By David Raths
It’s an exciting time in imaging informatics. By Stage 3 of meaningful use, providers will have to be able to give a medical portfolio to caregivers and patients, including images. In 2013, therefore, the pressure is on to think about systems on an enterprise level and improve interoperability.
Rasu Shrestha, M.D., vice president for medical information technology and medical director for interoperability and imaging informatics at the University of Pittsburgh Medical Center (UPMC), says his health system is taking an approach that is more patient-centric rather than the traditional application-centric approach. “We need a comprehensive view so we created a federated archive called SingleView that can offer one unified umbrella view of the patient,” he explains. “We are looking at how we can include additional data elements such as relevant labs.” SingleView is already tied in at the back end to the larger EMR system in use, whether Cerner or Epic. “This type of image-enabled EMR allows a user to dive into a study as it is contextually presented to them” he says. The real trend, Shrestha adds, is the enterprise archive decoupled from the picture archiving and communications system (PACS), but where you store more than just DICOM images. “You create enterprise storage strategy layered at the back end, he says.
Many imaging informatics groups will spend 2013 working on strategies around enterprise vendor-neutral archives. For instance, Christopher Roth, M.D., associate chair of radiology for health information technology and clinical informatics at Duke University Medical Center and director of imaging IT strategy for Duke Medicine, says his organization is working to implement TeraMedica’s enterprise vendor neutral archive (VNA) this year. The technology of the VNA is pretty straightforward, he says. “It is the operational aspect and getting people to agree about how we are going to use it that is the hard part.” Durham, N.C.-based Duke and other medical centers have power users in radiology and cardiology who have been using sophisticated image management, manipulation and interpretation tools for years, while for other specialties the opportunity has only just become available. Digital pathology is relatively new, yet their storage needs could soon dwarf other uses, he adds.
“The whole point of this effort is to integrate images into the EMR so that clinicians who need it can have text supplemented with pictures,” Roth says. “Without meaningful use pushing for enterprise EMR, this probably wouldn’t have been possible. Integrating image storage and presentation seamlessly into a physician’s daily workflow can facilitate watching a skin mole change over time and immediately change medical treatment. We have to work on the IT infrastructure to make those images easily accessible. We want to provide the most salient clinical information, and often a picture is more important than a measurement or text,” he says. “We want a surgeon to actually see the aneurysm as opposed to just reading about it.”
Michael Gray, a Novato, Calif.-based imaging technology consultant, notes that some in the industry have described the current situation as the early stages of a transition from PACS 2.0 to PACS 3.0. This change began about three years ago with taking the “A” out of PACS, he says, by moving to vendor-neutral archives.
The tools radiology departments want now tend to fall into three categories:
• new technologies such as advanced visualization tools, and server-side rendering to better support enterprise viewing but also at-home diagnostics;
• better workflow engines to help build and organize enterprise-wide reading lists, especially when multiple facilities and disparate PACS are involved;
• business analytics to help understand usage, cost and referral patterns;
The PACS vendors so far seem to be failing to bring these innovations to market, Gray notes. “Provider organizations are starting to look at creating their own best-of-breed systems using one firm’s vendor-neutral archive, another’s enterprise work-flow and analytics tools and a third’s advanced visualization piece and thereby bringing together a new generation of PACS that is better than what is being offered by any one vendor,” he adds. The challenge there is it may require three separate service level agreements.
Image-sharing outside the enterprise, with or without health information exchanges (HIEs), is another area that needs to be worked out because the meaningful use regulations will require it, Gray says. There are proprietary image-sharing solutions on the market. But some HIEs see image sharing as a service they can provide that may enhance their sustainability and reduce costs for members.
The HealthInfoNet HIE in Maine is in the pilot phase of setting up a cloud-based medical image archive, which it expects to take live this summer. The system will be able to link each image with a single patient identifier through its HIE’s master person index, allowing clinicians to search for all a patient’s prior images.
“The bane of radiologists’ existence is trying to get their hands on studies done elsewhere,” says Jerry Edson, a consultant on the project and the former CIO of the Maine Medical Center (Portland). “They have handled this by burning CDs and handing them to patients to carry around. This solution completely eliminates that problem, and provides a very robust solution for them in terms of business continuity and disaster recovery, something that many radiology centers may not have been doing a great job of.”
Users will have two ways to access the images: through the HIE portal or directly through their own PACS application.
HealthInfoNet estimates that Maine healthcare providers will save a total of $6 million over seven years through a reduction of distributed-image storage and transport costs. “That is one of the benefits of group buying,” Edson says.
Likewise, the Indiana Health Information Exchange (IHIE) has partnered with SeeMyRadiology.com to roll out ImageZone, a cloud-based image-sharing solution. “IHIE already delivers most of the radiology reports in the state, so we see this as a natural progression,” says Joan Callahan, the ImageZone product manager. The project is still in the rollout and provider education stage, she adds. “If we do get traction, we will look at integrating this service with those radiology reports. In our research, radiologists told us that in 18 percent of cases, they would like access to relevant prior imaging. We’d like to turn that into an ‘Easy Button’ that tells them there are earlier images of their patient in ImageZone they can request.”
With so much changing so fast, UPMC’s Shrestha warns against falling too easily for technology hype. “Buzzwords like cloud or mobile tend to confuse people who might make decisions that are expensive yet make things more difficult for themselves,” he says. “You really have to focus on what could be the benefits from embracing a mobile platform. You have to build it for a specific purpose rather than just because it is popular.”