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Debe Gash’s Midwestern Common Sense and the Ubiquity of Images

July 19, 2015
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The success of the cloud-based information exchange for diagnostic images at Saint Luke’s Health System in Kansas City shows that HIE with a vision grounded in reality can work wonderfully well

It was an honor and a pleasure to moderate the webinar sponsored by our sister organization, the Institute for Health Technology Transformation (iHT2) last Thursday (July 16). The presenter was Deborah Gash, the vice president and CIO of Saint Luke’s Health System, a Kansas City-based integrated health system that encompasses 10 hospitals, 918 staffed beds, 9,000 employees, 450 employed physicians, and 2,440 affiliated physicians, and delivers patient to care to patients in a 67-county service area surrounding the Kansas City, Missouri/Kansas metropolitan area.

In the webinar, Debe Gash shared with webinar attendees the story of her organization’s implementation of a cloud-based information exchange system for diagnostic images. Like many hospital-based organizations, Saint Luke’s had been struggling with a complex, disjointed system of diagnostic image management, with diagnostic images not readily available, or difficult to share between and among clinicians and care sites; access to studies not timely; and with complicated, awkward practical challenges around the fact of diagnostic images constantly being moved around from one location to another, being lost, not capable of being read, and so on.

“As CIO, I try to get out and meet with our various stakeholder groups and talk with them about their technology and really hear first-hand from them about what’s working well and not,” Gash told her audience. “And it has always come up that the access to information and in particular images, has been problematic. Our previous state was reliant on people, had lots of points of failure, and was a particularly challenging area for us. Although we had an enterprise PACS [picture archiving and communications system], we were really struggling with making those images from outside the organization available to our providers. Images might come via CDs from patients, or via ambulance service. So the only time we could view those studies was when a patient physically arrived and we physically had the studies with us. So being able to understand what was happening with the patients before that was very challenging for physicians.”

And even as diagnostic images were being produced at a faster rate than ever before, and technology had made their storage in PACS systems easier, sharing diagnostic images among clinicians remained a daunting problem for Gash and her colleagues at Saint Luke’s Health System. Ultimately, as she explained to her audience on Thursday, she helped lead an initiative that based image access in the cloud, a solution that has improved patient care delivery, patient safety, and care quality, clinician workflow, operational efficiency, and cost-effectiveness, and dramatically improved the satisfaction of both salaried and community physicians, with Saint Luke’s Health System.

Gash made it clear that moving forward with a cloud-based solution did mean engaging in a lot of provider and staff education. “I did have to spend a lot of time talking with people about cloud-based technology and security,” she noted in her webinar presentation. “People weren’t very knowledgeable about it at the time. And we still have lots of conversations about whether it’s secure or not and whether we’ll get into privacy issues. So this is key: you have to spend a lot of time educating on security, etc. I even had to spend a lot of time meeting with risk management and others. It required a lot of socialization to get people comfortable.”

But it has all paid off, in spades. Not only has image access become extremely streamlined and clinician-friendly, the fact that the CIOs in the Kansas City market were all investing in the same cloud-based technologies meant that, by the time Saint Luke’s Health System’s cloud-based image-access solution had been fully implemented, the entire metropolitan area was on the way to what has essentially become a regional image information exchange. “So now I have my peer hospitals leveraging the same technology, so it kind of by default created a regional information exchange for images,” Gash noted. “And it has really been an interesting experience in our market to share images in that way. So sharing with fellow CIOs helped our community to create this information exchange for images.”

I have to say, I find all this eminently commonsensical, in an unpretentious, Midwestern kind of way. What Debe Gash and her colleagues at Saint Luke’s, and her fellow CIOs in the Kansas City metro area, have done, is to create structures for image-sharing that meet the real, previously umet, needs, of clinicians delivering patient care, and that improve both the care quality and cost calculus in U.S. healthcare. It is interesting to me to see this kind of success, at a time when many health information exchanges are failing nationwide, as the federal and state grants that funded dozens and dozens of HIEs starting several years ago, are now fading out, leaving those HIEs without very strong rationales and business models floundering.

I will further venture to predict that the kinds of HIEs that are successful going forward will have strong business models, strong governance models, and above all, the strong care delivery rationales that Saint Luke’s Health System’s image exchange and the broader de facto regional image exchange emerging in the Kansas City market, have. Now is a time of burgeoning needs, but also straitening circumstances, in U.S. healthcare, and it will be more and more difficult to get initiatives off the ground that are not, in fact, strongly grounded in realism to begin with.