Muller H, Michoux N, Bandon D. et al. A review of content-based image retrieval systems in medical applications – clinical benefits and future directions. Int J Med Inform 2004; 73: 1-23.
  • 7 Masseroli M, Pinciroli F. Web architecture for the remote browsing and analysis of distributed medical images and data. Medinfo 2001; 10: 43-7.
  • 8 Fitch CJ. Information Systems in Healthcare: Mind the Gap. Proceedings of the 37th Hawaii International Conference on System Sciences. 2004
  • 9 Tobis J, Aharonian V, Mansukhani P. et al. Video networking of cardiac catheterization laboratories. Am Heart J 1999; 137: 241-9.
  • 10 Ting HH, Garratt KN, Singh M. et al. Low-risk percutaneous coronary interventions without on-site cardiac surgery: two years’ observational experience and follow-up. Am Heart J 2003; 145: 278-84.
  • 11 Stahl JN, Zhang J, Zellner C. et al. Teleconferencing with dynamic medical images. IEEE Trans Inf Technol Biomed 2000; 04: 88-96.
  • 12 Maliff RP, Launders J. Using technology assessment as the picture archiving and communication system spreads outside radiology to the enterprise. J Digit Imaging 2000; 13: 114-6.
  • 13 Sable C. Telecardiology: potential impact on acute care. Crit Care Med 2001; 29: N159-65.
  • 14 Weterings RA. Integrated image storage solution for the Cath department. Int J Card Imaging 1998; 14: 349-56.
  • 15 Jegelevicius D, Marozas V, Lukosevicius A. et al. Web-based health services and clinical decision support. Stud Health Technol Inform 2004; 105: 27-37.
  • 16 Vanececk G. Enabling Hybrid services in Emerging Data Networks. IEEE Communication Magazine. July 1999
  • 17 Java Server Pages Technology – Implementations and Specifications. http://java.sun.com/products/jsp/reference/api/index.html.
  • 18 MySQL AB: MySQL Documentation. http://dev.mysql.com/doc.
  • 19 The Apache Tomcat 5.5 Servlet/JSP Container – Documentation Index. http://jakarta.apache.org/tomcat/tomcat-5.5-doc/index.html.
  • 20 JDBC downloads and specifications. http://java.sun.com/products/jdbc/reference/api/index.html.
  • 21 Java Media Framework API (JMF). http://java.sun.com/products/java-media/jmf/reference/api/index.html.
  • 22 Scanlon PJ, Faxon DP, Audet AM. et al. ACC/ AHA guidelines for coronary angiography. A report of the American College of Cardiology/ American Heart Association Task Force on practice guidelines (Committee on Coronary Angiography). Developed in collaboration with the Society for Cardiac Angiography and Interventions. J Am Coll Cardiol 1999; 33: 1756-824.
  • 23 Smith Jr. SC, Dove JT, Jacobs AK. et al. ACC/ AHA guidelines of percutaneous coronary interventions (revision of the 1993 PTCA guidelines) – executive summary. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (committee to revise the 1993 guidelines for percutaneous transluminal coronary angioplasty). J Am Coll Cardiol 2001; 37: 2215-39.
  • 24 Serruys PW, Unger F, Sousa JE. et al. Comparison of coronary-artery bypass surgery and stenting for the treatment of multivessel disease. N Engl J Med 2001; 344: 1117-24.
  • 25 Berger PB, Velianou JL, Aslanidou Vlachos H. et al. Survival following coronary angioplasty versus coronary artery bypass surgery in anatomic subsets in which coronary artery bypass surgery improves survival compared with medical therapy. Results from the Bypass Angioplasty Revascularization Investigation (BARI). J Am Coll Cardiol 2001; 38: 1440-9.
  • 26 Antman EM, Anbe DT, Armstrong PW. et al. ACC/AHA guidelines for the management of patients with ST-elevation myocardial infarction: a report of the American College of Cardiology/ American Heart Association Task Force on Practice Guidelines (Committee to Revise the 1999 Guidelines for the Management of Patients with Acute Myocardial Infarction). Circulation 2004; 110: e82-292.
  • 27 Braunwald E, Antman EM, Beasley JW. et al. ACC/AHA guideline update for the management of patients with unstable angina and non-ST-segment elevation myocardial infarction – 2002: summary article:a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on the Management of Patients With Unstable Angina). Circulation 2002; 106: 1893-900.
  • 28 Decruyenaere J, De Turck F, Vanhastel S. et al. On the design of a generic and scalable multilayer software architecture for data flow management in the intensive care unit. Methods Inf Med 2003; 42: 79-88.
  • 29 Hu B, Bai J, Ye D. A telemedicine management model based on message-trigger service. Methods Inf Med 2000; 39: 73-7.
  • 30 Cubano M, Poulose BK, Talamini MA. et al. Long distance telementoring. A novel tool for laparoscopy aboard the USS Abraham Lincoln. Surg Endosc 1999; 13: 673-8.
  • 31 Coleman J, Goettsch A, Savchenko A. Towards Collaborative Volume Visualization Environments. Computers & Graphics 1996; 20: 801-11.