Providers Sharpen their Enterprise Imaging Focus

However, there is one state that is building a statewide image repository. Maine’s image repository that jumpstarted in May is a central cloud archive spread across three data centers that houses the full study and report for radiology and cardiology images. Currently, five hospitals are involved in the pilot, which is expected to come to conclusion by early 2013, says Todd Rogow, director of information technology at HealthInfoNet, Maine’s statewide health information exchange. At a future point the image repository and the HIE will align so clinicians can access images and other clinical content from one central location.  

Todd Rogow

Among the lessons Rogow has been learning from the pilot is that is difficult fitting imaging in with all of the competing health IT priorities of meaningful use and ICD-10. For smaller organizations, the difficulty lies in their lack of IT resources; while larger health systems present their own challenges because they already have well-established regional PACS in their geographic area. HealthInfoNet is preparing to hire additional account managers to handle issue resolution for customers.

Multi-Hospital/PACS Approaches

When it comes to complexity, the 40-hospital Dignity Health system (formerly Catholic Healthcare West) has it in spades. To pursue its enterprise imaging strategy, the San Francisco, Calif.-based health system has sought interoperability before consolidation and is in the midst of connecting all 30 of its imaging care centers to its enterprise archive before paring down its five PACS providers to one.

“Enterprise imaging for Dignity Health focuses on imaging interoperability,” says Scott Boswell, the organization’s IT director for medical imaging and identity management. “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. “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.”

KLAS’ Ben Brown agrees that organizations can get a better discount when creating economies of scale by consolidating larger bulk storage purchases. “As tight as budgets are, when you can consolidate a purchase and get greater discounts, everyone is looking to squeeze as much juice out of the lemons that are available,” he says.

Image-Enabling the EHR

Dignity Health is also in the process of image-enabling its EHR 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.