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LIVE FROM RSNA: Cleveland Clinic's Enterprise-Wide Approach to Images

December 3, 2013
by Mark Hagland
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Cheryl Petersilge, M.D., is helping to lead a broad imaging informatics initiative at Cleveland Clinic

Cheryl Petersilge, M.D., is helping to lead a broad imaging informatics initiative at Cleveland Clinic, one that could possibly be a model for a large number of multi-hospital health systems nationwide. Dr. Petersilge, a clinical professor of Radiology at Cleveland Clinic, has wears several hats. She continues to practice clinically two days a week, while also doing clinical informatics at Cleveland Clinic part-time; she has been working in that split capacity for four years. She is also now medical director of MyPractice Imaging Solutions, which is a consulting arm of Cleveland Clinic that has been launched to spread knowledge and insights about the innovations taking place at the organization, with others nationwide. In that capacity, she and her colleagues are partnering with Agfa Healthcare.

With regard to the enterprise imaging initiative at Cleveland Clinic, Dr. Petersildge has helped to create an umbrella internal program that is creating a comprehensive longitudinal medical record encompassing not only radiology and cardiology, but also arthroscopy, endoscopy, wound care, and dermatology, and which is making images from all of those disciplines available across the hospitals, emergency departments, and medical clinics that are part of the Cleveland Clinic integrated organization. While participating in RSNA 2013, being held at Chicago’s McCormick Place, Petersildge sat down with HCI Editor-in-Chief Mark Hagland to share her perspectives on the Cleveland Clinic initiative. Below are excerpts from that interview.

When did you go live with this enterprise imaging initiative at Cleveland Clinic?

We’ve been live now for about 18 months. And since going live, we’ve brought over 200,000 images that were not from radiology or cardiology. It’s a very large program.

Is this a vendor-neutral archive [VNA]?

It’s based on the VNA and is exploiting the full capabilities of the VNA, as opposed to the launched EMR. If you didn’t know, you wouldn’t know you weren’t still in the EMR. So the images are indexed to clinical content to and to a clinical timeline.

How many physicians at Cleveland Clinic are making use of the program?

All of the clinicians at Cleveland Clinic enterprise are using it; thousands.

And it’s live and available to the ED physicians, too?


What have the biggest benefits been so far?

It keeps the clinicians working in one environment, and gives them access to images they didn’t have before. So you’re a GI doc in the office and you’re seeing Mrs. Smith, and now you can show her the images, and what the studies look like. Currently, I’m setting up a research study to look at the impact of the program on physician as well as patient satisfaction.

Anecdotally, what are doctors telling you?

They’re loving it. I have  a whole physician advisory group that is so engaged. Our oncologists are particularly pleased at their ability to access their radiology images, as well as to be able to look at the endoscopy images they couldn’t see before.

What was the most challenging thing in implementing the program?

One of the biggest challenges is really getting a sense of the scope of images in an enterprise, because it’s so far beyond radiology. And also, getting some people to buy into the value of it. We haven’t convinced everyone… Some image generators—primarily radiologists—still believe that they create an image or themselves, some are radiologists; getting them to understand that the image is just as valuable as themselves, and that it doesn’t diminish their importance, has been a bit of a challenge.

What would your advice be for other organizations trying to do this?

I think they have to have a defined plan; they have to know where they’re going. They need to work with their clinicians. We have a very heavy clinician-driven focus, we’re not IT-driven or radiology-driven; we’re driven by the clinicians.

I’ve been having a lot of conversations at RSNA this year about the value that radiologists need to add to the care delivery and care management processes in patient care organizations, and about the need for them to become consultative once again with referring physicians, not to remain in their “reading room caves.” Do you have any thoughts in that area?

Absolutely, that’s an important conversation to have. Radiologists have a couple of things they can help with. One, they are the ones in most enterprises most capable of doing this program; they have the biggest knowledge base. So they have technical value to the enterprise. I also think they can learn by using what’s in an enterprise imaging system to complement their reports and become more knowledgeable about the whole patient, and therefore tailor their reports more individually. And in some ways, the introduction of PACS [picture archiving and communications systems], and the ability to remotely view images that came with that, created some of that divide. I’m not sure this is going to totally solve that problem, but they have to find ways to do that, absolutely.