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Part 1: Making It Count

October 28, 2009
by Mark Hagland
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With an eye on connectivity and integration with other systems, three CIOs are creating new models for image management

Case Study: Fletcher Allen leverages EMR connectivity for optimized imaging

Chuck Podesta, senior vice president and CIO at 500-bed Fletcher Allen Health Care in Burlington, Vt., is dogged in his determination to use IT to improve care for patients across the state. Relatively small, Vermont's population is mostly rural and broadly scattered.

Fletcher Allen, an affiliate of the University of Vermont Medical School, is uniquely positioned. Other widely-scattered facilities often send patients to Fletcher Allen for tertiary - even, quaternary care. Podesta saw an unusual opportunity with regard to his relationship with his core EMR vendor, Verona, Wis.-based Epic Systems Corporation.

“Typically, Epic's market has been large academic medical centers and health systems and large medical practices; they haven't been that interested in smaller hospitals,” Podesta says. “And because we are the only academic medical center in Vermont, they've allowed us to extend our Epic product license to other hospitals in the state. I call it a ‘group-purchase, hosted' solution, because we host the single database,” he says.

Podesta and his colleagues have developed PRISM Regional, a core clinical information system whose capability extends throughout Vermont and across the border into the state of New York. The system has gone live at five of Vermont's 13 hospitals, as well two in upstate New York. In order to provide imaging access to hospitals throughout the region, the PRISM/Epic EMR is regionalizing imaging communications statewide, he says.

And this is true even though Fletcher Allen's RIS is the ImageCast product from GE Healthcare (Waukesha, Wis.) and its PACS is from McKesson Corporation (Alpharetta, Ga.), according to Podesta.

In terms of diagnostic imaging, Fletcher Allen's PRISM Regional initiative is improving clinicians' access to, and use of, diagnostic images as well as other clinical data in the broader context of clinical IT development. Any physician linked into the PRISM system can access any archived image by clicking on an icon on the main EMR screen and can launch the PACS Web viewer onscreen. And for patients in a state such as Vermont with low-density populations, improving such access inherently means improving patient care. In many cases, it can make the difference between an ambulance transfer and the ability to care for patients tele-medically, improving the speed and effectiveness of care.

In many cases, it can make the difference between an ambulance transfer and the ability to care for patients tele-medically, improving the speed and effectiveness of care.

“For example,” Podesta says, “often, a physician three hours away in a community hospital isn't sure whether to transfer a patient or not; and if the decision is being made during a telephone-based consult with a physician here, and the diagnostic images aren't available to the physicians in both facilities, then there can be uncertainty as to what to do. In that case, if you're not sure, you've got to transfer the patient. Then later on after the patient is transferred, sometimes you discover that the patient could, in fact, have stayed in the community hospital and not taken a three-hour ambulance ride, with the family driving behind.

“Now, with the ability of physicians in all the linked facilities to access those diagnostic images, the radiologist here at Fletcher Allen, and sometimes the ED physician here, can be on the phone with the ED physician at the outlying hospital, and all can be looking at the same set of images and come to a more optimal decision.” Podesta says it's more point-to-point than traditional teleradiology. “And in places like Vermont, New Hampshire, and upstate New York, this kind of technology has a huge impact, especially since the EMR is wrapped around everything.”

“We were very aggressive in terms of upgrading our infrastructure and our network, both inside the facilities and between and among them.”

Could this model of IT-supported care delivery be replicated elsewhere? Podesta says it's certainly a possibility, and Judith Faulkner, founder and CEO of Epic, agrees. “Actually, a few of our customers have extended their software to small neighboring hospitals over the past half-dozen years or so with our full support,” she says. Faulkner says Epic is set to release Sonnet, its inpatient EMR for smaller hospitals this month (an ambulatory version came onto the group practice market in the fall). In the meantime, Podesta and his colleagues will be busy for the next few years broadening and deepening the reach of their clinical information systems to further enhance care delivery across mostly rural Vermont.

Case Study: A strong integration focus takes hold in Nebraska

At Alegent Health, a 1,832-bed integrated delivery system in Omaha, Neb., Senior Vice President and CIO Ken Lawonn has been focusing on clinical IS integration for imaging management - RIS, PACS and EMR - for driving care delivery.

Ken lawonn

Ken Lawonn

“We're pretty advanced in terms of imaging. We signed a deal with Siemens seven years ago,” he says, referring to Malvern, Pa.-based Siemens Medical Solutions, “one of whose major aspects was to standardize and upgrade our technology and to integrate our RIS/PACS solution.” The deal also called for Siemens to standardize and implement a number of modalities at Alegent, including a variety of MRIs, CTs, and a PET CT. The work has also included deploying Siemens' Syngo Workflow RIS, SIENET Enterprise PACS, as well as Syngo Dynamics Cardiology PACS. By November 2008, the organization was live with all the various functionalities.