Dr. Christina Luong

Aortic stenosis is a common condition with effective treatment, but it requires accurate and consistent reporting of echo parameters to facilitate referral for aortic valve replacement. Echocardiographer physicians Christina Luong and Darwin Yeung recently turned to VPSA’s Small Steps, Big Idea project funding to support collaboration between echocardiographers and the Cardiology IMITS team to enhance and standardize echocardiogram reporting templates and practices across Lower Mainland labs.

“The regional echocardiography program completes over 40,000 studies annually across a broad network of sites, including Squamish, qathet General Hospital (Powell River), Sechelt, Lion’s Gate Hospital (North Vancouver), Richmond Hospital, Mount Saint Joseph’s Hospital, UBC Hospital, St. Paul’s Hospital, and Vancouver General Hospital,” said Dr. Luong. “All studies are reported and distributed using a unified platform, Siemens Syngo Dynamics, which enables cross-site access to images and reports and facilitates the use of standardized templates.”

Dr. Darwin Yeung

Dr. Luong went on to explain that the implementation of Syngo Dynamics archiving and reporting system in 2017 marked a significant advancement in the delivery of cardiac imaging services. However, to meet local clinical and operational requirements, substantial customization was required during the initial rollout to meet reporting guidelines and local practice patterns, particularly within the first two to three years. As a result, the reporting template had evolved to include over 150 data fields, many of which were redundant or inconsistently used, contributing to inefficiencies and variability in reporting practices.

“The IMITS team raised concerns regarding practices across sites, primarily due to variable use of the existing reporting template,” she added. “This resulted in missing or incomplete data elements, which undermine report quality and limit the utility of structured data for clinical care, quality improvement, and research.”

Using VPSA’s Small Steps, Big Idea funding to support physician engagement, the working group has laid the foundation and framework for ongoing revisions and long-term maintenance of the reporting template.

“The project delivered a redesigned aortic valve worksheet and reporting template that has been deployed across the Lower Mainland echocardiography labs (VGH, UBC, PHC, and regional sites) that standardizes how aortic stenosis severity is captured and reported,” said Dr. Luong. “Beyond the technical deliverables, the project has built a durable collaboration between echocardiographer physicians across sites and the Cardiac Informatics/IMITS team, establishing a working group and a shared review process that can be applied to future reporting template improvements.”

To evaluate the effect of the redesign, the working group compared two matched two-month periods, one before and one after implementation. Among exams in which at least two of the three guideline severity parameters met thresholds for moderate or greater aortic stenosis, the group calculated the proportion that had a reported aortic stenosis grade. Although the final severity grade rests on the echocardiographer’s integrated assessment, meeting two of three guideline thresholds indicates probable significant aortic stenosis, so these exams should always include a severity grade to guide clinical management.

“The primary finding was a significant improvement in reporting completeness,” said Dr. Luong. “Overall, the proportion of qualifying exams with a completed aortic stenosis degree field rose from 88 per cent to 100 per cent after the redesign, meeting the project’s core objective of eliminating missing aortic stenosis severity reporting.”

As she and her colleagues look to the future, Dr. Luong expects the group to monitor sustainment of the 100 per cent aortic stenosis severity reporting completion rate over a longer window and across all sites to confirm the improvement holds beyond the initial post-implementation period. They will also track the downstream impact to determine whether clearer, more consistent aortic stenosis reporting translates into more timely and appropriate referrals for aortic valve replacement/valve clinic assessment. The redesigned template and decision-support logic will be shared with additional labs regionally and provincially to broaden standardization. The team also plans to formalize an ongoing review process so reporting templates are periodically re-evaluated against evolving guidelines and reader feedback.

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