Integrating AI into cardiology imaging and reporting workflows for enhanced echo measurements

Introduction

The Christ Hospital Health Network, renowned for its state-of-the-art cardiology program in the Cincinnati, Ohio tri-state region, has been addressing the challenges of increasing patient volumes and echocardiography appointment backlogs while continuously improving cardiology workflows and patient outcomes.

Over more than 20 years of partnership with Merge and their deployment of Merge Cardio, a 10-time Best in KLAS solution for cardiology imaging, the Christ Hospital has seen a transformation in its cardiology department. In addition to automating its cardio imaging and reporting workflows, the hospital has prioritized improving scan time efficiency, consistency in measurements, quicker patient report turnaround, and significant operational enhancements – all of which have positioned the Christ Hospital to be acknowledged as a leader in cardiology innovation and care.

Background

The Christ Hospital, a 620-bed facility based in Cincinnati, Ohio, is a national leader in cardiovascular care. Known as the region’s "Heart Hospital,” its cardiology program has 50 cardiologists on staff and spans services such as interventional cardiology, transplant surgery, advanced heart failure, electrophysiology, women's and South Asian heart health, cardio-oncology, and a robust cardiovascular research center.

The Christ Hospital's history with Merge Cardio goes back decades. Since first implementation back in the 1990s, originally to help convert its cath lab imaging to DICOM, the hospital’s cardiology department has doubled in size and now does echocardiogram tests at five outpatient sites.

With more than 33,000 echocardiogram procedures completed in 2024, the hospital has an extremely busy echo lab. And, like many leading healthcare organizations, it has remained committed to maintaining clinical quality and consistency, even as patient volumes continue to rise. But, also like every imaging organization across the United States, the Christ Hospital has faced a number of growing clinical and technical workflow challenges, including:

• Workflow inefficiencies
• Growing patient backlogs
• Echocardiography measurement variability
• Mounting pressure on clinical and IT resources
• High patient throughput pushing sonographers and cardiologists to the limits of their daily capacity and causing burnout.

[getModule name="blockquote" quote="Merge Cardio has streamlined our workflows and the care we provide to patients. We can now turn echoes around faster and produce reports faster. Merge has put us light years ahead of where we were in cardiac care." author="Rob Brayfield, Echo/Vascular Clinical Support Specialist, The Christ Hospital Health Network"]

Over the course of a 20-year partnership, the Christ Hospital’s deployment of Merge Cardio has evolved to tackle these challenges as they come. The next step in that evolution came when the Christ Hospital launched an early adopter program integrating Merge Cardio with cutting-edge AI capabilities from Us2.ai, an artificial intelligence platform designed to automate echocardiogram measurements. The goal: to improve the capabilities of AI for evaluating less-than-perfect images.  

How Merge Cardio’s AI integration with Us2.ai is enhancing echocardiogram measurements

The Christ Hospital has been an advocate for implementing artificial intelligence into its echocardiography workflows. That’s why they were keen to be an early adopter of Merge Cardio 12.5, the latest release of our leading cardiology workflow solution and the first version of the solution to include directly integrated AI capabilities from Us2.ai.

Dr. Wojciech Mazur of The Christ Hospital met with Us2.ai developers and Merge to plan out the best way AI integrations could be utilized by and integrated into Merge Cardio. These discussions led to the launch of the pilot program in December 2022, which used over 4,000 anonymized exams to train the algorithm.

[getModule name="blockquote" quote="Merge really knocked it out of the park as far as their new release, Merge Cardio 12.5, goes. This was the best product upgrade I’ve been involved with during my tenure at The Christ Hospital – this one was flawless. Consistent AI-powered measurements, combined with faster scans, have revolutionized how we approach echocardiography." author="Rob Brayfield, Echo/Vascular Clinical Support Specialist, The Christ Hospital Health Network"]

The integration of Merge Cardio and Us2.ai aims to deliver real, value-adding benefits for the Christ Hospital’s cardiology imaging teams, including:

• Automated echocardiogram measurements with AI to reduce scan times.
• Enhanced consistency and reproducibility, taking user-to-user variability in measurements out of the equation.
• Improved workflow integration, to ensure seamless data flow from imaging to reporting to the EHR, cutting down the amount of tedious manual work facing echocardiographers and stenographers.
• Newly empowered research and data mining capabilities backed by detailed and structured AI-generated insights.

The hospital had a 30-day back log of echocardiography appointments and has a goal to cut scan times by 15 minutes, increasing the number of exams each sonographer could perform daily, streamlining operations, and improving efficiency.

But how did these aspirational goals meet the reality of deploying AI with Merge Cardio 12.5, though?

Paving the way for real AI enhancements in cardiology workflows

The Christ Hospital’s pilot program helped pin down both major benefits reaped for the organization and lessons learned for successful implementations at other cardiology imaging organizations.

Benefits achieved from Merge Cardio and Us2.ai integration:

• System stability and upgrade experience exceeded expectations, was described as “flawless.”
• Beyond just initially demonstrating the new AI functionalities, little additional training was needed on the integration.
• The end user full application was smooth, and the integration with Merge Universal Viewer as a means of launching Us2.ai was also well received.
• Communication between Christ Hospital, Merge, and Us2.ai was responsive and transparent
• Cardiologists reported consistency in the use of AI in their workflows.

[getModule name="blockquote" quote="Merge has truly exceeded expectations with their new measurement tools in Merge Cardio 12.5. I initially thought the tools would be a basic upgrade, but they're incredible impressive. One is that you can not only adjust the VTI after creating it, but the VTI calculation also updates in real-time." author="Rob Brayfield, Echo/Vascular Clinical Support Specialist, The Christ Hospital Health Network"]

Through early evaluation of Merge Cardio 12.5 and its AI integrations, the Christ Hospital has been able to take advantage of remote echocardio measurements, enhanced reporting accuracy, and a seamless user experience, to bring even greater efficiencies, reduce inconsistencies in echo reports, and boost clinical confidence.

The Christ Hospital’s early adoption of Merge Cardio 12.5 also returned some critical lessons learned on how to best take advantage of AI enhancements in cardiology workflows, including:

• Best practices on optimizing the plan of adoption – from identifying which exams to be analyzed, to mapping all measurements and tracking missing measurements.
• Making clear delineations on ownership roles between Us2.ai and physicians, so that AI can’t overwrite sonographer-entered data and physicians are empowered to review measurements and flag to Merge.
• Identifying and resolving confusion around launching workflows in Merge Cardio vs. within Us2.ai, so that physicians can use their preferred workflows.

Not only did these lessons lead to a more successful AI workflow experience for The Christ Hospital, they also helped informed and optimize successful Merge Cardio 12.5 deployments for other organizations looking to advantage of AI in their cardiology workflows.