Feature Article

Echocardiography in the new normal

How Structured Reporting Can Help Improve Workflow Efficiency, Provide More Time with Patients

Patients have been putting off routine, and even acute care, for the past three months as they sheltered in place during the COVID-19 lock-down and as hospital and physician offices closed to non-essential tests and procedures. Now things are opening back up and that means a backlog of patients for cardiologists as well as new protocols to ensure staff and patient safety.1&2 Cardiology is also likely to be one of the hardest hit specialties, given the virus’ effects on the cardiovascular system.3 

All of which will require taking workflow efficiency to a higher level, something that wasn’t an easy thing to do even in the pre-COVID days. Indeed, cardiologists were already overworked and stressed. 

Consider the following:

• 43 percent of cardiovascular specialists say they are burnt out.4
• Cardiologists work longer hours than any specialty except general surgery and urology.4
• More than half of cardiovascular specialist’s report “too many bureaucratic tasks” as their number one reason for burnout.5 
• Cardiologists spend twice as much time interacting with the electronic health record as they do interacting with patients.5
• Cardiovascular patients are increasingly co-morbid and complex.4

Much of the frustration comes from reporting requirements. Nearly two-thirds (70%) of cardiologists say they have to log-on to multiple systems to create the necessary information for a report, taking time away from patient care. Ideally, they say, they should spend five minutes or less on reports.6 

A good example is adult echocardiography, the predominant form of cardiac imaging.7 It involves hundreds of measurements that must be assessed in order to provide a diagnosis. And all information must be conveyed in structured reports with mandated criteria from the International Accreditation Commission (IAC) and the American Society of Echocardiography (ASE). This work takes precious time away from patient management. It also introduces the potential for errors and reduces reporting variability from physician to physician.8  

Instead, as one group of echocardiographers wrote, “Imagine a system where the learned experience based upon review of billions of echocardiographic images is used to draw upon differentiation between various pathologies.8

You don’t have to imagine it. GE Healthcare’s Centricity™ Cardio Enterprise with intelligent reporting features a rules-based artificial intelligence (AI) engine that can automatically provide findings based upon incoming measurement values from an echo cart. Not only can it provide enormous time savings, but it can help standardize analysis within the healthcare organization and improve reporting consistency across clinician users.8

Numerous other specialties have embraced AI, including dermatology and radiology, but it has been slow to make inroads into cardiology.8 However, echocardiography offers the perfect entry, with the clear rules from the IAC/ASC ideal for using artificial intelligence to improve workflow, reporting quality, and analytics. In fact, AI was named as one of the top three trends in echocardiography this year.9 

While structured reporting in cardiology has been available for years, the solutions have been cumbersome and rigid, without allowing for the dynamic interactions and personalization cardiologists require.

Structured reporting brings tremendous value to cardiovascular practices, enabling hospitals to:  

• Guide the user to compliant documentation, which helps reduce errors while facilitating accreditation.
• Drive report completeness to prevent data capture omissions that may impact reimbursement.
• Standardize workflow across care areas and health systems.
• Capture structured data to feed clinical analytics.
• Uncover actionable insights that help enhance financial and operational decision making.

Used properly, structured reporting with Centricity Cardio Enterprise and intelligent reporting can provide an adult echo report that is 83% complete before the physician even sits down at the computer.10 

Implementing Structured Reporting

With the coming tsunami of cardiovascular patients, there is no better time to transition to a robust structured reporting solution; however, change is never easy, particularly in cardiology.11 That’s why we developed a road map for our customers.

1. Find a physician champion. This should be a project team member who enjoys working with technology and embraces change.
2. Engage physicians. This means preparing studies for training events; focusing on physician workflow; and using the physician champions to help settle clinical questions
3. Go live. But make sure you have plenty of support from IT staff and application trainers standing by. Also make sure that physicians have a way to report any problems and receive fast support.
4. Plan for post-live support. This includes inviting “super users” to help with physician training and provide onsite support. Ensure that the communication channels remain open with rapid response for users to submit questions and problems.

To learn about GE Healthcare’s Cardiovascular IT solutionvisit our website.

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[1] Hung J, Abrahama TP, Cohen MS, et al. ASE Statement on the Reintroduction of Echocardiography Services During the COVID-19 Pandemic. American Society of Echocardiography. May 2020. https://www.asecho.org/wp-content/uploads/2020/05/ASE-Reintro-Statement-FINAL.pdf.

[2] Maxwell YL. Cardiology After COVID-19: Physicians Predict Lasting Change. The Heart Beat. May 20, 2020. https://www.tctmd.com/news/cardiology-after-covid-19-physicians-predict-lasting-change.

[3] Smith DG. Coronavirus May Be a Blood Vessel Disease, Which Explains Everything. Medium. May 29, 2020. https://elemental.medium.com/coronavirus-may-be-a-blood-vessel-disease-which-explains-everything-2c4032481ab2

[4] The Advisory Board Webinar: Promoting Physician Engagement; Medscape National Physician Burnout, Depression & Suicide Report 2019; Anagnostopoulos, F. et al., “Physician Burnout and Patient Satisfaction with Consultation in Primary Health Care Settings: Evidence of Relationships from a One-with-many Design,” Journal of Clinical Psychology in Medical Settings 19, no. 4 (2012): 401-10; Shanafelt, TD, et al., “Burnout and Medical Errors Among American Surgeons.” Annals of Surgery 251, no. 6 (2010): 995-1000; Grisham, Sarah, “Medscape Cardiologist Lifestyle Report 2018,” Medscape; Kane L, “Medscape Cardiologist Compensation Report 2019,” Medscape.

[5] The Advisory Board Webinar “Promoting Physician Engagement; Grisham, Sarah, “Medscape Cardiologist Lifestyle Report 2018,” Medscape; Sinsky C, et al. “Allocation of Physician Time in Ambulatory Practice,” Ann Intern Med. 165, (2016): 753–760.

[6]  https://www.acc.org/~/media/Non-Clinical/Files-PDFs-Excel-MS-Word-etc/Membership/Publications/CardioSurve/CardioSurve_Newsletter_July_2013.pdf?la=en s

[7] Nolan MT , Thavendiranathan P. Automated Quantification in Echocardiography

JACC Cardiovasc Imaging . JACC Cardiovasc Imaging. 2019 Jun;12(6):1073-1092.

[8] Ghandi S, Mosleh W, Shen J, Chow C. Automation, machine learning, and artificial intelligence in echocardiography: A brave new world. Echocardiography. 2018;35:1402–1418.

[9] Fornell D. Three Key Trends in Echocardiography Systems. DAIC. April 30, 2020. https://www.dicardiology.com/article/three-key-trends-echocardiography-systems

[10] Centricity Cardio Workflow v7 Intelligent Reporting out-of-the-box configuration compared to 2017 IAC guidelines excluding doppler

[11] Fornell D. Structured Reporting Has Become Key in New CVIS System Adoption. DAIC. May 1, 2020. https://www.dicardiology.com/article/structured-reporting-has-become-key-new-cvis-system-adoption