HealthInfoNet and some of Maine’s largest healthcare organizations will begin piloting the nation’s first statewide medical image archive to reduce the cost of storage and transport of electronic medical images and share these images through the health information exchange (HIE).
HealthInfoNet, Maine’s statewide HIE, has connected 25 of Maine’s 39 hospitals and will soon add an additional nine hospitals that are ready to connect. The exchange has also linked up 182 physician practices, as well as two long-term facilities and three home health agencies for a total of 1 million individual lives covered by the HIE.
For several years, HealthInfoNet has shared radiological reports, says Todd Rogow, director of information technology at HealthInfoNet, but it was clearly a clinician-led effort to get images into the central archive. “Clinicians want to see the image themselves, even though they get the transcribed report [through the HIE]. They want to make their own judgment of the condition. I’ve heard over and over that a picture is worth a thousand words. They want to have those images available.”
Jerry Edson, former CIO of Maine Medical Center and a healthcare consultant on this project, says that there has been a collaborative effort within the state to push images over virtual private networks, which turned out to be very labor-intensive. “It’s been an ongoing struggle on the clinical side to get images into the clinicians’ hands, and that is essentially what’s made it the priority at this time, Edson says. “They struggle every day now to get their hands on images, what they call ‘relevant priors,’ and they try to transport images through CDs.”
Clinicians will soon have the ability to look at prior studies across organizational boundaries and have immediate access to images in three different ways: through their picture archiving and communication system (PACS), their electronic health record (EHR), or the HealthInfoNet portal.
In addition to leveraging the HIE, the archive prepares Maine’s providers for sharing images through the NwHIN Direct and Connect systems. It also supports the development of accountable care organizations and other shared risk-model care delivery structures.
Reducing Storage, Transport Costs
An estimated 1.8 million medical images (X-rays, mammograms, CT scans, MRIs, etc.) are generated in Maine each year, totaling more than 45 terabytes of data. The organizations participating in the pilot, which were selected based on their size and volume of images, include Eastern Maine Medical Center (Bangor), MaineGeneral Medical Center (Augusta and Waterville), Maine Health (Portland), and Cary Medical Center (Caribou). Together, these organizations generate 1.4 million of those images. Currently those images are stored in a number of different electronic archives and mostly shared between non-affiliated providers by copying the images to CDs.
A formal study of Maine’s four largest health systems showed the cost of storing a study ranged from 50 cents per study to more than $4 a study, while transport costs ranged from $4 to $15. Edson says the industry norm is approximately $12 a study. By consolidating medical images into a single archive, HealthInfoNet estimates that Maine’s providers could save $6 million over seven years through reduced storage and transport costs.
“[The archive] is self-sustaining because essentially we are going to be able to offer it on a fee for study basis that is less than the cost of what it’s currently costing them,” says Edson. Interface and implementation costs will be spread over the organization’s five-year contract.
Beyond reducing repeat tests and allowing easier image search through a single patient identifier, Edson says another added benefit of the archive will be augmentation of an organization’s business continuity and disaster recovery practices. The five years of onsite storage, as well as complete cloud archival, is being offered less expensively than these organizations current archives, says Edson.
HealthInfoNet selected the Round Rock, Texas-based Dell to build and operate the new cloud-based archive through a rigorous RFP process that involved vetting by both Maine clinicians and health information technology professionals. Part of Dell’s offering is an interoperability library that enables compatibility for 30 of the major PACS suppliers and more than 10,000 interfaces for the PACS suppliers different release levels.
All pilot sites will be interfaced in parallel and will work together with HealthInfoNet over the next five months to confirm the system design and integrate the service with existing PACS systems and the HIE. HealthInfoNet expects to end the pilot phase in the fall and expand the service statewide by 2013.