Facing diverse technology and local-market histories and situations, CIOs and their healthcare IT leader colleagues are working to make electronic health record (EHR), picture archiving and communications system (PACS), and radiology information system (RIS) products interoperable, while optimizing referring physicians' access to images and reports from anywhere. In doing so, they are facing up to organizational, process, and technological complexities-and moving forward in spite of the obstacles involved.
Karen Thomas, vice president and CIO, and Paul Maurer, director of applications, of the integrated health system Mainline Health, based in the Philadelphia suburbs, face a situation common to many healthcare IT leaders. Their 1,200-bed health system, which includes four acute-care hospitals, as well as two rehab hospitals and other services, has grown through merger and acquisition, meaning that their information technology infrastructure is also typically mixed. Thus, the core inpatient EMR at three of their four acute-care hospitals is from the Malvern, Pa.-based Siemens Healthcare, while that of the fourth is from the Kansas City-based Cerner Corp. Meanwhile, they've got different PACS, from the Alpharetta, Ga.-based McKesson Corp. and the Mortsel, Belgium-based Agfa HealthCare; and different RIS, from Siemens and Cerner.
With such a patchwork quilt of information technologies, it was inevitable that Thomas, Maurer, and their colleagues would be compelled forward on a journey towards creating smoother access to diagnostic images, radiology reports, and other information, on behalf of their salaried and affiliated physicians. The Mainline folks have been live for more than 10 years now with a Web-based physician portal (two, actually, encompassing the most recently acquired facility within the system), through which their physicians can quickly access all the images and data they need.
Meanwhile, in the background, Thomas, Maurer, and their colleagues have been working to knit the connections of the various clinical information systems together more seamlessly. In fact, the level of complexity of the IT situation is even more complex than appears at first blush, as they are working to create a single core diagnostic images database, for both radiology and cardiology images. It is a multilayered task.
“When we first embarked on PACS, we did not want separate PACS all over the organization; we wanted a single repository,” Thomas explains. “And McKesson”-the organization's primary PACS vendor-“had partnered with a company called Camtronics for cardiology PACS, but later grew their own cardiology PACS, so we've migrated to McKesson on cardiology, and are working on that single image repository across cardiology and radiology.”
In fact, Maurer notes, “You can get to the cardiology images in the radiology Web-viewer; though for full feature-function, some physicians will go into the cardiology Web-viewer.”
The stakes are high. Mainline's clinician's produce 640,000 radiology studies a year, 36,000 cardiology studies a year; they are already up to more than 400 terabytes of long-term storage, and 120 terabytes of short-term storage, of diagnostic images.
THE KEY FOR CIOS IS TO REALLY UNDERSTAND WHAT KIND OF INVESTMENT, AND HOW MUCH TIME IS REQUIRED, IN ORDER TO ACHIEVE AN INTEGRATED PACS SYSTEM. THESE ARE EXPENSIVE SYSTEMS.-KAREN THOMAS
The key for CIOs, says Thomas, is “to really understand what kind of investment, and how much time is required, in order to achieve an integrated PACS. These are expensive systems. We were very fortunate to have a partner that provided a great deal of integration from the beginning, because we moved aggressively to put as much onto PACS as early as possible” in imaging IT development, she says. And Maurer adds that “The amount of integration and back-end hardware involved makes it very challenging for organizations to support multiple PACS. Clearly, it's requiring extra hardware and resources, so I think you'll see organizations moving towards a single architecture. Meanwhile, he says, “organizations are challenged by the storage issues, particularly with 3D images and multi-slice studies, so the images are getting larger and the volume of images is growing.”