CARDIOLOGY SPECIALTY

CARDIOLOGY SPECIALTY

A) SPECIALTY OVERVIEW

Defined: Cardiology is defined as the scientific study of the heart and its actions and diseases.

Cardiologists: A cardiologist is a physician who is certified to treat problems of the cardiovascular system - the heart, arteries, and veins of the body. Cardiology is classified as an internal medicine subspecialty, and knowledge of internal medicine and other specialties is required in order to obtain certification.

In order to be board certified, a cardiologist must first become certified in internal medicine. A subspecialty educational program in cardiology must provide training and supervised experience in the evaluation and management of a variety of patients with cardiovascular conditions. This training must be 3 years in duration and at a level sufficient to acquire the competency of a specialist. Once training is completed, the physician is eligible to take the American Board of Internal Medicine cardiology examination.

Subspecialties have evolved with new tests and therapeutic interventions. Subspecialization is this area typically requires 1 or 2 years of additional and highly specialized formal training. The subspecialties that fall into this category are Interventional cardiology (including catheterization and angioplasty), Electrophysiology, Nuclear cardiology, and Echocardiography.

Treatment: Cardiology is an extremely complex specialty, and treatments vary widely based on the patient’s diagnosis and prognosis. A primary care physician typically refers a patient to a cardiologist.

A cardiologist typically begins a cardiovascular workup by examining the heart and taking the patient’s blood pressure. The physician will also feel, or palpate, different pulses to determine whether the heartbeat is regular and strong. It is important that the physician listens to the pulse in different places; a pulse that is normal in one place but weak in another may indicate a possible clogging of certain arteries. As the physician checks pulses, he or she will also look for swelling in the limbs, which can be a sign of heart malfunction. The physician will listen through a stethoscope to hear the sounds of the heart, lungs, and blood vessels; he or she is trained to interpret the sounds to provide clues about how well the heart and blood vessels are functioning. The physician will also place a stethoscope over different arteries which can tell indicate whether blood is flowing normally. During the physical exam, the doctor will also look into the eyes of the patient with a lighted magnifying instrument; this allows inspection of the tiny blood vessels that are visible inside of the eyes; abnormalities such as ruptures, tangles or swelling of the blood vessels can point to damage from high blood pressure, diabetes, or other disorders.

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Once the cardiologist has done a detailed physical examination, he or she will decide how to proceed; the doctor may determine that he or she needs to do additional testing, such as an electrocardiogram or stress test, to further assess the cardiovascular condition of the patient. Once all pertinent information is gathered, the cardiologist will make a diagnosis and create an appropriate plan for treatment.

B) COMMON DIAGNOSES

There are many common diagnoses made by cardiologists on a regular basis. Below are some of the most common diagnoses. However, this listing is by no means exhaustive; rather, it is a synopsis of some of the more frequently seen problems.

ANGINA: Angina is a term for the discomfort felt when a blockage in a coronary artery prevents enough oxygen-rich blood from reaching a part of the heart. Angina pain is often felt in other places than the chest such as the neck, jaw, back, and/or arms. Unstable angina is anginal pain that occurs with lesser degrees of exertion, increasing frequency, or while at rest; this is the most serious form of angina.

ATRIAL FIBRILLATION: Atrial fibrillation is an abnormality of the heart rhythm in which the chambers of the heart no longer contract in a repetitive, organized manner. The heart rate often becomes irregular and may beat very fast which causes palpitations. Atrial fibrillation can lead to symptoms of heart failure, chest pains, and stroke.

CHEST PAIN: There are many different causes of chest pains - some of the causes are life threatening in nature while others are not as serious. Any serious chest pain should receive prompt medical attention. Chest pain can be associated with angina, aortic dissection, pulmonary embolism, pneumothorax, heart attack, and pericarditis.

CONGESTIVE HEART FAILURE: Congestive heart failure is a medical term used to describe any condition in which the heart is not able to adequately pump blood throughout the body and/or unable to prevent blood from overflowing into the lungs. Congestive heart failure causes symptoms such as shortness of breath, fatigue, weakness, and swelling of the legs and abdomen.

HEART ATTACK: If a blood clot becomes large enough, it can completely block the flow of blood through the coronary artery. As a result, the heart will not receive enough oxygen to survive. If the muscle in the heart is deprived of oxygen for more than 30 minutes, it starts to die. The longer that the heart is deprived of blood-borne oxygen, the more heart muscle dies. The complete blockage of a coronary artery leading to the death of the heart muscle is called a heart attack.

