One of the most challenging aspects involved in building out the health information exchange (HIE) concept continues to be around the sharing of diagnostic images. For a variety of policy, process, and technical reasons, most HIEs around the U.S. continue to struggle with how and when to enable the relatively free-flowing sharing of diagnostic images among participating individuals and entities. For many HIE leaders, the “image question” continues to loom large, as they work to become more responsive to their participants, while at the same time putting into place the processes and procedures that can facilitate optimal image-sharing.
One organization that has been pushing ahead to fully empower image-sharing is Coordinated Care of Oklahoma (CCO), based in Norman. That HIE, led by chief administrative officer Brian Yeaman, M.D., a practicing family physician, has been focusing on data liquidity in the imaging realm as in the realm of documents. And the HIE has in the past two weeks gone live with image-sharing.
During the annual RSNA Conference, being held this week at the McCormick Place Convention Center in Chicago, executives at the Burlington, Mass.-based Nuance Communications announced that the leaders of CCO had been able to use its cloud-based PowerShare Network to enhance image-sharing. As a Nov. 28 press release noted, “This evolution in HIE interoperability provides full access to and the seamless exchange of digital medical images and reports through the cloud plus real time awareness of patient’s prior medical images at the point of care. Nuance PowerShare for HIE provides clinicians with intelligent access to consolidated patient imaging records across systems and facilities in a way that immediately becomes actionable. This delivers clinical and patient advantages, and adds sustainability and profitability where HIEs have struggled in the past.”
And the press release quoted Dr. Yeaman as stating that “We went looking for data and image liquidity across our HIE and took a real world, nuts and bolts approach that we know will work, will be familiar to users and drive immediate value. We looked to DICOM standards and the cloud as the most logical way forward. Since DICOM standards are the way all PACS systems currently handle images, it made sense to leverage it as a basis for this new evolution in HIE interoperability. To move images from one facility to the next, it's important to do more than just move pieces of the image, and Nuance PowerShare provided a solution that is awesome with full access to records through the cloud.”
Dr. Yeaman’s statement continued, “We are focused on delivering value to our clients, our providers and to our members in terms of reimbursement, and quality of services in a network. Nuance solved our problem because today we are able to exchange images across different PACS [picture archiving and communications systems] systems inside of one health system, as well as across multiple health systems, bringing that patient data including medical images and reports at the point of care.”
Brian Yeaman, M.D.
During the RSNA Conference, Dr. Yeaman sat down with Healthcare Informatics Editor-in-Chief Mark Hagland to discuss Coordinated Care Oklahoma’s journey into optimizing image-sharing as an HIE. Below are excerpts from that interview.
Tell me a bit about Coordinated Care Oklahoma, and your journey as an HIE to date.
Back in the day, we were SmartNet. We evolved ourselves as an HIE in 2014 to Coordinated Care of Oklahoma. SmartNet was started in 2007. So we narrowed the organization down to make it a service organization, for sustainability. So we narrowed the organization down to make it a service organization, for sustainability. We’ve got over 65 hospitals and about 250-plus clinics, and another 100 or so post-acute care facilities. So we’ve got the care continuum piece; in fact, we cover 5 million patients across facilities in five states. So we’re doing high transaction volume: over 2 million inbound ADTs and CCDs a month. Our master patient index is very strong and mature, fewer than 5 percent duplicates. We’ve been talking with Nuance for about a year, where we use our MPI as the backbone for image-sharing through PowerShare. We bring the clinical data across the care continuum, and the images as well. So this use of the master patient index in an enterprise approach to the entire region is very different from how any of this was done in the health information exchange world. We were determined to make sure that this was not a centralized, point-to-point model. And that makes sense, given that 60 percent of our patients see two or more hospital systems, 28 percent three or more. It shows you the crossover involved with so many patients.
When did you go live with image-sharing?
About ten days ago. And we’re really able to improve our ability to ensure patient matching as well.
As a hospitalist who has worked in an ED, what is your perspective as a clinician, on diagnostic image-sharing via HIE?
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