Like other areas of medical imaging, cardiovascular imaging is extremely data intensive. To manage these large data sets, many healthcare institutions use picture archiving and communications systems (PACS), but cardiology PACS and radiology PACS are often separate systems with different information storage and user interfaces. Integrating these systems can lead to a more efﬁcient workﬂow and improved access to images and data.
Like other areas of medical imaging, cardiovascular imaging is
extremely data intensive. To manage these large data sets, many
healthcare institutions use picture archiving and communications
systems (PACS), but cardiology PACS and radiology PACS are often
separate systems with different information storage and user
interfaces. Integrating these systems can lead to a more efficient
workflow and improved access to images and data.
"The challenge is to make cardiology part of the PACS," said
Rasu B. Shrestha, MD, Informatics Director and Assistant Professor
of Research Radiology at the University of Southern California
(USC), Los Angeles, CA. "We were getting to a point at which the
management of cardiology and radiology images were becoming two
separate things. In my opinion, this was not good for patient care.
I think it is critical for the two to merge and leverage their
synergies for improved patient care."
FUJI acquires ProSolv CardioVascular
FUJIFILM Medical Systems USA, Inc. (Stamford, CT) hopes to
accomplish this integration with its recent acquisition of the
cardiology PACS vendor, Problem Solving Concepts, Inc. (ProSolv,
Indianapolis, IN). The company, which will now be known as ProSolv
CardioVascular, a FUJIFILM company, developed and markets the
ProSolv CardioVascular Enterprise PACS solution.
ProSolv CardioVascular is a multimodality, nonproprietary
imaging and reporting solution that includes the ProSolv image
format, database, and interfaces for a hospital information system,
billing, and scheduling. The system can be connected to all current
cardiology imaging systems (eg, echocardiography,
electrocardiography, vascular imaging, nuclear imaging, and
catheterization and vascular laboratories) across multiple hardware
vendors (Figure 1). "ProSolv CardioVascular is a full
cardiovascular information system for the management of all data
from all cardiology modalities that also provides fully integrated
report generation and distribution," said Bob Cooke, Vice
President, Network Business Management, FUJIFILM.
Throughout ProSolv's history, Harvey Feigenbaum, MD,
Distinguished Professor of Medicine, Indiana University,
Indianapolis, IN, who is often referred to as "the father of
echocardiography," has served as a key advisor. The company has a
collaborative product development re-lationship with Indiana
Maximizing system synergies
According to Cooke, it was the similarity of the ProSolv
architecture to FUJI's Synapse PACS that led to the acquisition and
enabled rapid systems integration. "There were basically a few
aspects that attracted us to ProSolv," he said. "First was the
significant amount of cardiology experience and expertise of the
employees, as well as a product architecture that is very similar
to the Synapse design philosophy. Another attraction was that they
had broad coverage of all cardiology modalities," Cooke continued,
"and they had very high user-satisfaction ratings."
Shrestha also noted that the integration of the systems
influenced USC's decision to purchase ProSolv CardioVascular. "We
have the Fuji Synapse PACS at the USC County Hospital and the
Childrens Hospital of Los Angeles; and we are implementing it
across our other hospitals: USC University Hospital and the Kenneth
Norris Jr. Cancer Hospital. We have now implemented Synapse at our
private imaging centers. We plan to have Fuji across the
"As we were installing Synapse, we were looking at cardiology
PACS, and, almost coincidently, we were narrowing it down to
ProSolv," continued Shrestha. "When Fuji announced the acquisition
of ProSolv, it helped to seal the deal. During our analysis, we had
seen the synergy between ProSolv and Synapse, since they are both
Windows- and Web-based applications and are both
"We are no longer looking at a stand-alone cardiology imaging
application," said Shrestha, "but a cardiology imaging application
with postprocessing capabilities that are inherently tied in with
the PACS. We have one database to store all the studies, whether
they come from stress echocardiography, cardiac cath-eterization,
magnetic resonance imaging, or multislice computed tomography. We
have the workstation capabilities of a traditional PACS (including
the ability to window/level, zoom, pull in relevant prior studies,
and have hanging protocols) and we have the cardiology
postprocessing toolsets and reporting toolsets."
"As organizations move to a more horizontally integrated
solution for enterprise imaging, there is clearly a need for Fuji
to be able to manage both radiology and cardiology data and to
provide seamless access to that data throughout the enterprise,"
said Cooke. "Our goal is to provide appropriate access to
information integrated into clinicians' workflow. But information
access is only one dimension. The other is offering that
information in an application in a manner that is consistent with
their workflow. For example, radiologists using a radiology PACS
need access to cardiology data, but we don't want to take them out
of their workflow to access that data. Data access should be
consistent with the tools that clinicians are used to using.
Similarly, cardiologists will need data stored on a radiology
system, but they will also want to access that data as efficiently
"A great example of the integration between these applications
is that cardiologists can use familiar tools on the ProSolv
CardioVascular application to access data stored on Synapse,"
continued Cooke, "just as Synapse users can access data stored on
the ProSolv CardioVascular system with their tools."
"Because the applications share an infrastructure," Cooke noted,
"the enterprise-level implementation can share a common
infrastructure, achieve an economy of scale, and provide a solution
that is integrated well with the enterprise image management
"One of the advantages was that we were able to leverage some of
the IT investments we made," agreed Shrestha. "We have a great IT
team here within our radiology department, and the plan is to have
the ProSolv application piggyback on the Synapse. Now that we can
launch ProSolv from Synapse or vice versa, it will be easier to tie
in the backend portion of this as well. We're happy with the
integration between radiology and cardiology," said Shrestha. "We
believe we are leveraging the best from both sides, so it's a
Fuji has recently announced the expansion of its radiology PACS
system to cover tasks that were traditionally handled by radiology
information systems through a strategy they call "Synapse
"Essentially, Synapse Comprehension allows us to accomplish
end-to-end clinical workflow inside the radiology clinical system,"
said Cooke. "We believe that there are opportunities for a similar
approach in the cardiovascular arena, essentially moving beyond
just cardiovascular 'images' to extended functionality, including
information, scheduling, and ordering. We want users to have access
to the full clinical record regardless of where the images and
information are stored," he continued.
"A patient who goes in for a cardiac examination is not separate
from the rest of the studies that he has had," concluded Shrestha.
"That is one of the main benefits that we will be gaining from this
integration. We won't be treating a cardiology study, we'll be
treating a whole patient."