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Cardiology Fast Forwarding to Integrated ERA

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Cardiology

[This article was published in the June 2011 issue of the eHEALTH Magazine (http://www.ehealthonline.org) ] The future will be dominated by digital technologies which will prevent, treat and finally cure the disease without expecting a blockbuster drug to be discovered

The future will be dominated by digital technologies which will prevent, treat and finally cure the disease without expecting a blockbuster drug to be discovered

By Shally Makin

Mark wouldn’t have been alive today, had the cardiac scanner trial not been conducted by his doctors. The report revealed a major blockage in his coronary arteries and he was operated without any further delay, which saved his life. The digital world has generated amazingly detailed, three-dimensional images through sophisticated computer and IT infrastructure.

In 1816, stethoscope was one valuable patient assessment device used to monitor every heart beat. The breath sounds diagnose the condition of heart and provide information regarding the patient’s ventilation-perfusion relationship. However, since then there has been great development in the medical field. Traditionally, the treatments were performed via face to face uation by specialists and trained staff. No one would have imagined that there will be a day when a doctor will be just five minutes away. At the time of cardiac arrest, the immediate aid one needs is the CPR and today the ambulance has got it on wheels for the patient. This way the whole healthcare delivery system is turning towards digital processes. Today the evolution in device technology, increased demands in healthcare system and larger public acceptance of networks and communications has shown a paradigm shift in the sector.

Since 1977, with the advent of interventional cardiology, the cardiologists have received various devices to examine the pace of heart and its functioning. Cardiac treatments nowadays are inclining towards technological innovations. The myriad data elements such as cardiology images, ECG waveforms, lab results, patient histories and hemodynamic monitoring and procedure data are successfully integrated to deliver care. For cardiology, the complications lie in the assimilation of relevant patient data and follow up of patient throughout the gamut of care. Several researches, innovations and devices have proved to provide treatments, which are less invasive, faster and successful. The massive campaign started by the IT infrastructure to implement digital processes and image updating has standardised the process to help meet key goals including trimming costs, optimising quality and increasing efficiency.

Cardiology is a very sensitive department which needs effective integration of various information systems. The continuum of cardiac devices purposely needs a ‘DICOM like’ standard, which enables the transfer of images regardless of vendor and hemodynamic equipment such as Sensis, by Siemens Healthcare. This sector is now following the path of radiology with the introduction of a large number of devices using technologies, including capnography (method for patient monitoring of ventilation, pulmonary dead space and blood flow), PADnet, wireless technology in Cardiac telemetry and advanced cardiac monitors like ANSI/AAMI EC13.

Industry presence

Global interventional cardiac devices industry forecasts to reach at US $15.7 billion by 2015 at a high CAGR of 9.9 percent during the analysis period 2009-2015. It is estimated that remote monitoring could decrease the 5-year costs of standard device monitoring by US $2100 to US $3000 per patient. The industry is greatly emphasising into incorporating patient data, which includes cath lab reports, echocardiograms and/or vascular services. Then we need to merge the patient’s ancillary services, including cardiopulmonary, rehabilitation and implantable cardioverter defibrillator (ICD) follow-ups to access and potentially input patient data into the CVIS. The cardiovascular information system (CVIS) is the patient and department management tool to facilitate the management services effectively with detailed statistical data and not merely an information capture device. Philips Healthcare has purchased Tomcat’s software, which connects with different clinical information systems and with systems from other vendors. It also provides scheduling, staff and resource management, cost capturing, generation of reports and statistical information. There are presently various products in the market with great success rate; latest products including AirStrip CARDIOLOGY, MUSE Cardiology system by GE Healthcare, CARE cardiology software by i2i solutions and InstaCath by Mediff technologies.

The technological revolution has brought a cost effective plan for cardiac treatment and improved delivery of health. Such devices target to avoid routine follow-up visits such as integrity check. A decrease in patient follow-up visits and early identification of problems can lead to a reduction in hospitalisations. Fully automated remote monitoring capabilities will probably be included in all upcoming IECDs, which will shift the emphasis from a device-oriented to a patient-oriented monitoring, allowing a new broader multidisciplinary approach. The devices attached with alerts and transmission of patient information to center and interpretation would ultimately reduce the time for treatment.  IT in Cardiology improves patient care, workflow and other key metrics.


“Medtronic’s Care Link Service advanced technology includes a patient monitor that enables patient to ‘connect’ the implanted device in”

Milind Shah
Managing Director, India Medtronic


Implementing a system, such as CVIS, however, is a multi-faceted process that requires hospitals to analyse particularly store and network. Designing the storage system requires close collaboration between cardiac imaging and IT. One of the most advantageous aspects of connectivity in cardiac telemetry is the videoconferencing and echocardiography equipment which enables real-time transmission of echocardiograms from the remote center to the cardiologist at the referral center.  Milind Shah, Managing Director, India Medtronic says “Medtronic’s Care Link Service, remote monitoring of Medtronic heart device, helps improve patient care and reduce the healthcare costs. This advanced technology includes a patient monitor that enables patient to ‘connect’ the implanted device in heart to doctor’s clinic via a standard phone line. This allows the doctor to conduct a routine checkup or review a special situation no matter where the patient is. When directed by the doctor, the patient simply needs to connect the monitor to a regular phone line, push the start button, and hold the antenna over the heart device. The monitor automatically transmits the data, turning itself off when the transmission is complete.”

He adds, “This technology reduces healthcare utilization costs compared to standard in-office follow-up. Clinical trials have established that remote monitoring helps in quick and efficient decision making, reduces hospitalization days and in the process helps in saving costs for the patients.”


Cardiac treatments nowadays are inclining towards technological innovations. The myriad data elements such as cardiology images, ECG waveforms, lab results, patient histories and hemodynamic monitoring and procedure data are successfully integrated to deliver care



Step ahead

The voluminous data, which include images, ECG recordings, etc has now exploded and needs to be organised as cardiology today has reached to a tipping point. Still cardiology is in a dearth of IT and its application to offer new and improved models to build an efficient solution to cardiology informatics.

Government needs to shed its suspicion towards the private sector and involve them proactively for various PPP initiatives through a well designed concession scheme, simultaneously the private sector needs to sacrifice a bit of the profits in expectation of huge volume through these initiatives. Remote monitoring and tele-cardiology is in penury of guidelines as it presently incurs multiple legal issues.

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