Download PDF
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
› Author Affiliations
Further Information

Publication History

Publication Date:
20 January 2018 (online)

    Permissions and Reprints

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.

Keywords

Medical services integration - medical informatics - Java - JMF - radiation exposure - interventional cardiology - heath services research - cost analysis - collaborative services - medical education - hybrid systems
 

  • References

  • 1 Togni M, Balmer F, Pfiffner D. et al. Percutaneous coronary interventions in Europe 1992-2001. Eur Heart J 2004; 25: 1208-13.
    CrossrefPubMedGoogle Scholar
  • 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.
    CrossrefPubMedGoogle Scholar
  • 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.
    CrossrefPubMedGoogle Scholar
  • 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.
    CrossrefPubMedGoogle Scholar
  • 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.
    CrossrefPubMedGoogle Scholar
  • 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.
    CrossrefPubMedGoogle Scholar
  • 7 Masseroli M, Pinciroli F. Web architecture for the remote browsing and analysis of distributed medical images and data. Medinfo 2001; 10: 43-7.
    PubMedGoogle Scholar
  • 8 Fitch CJ. Information Systems in Healthcare: Mind the Gap. Proceedings of the 37th Hawaii International Conference on System Sciences. 2004
    PubMedGoogle Scholar
  • 9 Tobis J, Aharonian V, Mansukhani P. et al. Video networking of cardiac catheterization laboratories. Am Heart J 1999; 137: 241-9.
    CrossrefPubMedGoogle Scholar
  • 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.
    CrossrefPubMedGoogle Scholar
  • 11 Stahl JN, Zhang J, Zellner C. et al. Teleconferencing with dynamic medical images. IEEE Trans Inf Technol Biomed 2000; 04: 88-96.
    CrossrefPubMedGoogle Scholar
  • 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.
    PubMedGoogle Scholar
  • 13 Sable C. Telecardiology: potential impact on acute care. Crit Care Med 2001; 29: N159-65.
    CrossrefPubMedGoogle Scholar
  • 14 Weterings RA. Integrated image storage solution for the Cath department. Int J Card Imaging 1998; 14: 349-56.
    CrossrefPubMedGoogle Scholar
  • 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.
    PubMedGoogle Scholar
  • 16 Vanececk G. Enabling Hybrid services in Emerging Data Networks. IEEE Communication Magazine. July 1999
    PubMedGoogle Scholar
  • 17 Java Server Pages Technology – Implementations and Specifications. http://java.sun.com/products/jsp/reference/api/index.html.
    PubMedGoogle Scholar
  • 18 MySQL AB: MySQL Documentation. http://dev.mysql.com/doc.
    PubMedGoogle Scholar
  • 19 The Apache Tomcat 5.5 Servlet/JSP Container – Documentation Index. http://jakarta.apache.org/tomcat/tomcat-5.5-doc/index.html.
    PubMedGoogle Scholar
  • 20 JDBC downloads and specifications. http://java.sun.com/products/jdbc/reference/api/index.html.
    PubMedGoogle Scholar
  • 21 Java Media Framework API (JMF). http://java.sun.com/products/java-media/jmf/reference/api/index.html.
    PubMedGoogle Scholar
  • 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.
    CrossrefPubMedGoogle Scholar
  • 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.
    CrossrefPubMedGoogle Scholar
  • 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.
    CrossrefPubMedGoogle Scholar
  • 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.
    CrossrefPubMedGoogle Scholar
  • 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.
    PubMedGoogle Scholar
  • 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.
    CrossrefPubMedGoogle Scholar
  • 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.
    Article in Thieme ConnectPubMedGoogle Scholar
  • 29 Hu B, Bai J, Ye D. A telemedicine management model based on message-trigger service. Methods Inf Med 2000; 39: 73-7.
    Article in Thieme ConnectPubMedGoogle Scholar
  • 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.
    CrossrefPubMedGoogle Scholar
  • 31 Coleman J, Goettsch A, Savchenko A. Towards Collaborative Volume Visualization Environments. Computers & Graphics 1996; 20: 801-11.
    CrossrefPubMedGoogle Scholar