ImageGuide™ Update

Abstract

TM-continues to make exceptional progress toward implementation this summer. The culmination of this historic journey has been achieved by involving a broad spectrum of experts in the fields of nuclear cardiac imaging, data registries using outcomes-based research, our industry partners, and, most importantly, ASNC membership. This initiative is the result of a shared vision of what nuclear cardiology's future role will be in impacting patient management. Focused registries were initially considered 15 years ago, and in 2011, ASNC leadership developed a vision for a clinical registry which would function to guide, inform, and partner with physicians, industry, payers, and governmental regulators at their respective agencies. In the last 2 years, there has been significant progress toward achieving this goal. As noted in previous publications led by Drs. Shaw, Williams and Tilkemeier, the registry will be a living project that will evolve over time as the field of nuclear cardiology evolves. [1][2][3] Historically, registries have played an important role in the development and implementation of quality benchmarks-most notably, disease characterization, surveillance of community-based event rates, and realworld evaluation of a test or therapy's clinical benefits, risks, and costs. Other quality metrics have included: (1) assessing adoption and implementation of evidencebased care in the community; (2) providing practices with information so as to effectively track and change their methods of health care delivery based on evolving standards and health policy decisions; and (3) identifying unmet needs and knowledge gaps. These analyses will aid in the design of future clinical trials and outcomes research. To be stated more simply: Are we doing the right things?, Are we doing the right things right?, and Ares our patients better off for it?Given this background, the ImageGuide TM mission and goals were identified by the ASNC Board of Directors. The mission of ImageGuide TM is to support nuclear cardiology specialists and laboratories in their efforts to enhance the quality, safety, and value of nuclear cardiology and clinical care locally, nationally, and across the globe. There are five specifically identified goals: (1) provide timely data feedback and tools for nuclear cardiology practices; (2) facilitate fulfillment of regulatory and other reporting requirements; (3) advocate for health policy and reimbursement reform; (4) demonstrate the value of nuclear cardiology; and (5) serve as a platform for research and education. In order to accomplish its mission and goals, the registry requires structured data so as to monitor compliance with current nuclear cardiac imaging acquisition and reporting guidelines and their integration into daily practice. Structured data will also ensure utilization of a ''single language'' which will allow automation of data entry and analysis, facilitating data flow from laboratories to the registry, and allowing for inter-site comparisons of performance measures. 4 As an extension of...

Performance of Comprehensive Transesophageal Echocardiography: Quality Improvement Through Educational Intervention

“…The sustainability of our quality improvement initiative and its adaptability to other practice settings remain to be seen. The ImageGuideEcho registry 11,12 could serve as an important resource for facilitating continuous quality improvement in the performance of comprehensive TEE. Further studies investigating the impact of the performance of comprehensive TEE on health care costs and clinical outcomes are needed.…”

Cardiac imaging: working towards fully-automated machine analysis & interpretation

“…There are initiatives in the cardiology community which can help in this respect. For example, in nuclear cardiology community, the American Society of Nuclear Cardiology has led efforts to gather all relevant clinical data via the ImageGuide registry [122]. Reporting software vendors are cooperating and will be providing appropriate interfaces to hospital systems to collect and transmit such data linking these with the images.…”

ASNC imaging guidelines for nuclear cardiology procedures

“…It has been shown that machine learning algorithms derived from integrating clinical, perfusion, and functional data elements for diagnosis of obstructive CAD yield results similar to or better than those obtained by experienced readers. 55 Furthermore, machine learning applications, integrating clinical, ECG, exercise, hemodynamic, defect quantification, and ancillary imaging data provide a patient-specific estimate of likelihood of early revascularization and allcause mortality, thus aiding in individualized decisionmaking in a way the human brain cannot do. 53,56 Machine learning algorithms are a natural complement to nuclear cardiology analyses packages and structured reporting software, from which multi-faceted data can be derived to generate risk estimates factored in DSTs and patient-centered decision guidance.…”

“…Thus, data from each study can be easily submitted from the laboratory to the ImageGuide TM Registry, which in turn tracks and publicly reports, in real-time, indicators of excellence in radionuclide imaging, including crucial reporting measures. 16,54,55 Such integration provides a constant quality improvement feedback loop for ever-improving report quality and patient care. 57 The ImageGuide TM Registry is a Qualified Clinical Data Registry (QCDR) through which participating physicians can receive CMS reimbursement credits for participating in a Physician Quality Reporting System (PQRS).…”