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As ACOs and Population Health Move Forward, No “Big Boxes” of Diagnostic Images Needed

November 18, 2014
by Mark Hagland
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Revolutions in accountable care and population health, HIE development, data-sharing and storage technologies, are all impacting imaging informatics now

Industry executives and thought leaders agree: the bottom line, when it comes to the intersectionality of accountable care and population health with imaging informatics and health information exchange (HIE) and data-sharing and data-storage technology advances, is this: the future is not about gigantic warehouses of diagnostic images and radiologic reports in the sky. Rather, it’s about intelligently connecting clinicians and other appropriate healthcare professionals in order to share and access diagnostic images and rad reports at the right moment and in the right way.

Perhaps, for some, that concept might seem self-evident. And yet it really isn’t, as the path of health information exchange has been a wandering one over the past decade, with all sorts of concepts and objectives involved. But as health information exchange matures, as the technology and processes around HIE mature, the focus is becoming clearer.

Phil Beckett, Ph.D. chief technology officer of Greater Houston Health Connect, is a good person to talk to in this context. Greater Houston Health Connect (GHHC), which became operational in October 2011, encompasses 10 hospitals across a broad region of Texas. Beckett says it’s clear that the direction of HIE is moving away from any notions of trying to replicate and store countless diagnostic images and reports in the cloud. “You don’t need one gigantic image repository,” he says. “And some are arguing for centralized repositories, but honestly, I think, leave the images where they are, get the meta-data, get the studies if you need them. There are some advantages in a centralized repository model with regard to workflow, per the cloud,” he concedes, “but more and more, even those are going away. In fact,” he says, “the workflow advantages of centralized models will go away.” Most importantly, he says, increasingly, “you’ll be able to access things remotely without having to move images from PACS [picture archiving and communications systems] systems to centralized repositories.”

Rasu Shrestha, M.D. absolutely agrees with Beckett that accountable care and population health advancement will shift the discussion around imaging informatics to one of availability and agility. “In fact,” says, Shrestha, the vice president of medical information technology at the vast 20-plus-hospital University of Pittsburgh Medical Center (UPMC) health system in western Pennsylvania, “the approach should not be one of boiling the ocean, but one of focus—especially with regard to the concepts of population health and accountable care, two distinct yet overlapping ideas. So yes, focus will be mot important.”

What’s more, Shrestha, a practicing radiologist, says, “If you look at what accountable care means for imaging groups, referring physician groups, hospitals, etc., it means different things to different people. And just moving everything into central repositories doesn’t make sense. So what we’ve already started to do is to embrace the power of the cloud, of collaborative care, and also of value-based healthcare across the continuum. And for imaging, the care continuum starts at the point of a patient searching for a physician; or of an order being placed for a certain type of imaging procedure. And the care continuum goes all the way through the imaging procedure, the study report, and archiving.”

Indeed, Shrestha says, “I call it the value-based imaging continuum—and we need to look at things from an end-to-end perspective. It starts from how you get scheduled and have imaging procedures ordered; and it goes into smarter reports that are more meaningful today, and managing archives, and  radiologists facilitating collaboration with the ED physician and the vascular surgeon and the neurologist, making sure follow-up happens. Looking at the care continuum is most important and what drives my thinking.”

Moving towards “semi-universal registries”

Rethinking patient care organizations’ enmeshment in proprietary systems of image storage will be an important step forward, says Joe Marion, founder and principal at the Waukesha, Wis.-based Healthcare Integration Strategies consulting firm, says a recent consulting experience really underscores for him one of the challenges to making images available for population health and accountable care purposes. “I’ve been working with a group in a western province of Canada,” he reports, “And in the Canadian healthcare system, hospitals are government-owned, while physicians contract with the government to do imaging procedures in the hospitals. In this case, a government study had recommended that the healthcare administrators of that provincial health authority should consolidate and store everything in the provincial PACS, for easy accessibility. The problem,” he says, “is that everything has now been stored in a proprietary system, and that there would be costs for the independent physicians of sending their studies in to be stored in that system. And that makes no sense. It would cost millions of dollars to do that, at $1.99 per study.”