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Interoperability and Consolidation in Enterprise Imaging

September 18, 2012
by Jennifer Prestigiacomo
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Dignity Health seeks to connect all its facilities before unifying them with a single-PACS provider

To pursue an enterprise imaging strategy, the 40-hospital Dignity Health system (formerly Catholic Healthcare West) seeks interoperability before consolidation. The San Francisco, Calif.-based health system is in the midst of connecting all 30 of its imaging care centers to its enterprise archive before paring down its five picture archiving and communication systems (PACS) providers to one.

“To start, enterprise imaging for Dignity Health focused on imaging interoperability,” says Scott Boswell, IT director, medical imaging and identity management, Dignity Health. “We wanted to create solutions that could extend and/or share the imaging study anywhere it was needed at any point in time. The solution would not just be to support extension and exchange within the Dignity Health system, but also with outside entities and our referring physicians.”

Dignity Health, not unlike other large health systems, is a regionally deployed integrated system, which has facilities that store images locally onsite for 18 to 24 months, and then houses the rest of the images in a centralized image repository in Phoenix.

So far, Dignity Health has deployed an interoperability solution (Merge iConnect; Chicago) to link up its 25 Catholic hospitals, 15 secular hospitals, and seven imaging centers. The health system currently has five different PACS providers at its facilities, all with various software versions that include 14 installations of Merge, 12 installations of DR Systems, eight installations of McKesson, three installations of GE, and one installation of Carestream.

Dignity Health is now moving toward a sole-source PACS strategy in order to achieve consistency, standardization, and vendor leverage, says Deanna Wise, executive vice president and CIO. “There are definitely some efficiencies to be gained from that financially,” she adds.

“Our stair step has been creating that network so that our facilities could leverage remote systems, and having that standard base,” says Wise. “The next step will be validating how do we put a consistent enterprise in place and what’s the true ROI. So I’m in the process of building that as we speak.”

Image-Enabling the EHR

Dignity Health is also in the process of image-enabling its EMR for its employed physicians, merging iConnect with its EHR through a clinical work interface, since its EHR (Dignity has an mix of Kansas City, Mo.-based Cerner and Westwood, Mass.-based Meditech installations) can’t launch native URLs. Beyond cardiology and radiology, Dignity Health has brought oncology and non-DICOM images (its imaging software wraps non-DICOM images in a DICOM wrapper) into its archive and will eventually route in digital pathology.

Referring physicians are able to access images through MobileMD, Dignity Health’s health information exchange (HIE), which launches an integrated viewer via a link contained within clinical reports. MobileMD was piloted in August 2011 by 5,000 physicians, and the HIE has since penetrated nine markets.

“Having accomplished our design for imaging interoperability, the next phase of enterprise imaging will focus on enabling the practice,” says Boswell. “For the next six months to a year, we are focusing on reducing our infrastructure while still maintaining our high-quality product to our end users; the imaging departments. We want to put together a foundation that would allow us to move into a tele-radiology enabled environment with enterprise reading work lists, central systems for advanced visualization (3-D) and voice recognition for reporting.”

Boswell says it’s been very important making sure its vendors partners are aligned with Dignity Health’s vision. Along with that, he admits the challenges of leveraging an enterprise system, while exploiting remote systems to create economies of scale. “We have a complex mix of acute and ambulatory facilities that are owned and some that we have joint ventures with,” says Boswell. “We’re not a closed system so we have to have a very dynamic and integrated system in order to do the kind of things needed to meet our Horizon 2020 goals.”

Boswell acknowledges the importance of IT leadership when it comes to enterprise imaging, citing the top-down buy-in at Dignity Health that has contributed to its success. Boswell’s four-person team is devoted to enterprise imaging strategy and collaborates with an IT steering committee, which includes Boswell, the COO, and other IT colleagues. This IT committee collaborates with several other councils including cardiology, cath labs,radiology, and a PACS administrator resource group.

Dignity Health is in an acquisition growth mode, says Wise, and will continue to balance its enterprise imaging strategy with other priorities like its EHR roll-out in acute and ambulatory spaces, ICD-10 transition, ACO preparation, and telemedicine exploration.