HYPERCHOLESTEROLEMIA: Hypercholesterolemia is a high level of cholesterol in the blood that can cause plaque to form and accumulate. This buildup frequently leads to blockages in the arteries (artherosclerosis) and

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increases the risk for heart attack, stroke, circulation problems, and death.

HYPERTENSION: Hypertension, or high blood pressure, occurs when a patient’s systolic or diastolic blood pressures are consistently above the normal range. There is a fairly wide range of systolic and diastolic pressures that are considered to be within in range. Systolic pressure is measured while the heart contracts and is pumping blood into the arteries of the body. Diastolic pressure is measured while the heart is resting between the beats. There is clear and convincing evidence that hypertension increases the risk for stroke, heart attack, congestive heart failure, and kidney failure.

C) COMMON MEDICATIONS

Listed below are some of the most common medications prescribed by cardiologists:

ASPIRIN: Aspirin makes platelets less sticky, thereby decreasing the chance of blood clot formation. Many cardiac patients take one tablet daily to reduce the chance of recurrent blood clots.

COUMADIN: Coumadin is anticoagulant, or blood thinner, which reduces the formation of blood clots. It is critical in the prevention of heart attacks, strokes, and the blockage of major veins and arteries.

HEPARIN: Heparin is used to thin the blood and prevent blood clot formation. Frequent blood tests are needed, however, to determine how thinned out the blood becomes.

CARDIZEM/NORVASC: Cardizem and Norvasc are calcium channel blockers that decrease the flow of calcium ions within the heart cells and the cells that line the walls of the arteries. They both work to open the coronary arteries, increase the blood flow to the heart, and are frequently used to treat unstable angina.

LIPITOR: Lipitor is a type of statin, which lowers LDL cholesterol levels by 20-40%. It also provides the added benefit of increasing good cholesterol levels by 5-10%.

NITROGLYCERIN: Nitroglycerin is a chemical that opens up the coronary arteries and potentially increases blood flow to the heart. It also opens up the veins, which can decrease the strain on the heart and its need for oxygen.

ACCUPRIL: Accupril is an ACE inhibitor that helps dilate the arteries; because of this dilation, the resistance to blood flow is decreased and the blood pressure is lowered.

D) COMMON PROCEDURES

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Listed below are some of the cardiologist’s most commonly performed or ordered procedures:

CARDIAC CATHETERIZATION: Cardiac catheterization is a procedure that produces special “pictures” of the arteries that supply blood to the heart and of the main chamber of the heart. The images can reveal if an artery is blocked and if the left ventricle is properly pumping blood throughout the body. There are several good reasons that a patient might need to undergo cardiac catheterization; these include those who suffer from angina pains, chest pains of uncertain cause, or extremely abnormal stress test results.

CORONARY ANGIOPLASTY: Angioplasty refers to a procedure for treating plaques or blockages and/or clots. Coronary angioplasty involves the use of thin balloons and other devices that are threaded through a blood vessel in the groin and into a coronary artery. The balloon is then inflated to break up the blockage or blood clot and stretch the artery back open to restore normal blood flow.

PACEAKER INSERTION: An “artificial pacemaker” is a small, battery-operated device that helps the heart to beat in a regular rhythm. Some of the pacemakers are internal and permanent while others are temporary and external. The device can replace a defective natural pacemaker or blocked pathway. The artificial pacemaker uses batteries to send electrical impulses to the heart to help it pump properly. An electrode is placed adjacent to the heart wall and small electrical charges travel through the wire to the heart.

ECHOCARDIOGRAM: The echocardiogram is a technique that sends sound waves into the chest to rebound from the heart’s walls and valves. The waves that are recorded show the shape, texture, and movement of the valves on an echocardiogram. They also show the size of the heart chambers and how well they are currently working.

ELECTROCARDIOGRAM: The electrocardiogram is a test used to find out if the heart rate and rhythm are normal or if heart damage has occurred. It is a graphical record of the heart’s electrical impulses. A Holter monitor is a 24-hour portable monitor of the electrocardiogram and is used to detect ischemia or other problems.

STRESS TEST: A stress test, sometimes called a treadmill test or exercise test, helps a cardiologist find out how well a heart handles work. As the body works harder during the test, it requires more oxygen and the heart must pump more blood. The test can indicate if the blood supply is reduced in the arteries that supply the heart. Heart rate, breathing, blood pressure, electrocardiogram, and how tired you feel are monitored during the test.

