Digital echocardiography reviewoffers practices an edge over video

Cardiac vendors mix images and information

Come the digital revolution in echocardiography, the echo labmasses will have nothing to lose but their video cine-loop chains.Integration of dynamic digital images with cardiology informationsystem software tools will raise diagnostic confidence, booststaff productivity, and provide a marketing edge for hospitals.

At least, it sounds good on paper. When and how rapidly digitalinnovations will spread throughout echocardiography depends toa great extent on whether physicians and equipment vendors canconvince managed-care groups and other healthcare providers thatboth practice and profits will benefit from an investment in technology.

The manifesto in this revolution is the DICOM 3.0 standard,which now includes a standard format for echocardiography imagesand has been endorsed by both the American College of Cardiology(ACC) and the American Society of Echocardiography (ASE).

Cardiology equipment vendors are busy ensuring that their scannersand workstations are compliant with this digital imaging standard.Even before full DICOM compliance has been reached at the scannerlevel, vendors are developing cardiology information systems thatwill integrate digital cine image display and archiving with casemanagement software. Some of this technology was on display lastmonth at the ACC conference in Orlando, FL.

Two leading echocardiography scanner vendors, Hewlett-Packardof Andover, MA, and Acuson of Mountain View, CA, were among thecompanies highlighting digital cardiac image display and managementtechnology at the ACC show.

Acuson's digital image management technology for echocardiographywas demonstrated as a work-in-progress in Orlando. This technologywill serve as an expansion of Acuson's Aegis digital image managementsystem. The vendor reported its 100th Aegis general imaging installationlast month at the University of Pittsburgh Medical Center.

HP made a more radical departure at the ACC show. The vendorshowed its EnConcert cardiology management system in an initialechocardiography application package. The product has been certifiedfor marketing by the Food and Drug Administration.

EnConcert is designed to access DICOM 3.0-compatible imagedata without the necessity of specialized hardware, said DavidAtaide, HP cardiology program manager. Initial shipments are expectedin June.

The software runs on standard PCs using a Microsoft WindowsNT network operating system and, at the minimum, an Intel Pentiumprocessor. That architecture is a bit of a departure for HP, which,in addition to its work in healthcare, is a leading manufacturerof Unix-based workstations. The company made the platform switchto make EnConcert more accessible to PC-based practices.

"It was a challenge for us to move from the Unix arenato the PC arena," Ataide said. "We wanted to deliverthis to a (computer) that will be commonly found on our customers'desks."

EnConcert will function as one Windows NT application amongmany, such as spreadsheets and e-mail, that are already installedon a computer or network, he said. Apart from the sale of straightsoftware packages, HP will offer a full range of services, includingproject management, network design, consulting, and installation.

HP will expand EnConcert in the future with the assistanceof ADAC Laboratories of Milpitas, CA, a radiology informationsystem and nuclear medicine vendor. The two announced an agreementto develop and market an integrated cardiology information-managementsystem at the ACC meeting.

Eventually, the system developed by HP and ADAC will bringtogether data, audio, and images from the full range of cardiology-relateddepartments within a hospital. These include the echocardiographyand cardiac catheterization labs, nuclear imaging, ECG, and patientmonitoring. While HP is active in many of these departments, thevendor has never before attempted to bring the various modalitiestogether in a hospital-wide information system, Ataide said.

Acuson's cardiology image management line will be offered atthree levels, said David Bruce, cardiology marketing manager.At the entry level, customers will be able to purchase a singleAcuson 128XP scanner with a digital capture module. The acquisitionmodule, which goes by the working title of QV200, captures digitalclips and stores them both internally and to magneto-optical disk.Users can then review the dynamic digital images on the scanneritself.

At the mid-tier of Acuson's cardiology offering, a scannerwill be tied to a Macintosh-based Aegis Review Station. The topof the line will include an Ethernet network of scanners and reviewstations tied into Acuson's CasePro patient and department reportingsoftware, which was introduced at the 1995 ACC conference (SCAN3/29/95).

Acuson expects to make an announcement regarding initial shipmentsof the product later this year, Bruce said. FDA clearance is stillrequired.

Selling the concept. Digital echocardiography is an emergingmarket. Apart from digital acquisition in stress echo procedures-- a different matter technologically -- 99% of echocardiographylabs use videotape technology, Bruce said.

"They (the echo labs) are in the process of determining,`Should we and how should we switch to digital?' They will (needto make) a paradigm shift to digital capture, reading, and archiving,"he said.

It will soon become clear that digital techniques are a morecost-effective and efficient way for echocardiographers to delivertheir services, Ataide said. HP has initiated benchmark studiesat its beta sites to gather the data it will need to convincehospital and private-practice customers.

"We will come up with a financial model that will givean actual number for the payback of a system, based on savingsin physician time, increased patient throughput (and other factors),"he said.

One reason that digital echo image management systems can cutphysician review time is that users can access particular partsof an exam immediately without having to rewind or search througha videotape, Bruce said.

A key hurdle in implementing digital echo image managementinvolves boosting digital capture and storage capacity, as wellas transmission rates over networks, he said.

"The trick is in combining the technical capability thatgets you (to the desired) storage capacity and data rate witha cost-effective implementation," Bruce said.

General computer technology, such as data compression algorithms,have been used whenever possible in the development of Acuson'sdigital echo image management system, he said. While dynamic medicalimages contain much more data than digitized movies, off-the-shelfcomponents have reached or are close to reaching the technicallevel to handle the data in a timely fashion.

Once the data-handling requirements are met, digital imagesprovide a much crisper alternative to Super VHS or standard VHSvideo images, Bruce said.

Apart from increased staff efficiency within a hospital, telemedicineapplications of cardiology information systems will drive marketdemand, Ataide said. Hospital groups will make the best use oftheir staff specialists while offering a valuable service to private-practicepartners.

"(Hospitals) are looking for systems that will electronicallybind referral patterns and their customers back to their own services.This really plays into that," he said.