It's an odd, fascinating time in the diagnostic imaging information technology arena. On the one hand, for the first time ever, a large plurality, if not a majority, of hospital-based organizations now have at least first-generation, if not second-generation PACS (picture archiving and communication system), along with radiology information systems (RIS)-which are often older and in need of upgrading-and electronic medical records (EMRs). What's more, as this month's cover story, which begins on page 10, notes, the healthcare IT leaders in patient care organizations have been moving forward to create all sorts of technological bridges and pathways to facilitate image and data availability for referring physicians.
In terms of what the end-user physicians need and want, “First and foremost is access to both images and data, because an image in isolation from a report or from a patient's medical record, is really limited,” David Voran, M.D., told me recently. Dr. Voran is a practicing family physician and the medical director of Heartland Clinic of Platte City, Mo. (an affiliate of the St. Joseph, Mo.-based Heartland Health system), and an enthusiastic tech adopter who has blogged about image and data viewing on iPads and other mobile devices.
Interestingly, Voran says, “I think people have too narrow a view of what clinicians’ needs are at a given time. What's frustrating is when only 30, 40, or 50 percent of the information needed to make decisions is accessible.” Making images and their related reports and data readily accessible, in a coherent and user-friendly way, is exactly what Voran and his colleagues need, and increasingly, across broader and broader realms, including trans-organizationally.
Not surprisingly, it is some thoughtful end-user clinicians like Voran who have quickly grasped the potential for health information exchanges to provide the connectivity ultimately needed for imaging informatics to work optimally for referring physicians and others. Yet the back-end interoperability that will be needed to support health information exchanges (HIEs) is still just beginning to be built in many organizations right now. It's a bit like our planning a manned flight to Mars when we're still trying to develop a truly fuel-efficient car here on Earth.
And that comes back to the subject of our cover story. On the one hand, far more hospitals, medical groups, and health systems have created bridging technology, via physician portals, unified-view dashboards, and other solutions, than have fully mastered the complexities around back-end RIS/PACS/EMR interoperability. Still, there are good reasons why that work is so difficult, and why the complexities only seem to be multiplying.
For one thing, in large organizations like the Boston-based Partners HealthCare and the vast, 20-hospital University of Pittsburgh Medical Center health system, growth through acquisition and merger has inevitably led to a Babel of technologies to manage. And what's fair to end-users at the various facilities in a multi-hospital system about ripping out and replacing successfully functioning PACS and RIS systems at their particular facilities, for the sake of system-wide uniformity? So the CIOs and their colleagues in those organizations are becoming resigned to living in a complicated, often messy, reality, and doing the best job possible of moving towards interoperability, while prioritizing end-user clinician satisfaction.
Finally, the fact that diagnostic imaging-related computing was not directly mentioned in the Stage 1 final rule on meaningful use, and the emerging need to integrate radiology and cardiology PACS systems are both going to influence how and in what order the various interoperability steps are tackled. Only time will tell how everything shakes out. Fortunately, the leaders in the field are already creating solutions that their peer organizations will be able to emulate over time.
Mark Hagland, Editor-in-Chief Healthcare Informatics 2010 November;27(11):8
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