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In Houston, Imaging is Included in the HIE

September 24, 2014
by Gabriel Perna
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Imaging in health information exchanges (HIEs) is a developing concept.

The Orem, Utah-based KLAS Research recently surveyed 193 providers and found that demand for image exchange products is growing among them. Slowly but surely, organizations are seeing the value of exchanging images. A study from University of Michigan researchers found that when hospitals share images, there are better outcomes for the patient and significant cost savings for all parties. In total, they estimated $19 million in annual savings if imaging sharing capabilities were implemented in HIEs nationwide.

Count the Greater Houston Health Connect among the believers. The public nonprofit regional HIE, covering 20 counties in southeastern Texas, recently invested in DICOM Grid’s (Phoenix, Ariz.) software to allow its members to share images in the cloud. The HIE has only rolled out the image-sharing capabilities at three of its 10 member hospitals, but CTO and acting CEO, Phil Beckett, Ph.D., is confident that the capabilities will provide more value for its members.

“Imaging is a key component of the patient’s medical record. They are expensive studies to perform. They expose patients to radiation. They are key in diagnostic determinations,” Dr. Beckett says.

Beckett recently spoke with Healthcare Informatics Senior Editor Gabriel Perna about this new investment, his ultimate plans for imaging sharing in Houston, and why imaging sharing capabilities should be included in any HIE. Below are excerpts from that interview.

Phil Beckett, Ph.D.

Why is image-sharing an important facet of your HIE? Or any HIE for that matter?

They’re expensive tests and if you’re an imaging center, you won’t get reimbursed for repeating the same test. There is a big risk of losing money. From a patient perspective, there is radiation exposure. It’s not insignificant. If you get a CT scan, that’s a year’s worth of background radiation. For a child, it’s worth ten times that.

Also, in terms of the old way of sharing images, through CDs, no IT security person wants CDs on their network. From a security perspective, what else might be on there?  Plus, it gives you access to prior, knowing where they are, and the ability to fetch (that information) and put it in your own PACS [picture archiving and communication system] seamlessly…you can’t do that off a CD. Providing that kind of operation across the community is critical.

From a revenue and sustainability perspective, you can deliver that solution more effectively than you can exchange CDs or having patients run around trying to get their old images. So I see it as a satisfaction factor for radiologists, a safety factor for patients, cost-savings for providers, and a revenue stream for the HIE. 

Was this something your members asked for or something you did on your own?

A little bit of both. We’ve done our market research on it but it was more we wanted to share images and asking our members if it was something they saw value in.  We had a large advisory council of customers or potential customers who helped us vet solutions and the concept. That was its genesis. We put it out there this is something we want to do and they validated it.

What will this new investment allow you to do?

We’ve focused on four workflows. One is annotating a report from a radiology information system and sticking an image availability link that. If I get that report in my EMR, I can click on that link. I don’t have to install software and I can view that image. In that, we’ve supported a federated model. We’re not pushing images to the cloud all the time; we’re only fetching them when someone asks for them. We store it there for 30 days. We’re not replicating that storage that’s an individual PACS system.

The second one is, not only can I view that image, but you can import that image into the PACS. There is a seamless workflow where you can manage the patient’s medical record so it matches to your own PACS. Third, you can share that image with anyone. The recipient has to authenticate and enable them to upload it. Fourth is the integration of the imaging solution with the master patient index, where we can match the patient’s medical record number in each facility and query every PACS to get a list of every study the patient has undergone across the community. Now you’ve got a full view of access to every image.  It’s the ability to share, download, import into PACS, and provide a list of community images.

Any concerns with security?

I worry about security all the time. The data itself is encrypted, both in transport and at rest. Our authentication is through the EMR, so we’re working with each of the organizations to ensure only the right people can access the data. We have policies in place, a business purchase agreements with every participating organization.

Have you seen any early results?

We’ve started doing it at just three of our facilities. We’re still early with that.  Because it’s early, we’re looking for those stories from organizations that say this has made a difference in the way they took care of patient. We’re not at that point yet, we’re still building.

What’s the ultimate goal with image-sharing?

To have every image producer connected in the community so that both patients and providers have all access to images in this community. 

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