E) HOW MISYS EMR FITS IN

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Without a doubt, the Misys EMR product would be an effective clinical solution for any Cardiology practice. Cardiology Consultants in Delaware has been using Misys EMR for Windows with pen units and Misys Document Manager for several years. They have 23 cardiologists at six sites throughout the state; the practice is currently taking phone calls and hosting site visits for prospects. Stephanie Hayden can help you set one up today!Consultants in Cardiology in Erie, Pennsylvania has Misys EMR 5, Transcription Assistant, and Misys Document Manager. With 16 cardiologists, 24 Misys EMR users and 36 Medic users serving 16 counties, it is one busy practice! Be sure to check out the Marketing profile that we have on Consultants in Cardiology.

The Problem Oriented Summary (POS) will be an important feature to focus on with the cardiologist. Because many of the diagnostic tests performed on a given patient are conducted repeatedly, the trending of this information is critical. POS tabs labeled “STRESS” or “ECHO” (or any other test for that matter!) will quickly allow the physician to compare the results for this patient over time. Coumadin flow sheets are also an essential part of a cardiology practice. For patients with blood clots, the drug Coumadin is administered over time in order to thin blood; patients on the drug must be monitored frequently to make sure that the blood does not become dangerously thin. In the past, practices have used a paper in the chart to track various Coumadin treatment plans and the values that result; with Misys EMR, this information can easily be summarized on a POS tab! Be sure to point out the Coumadin flow sheet that you have in your system for patient Jacob Heart.

When demonstrating Misys EMR to a cardiologist, there are several templates that you may want to use. EXAM-GENERAL (1997) has an in-depth menu available for CHEST PAIN in the DETAILED (NEW) SYMPTOM HISTORY; using this template will also allow you to show the full-blown Coding Assistant functionality to the prospect. In addition, there are several other applicable templates to show during a Cardiology demo: EXAM-CARDIOLOGY, PROCDR-CHEST X-RAY, PROCDR-EKG, and PROCDR-TREADMILL.Be sure to show the cardiologist some of the templates that we have in our system built just for their specialty; there are over 10 various exam-type templates and even more procedural templates. Take some time to familiarize yourself with these pre-built templates, and remind the physician that this means less work for his/her practice!

F) HOW DOCUMENT MANAGER FITS IN

The primary benefits of using Misys Document Manager (for any type of specialty practice) are increased staff productivity and reduced overhead costs. When a paper document enters a practice, it typically must be reviewed, copied, distributed, filed, and eventually retrieved. Once the staff time needed to complete the tasks is calculated, the cost savings become extremely clear. According to The Records & Retrieval Report (Greenwood Publishing Group, Westport, CT), the labor cost necessary to maintain a single standard four-drawer file cabinet for one calendar year is estimated to be $1700. Furthermore, the average cost of researching and replacing a misfiled record is almost $127 per record. The space required to

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store ten four-drawer legal-size file cabinets is approximately 70 square feet of office space. By scanning the documents stored in these cabinets into Misys Document Manager, that same office space could be converted into patient care space or even eliminated.

Aside from the financial savings associated with Misys Document Manager, it is a very practical business solution for many Cardiology practices. Explanations of Benefits (EOBs) can be scanned in the system and indexed to dummy patients if the practice would like to store these documents electronically as well. You will want to be sure to discuss Misys Document Manager’s capabilities with the practice; without a doubt, the Cardiology practice receives a lot of paper from external sources. Documents such as referral letters, surgery reports, and hospital discharge reports are commonplace in their specialty. Misys Document Manager ensures that these critical documents become part of the patient’s electronic medical record.

G) WHERE DO WE GO FROM HERE?

Clearly, Misys EMR is an effective solution for the Cardiology practice. The capability and flexibility of the system is there; now the challenge is to prove to the cardiologists that the system is the right one for them - regardless of whether or not they want to go to point-of-care. As we continue to work with more and more Cardiology practices, we can learn from them specifically what they like most about the Misys EMR, Orders Management, Transcription Assistant, and Misys Document Manager software solutions. In the mean time, it is up to all of us to make the demos meaningful, relevant, and applicable to the cardiologists.

H) DID YOU KNOW? The heart contracts 70 times each minute to pump blood to the head, arms,

chest, abdomen, and legs.

Only 27% of all hypertensive patients in the United States are being treated appropriately and adequately; the cause of 90-95% of the cases isn’t known.

People with diabetes are 2-4 times more likely to have heart disease or a stroke. Their heart disease is more severe, and they have a higher risk of congestive heart failure.

One out of every four people suffering from myocardial infarction (heart attack) does not experience any symptoms.

About 40,000 children are born with a heart defect each year; most of these children can benefit from surgery even if the defect is severe.

Arrhythmias are commonly experienced, and as many as 2 million Americans are living with atrial fibrillation.

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CARDIOLOGY SPECIALTY

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