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Beyond PACS: An Imaging Informatics Breakthrough

October 14, 2011
by Mark Hagland
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The leaders at Houston’s Memorial Hermann Health System self-develop an innovative solution for regional image interchange

Among the pioneering organizations in advancing interoperability in the imaging informatics arena is the 11-acute-care-hospital Memorial Hermann Health System, based on Houston. Because of the interconnectedness and complexity of the Memorial Hermann system, any solution the system’s leaders might choose to adopt would necessarily have to be somewhat comprehensive.

What has in fact happened is that the Memorial Hermann organization has self-funded the development of a cloud-based diagnostic image exchange called the MHiE Image Gateway, part of the Memorial Hermann Image Exchange, which is making available the thousands of new diagnostic imaging exams performed each day to appropriate clinicians and entities within the organization itself and to clinicians and entities that are a part of the image-sharing initiative (the Memorial Hermann folks worked collaboratively with the Phoenix-based DICOM Grid to create the cloud-based storage solution for the initiative). Created in less than six months from conception to go-live, the program has enhanced care quality, care management, and transition management, and expedited care; created savings from the elimination of duplicate exams; eliminated diverse problems related to the use of CDs carrying diagnostic images; and helped to strengthen and enhance relations among clinicians and facilities.

Recently, David Bradshaw, the chief information, marketing, and planning officer at Memorial Hermann, and Robert Weeks, the director of the health system’s information systems division, spoke with HCI Editor-in-Chief Mark Hagland regarding their organization’s breakthrough in image management. To find other compelling case studies in this area, please turn to the November cover story in the print edition of HCI. Below are excerpts from the interview with Messrs. Bradshaw and Weeks.

What was the core strategy or vision behind the creation of the MHiE?

David Bradshaw: As an organization, we believe that the interoperability between independent physicians who are part of our IPA, our contracted, post-acute providers, and our network of wholly owned delivery capability (from doctors’ offices to imaging centers, to surgery centers, to freestanding rehab centers, to our hospitals, to home health)—we believed we needed an interoperability platform for today’s and tomorrow’s needs. There are three main functions of the MHiE—one is around hooking up physicians, the EMR to our labs, and the EMR to our imaging centers; second is the image gateway, which moves images from imaging centers to hospitals to providers, replacing CDs that often don’t get created. And finally, a care continuity document (CCD)-aggregated exchange.

The image gateway is a cloud-based solution we’ve created with DICOM Grid, a company out of Phoenix. And we’ve got some really good use cases and stories about that.
David Bradshaw

Was it difficult to achieve and implement the vision?

Bradshaw: No, because we have a very clear business strategy, and when you understand our business strategy that we need to have in order to achieve our vision.

Please share with us some of the details of what types of images and data are shared.

Robert Weeks: There are three main use cases: trauma transfers, routine transfers, and serving as a kind of vendor archive-in-the-sky, a PACS [picture archiving and communications system] backup, so we have a redundant copy in the cloud. In the event of a large-scale system failure, we’d have that redundant copy of everything in the cloud.
Robert Weeks

How long have you been live?

Weeks: We’ve been live on the image gateway since the end of March. The initial scope included trauma transfer with Beaumont Baptist Hospital and Beaumont Orange Hospitals. Another one is Huntsville Memorial Hospital, which brings us trauma transfers from the north; and we also included a large orthopedic group, the Richmond Bone and Joint Orthopedic Group, a 20-orhopedist group with two locations. And we do image-share with them. Those 20 orthopods do surgery on many of our patients at Sugarland Memorial Hermann and Katy Memorial Hermann Hospitals. And often, patients would show up at their offices with CDs. And the orthopod might order more studies from us. And we send the images through our image gateway. So the beauty is, when one of those orthopods comes in to operate on one of our patients, we have any outside-created images and internally created images right there in the OR when they’re operating.

But the most awesome story I can share with you is around our trauma patients. Here’s an example of a trauma transfer case I’ll tell you about. From Beaumont, we had a 10-year-old girl who was running and fell and fractured her hip and femur; it was a very complex fracture. They imaged her, and realized she needed a high level of care. She was transferred from Beaumont to our Memorial Hermann Texas Medical Center. But the beauty of it was that they were able to get those images electronically to us here before the patient arrived. So the surgeons were able to study those images in the OR before the patient arrived. And that’s a very good thing.

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