Important things are happening these days at Triad Radiology Associates, a large radiology group that encompasses 38 radiologists and six mid-level practitioners, and a total professional and support staff of about 55, working across five imaging centers in the Winston-Salem metro area in North Carolina. The radiologists in the group read for four area hospitals, a vein and vascular clinic, and several physician practices, completing between 650,000 and 675,000 studies a year.
CIO Tom Smith has been helping to lead his colleagues forward on their meaningful use journey under the HITECH (Health Information Technology for Electronic and Clinical Health) Act. With his leadership, all 38 radiologists were able to attest to Stage 1 MU in the fourth quarter of 2013, and all have received their initial incentive payments. Triad Radiology’s leaders have also helped four other radiology groups attest to Stage 1—a group in Virginia with approximately the same number of radiologists, a 16-radiologist group in Illinois, a 15-radiologist group in Iowa, and a six-radiologist group also in Iowa.
Smith spoke recently with HCI Editor-in-Chief Mark Hagland regarding his group’s forward progress in this area. Below are excerpts from that interview.
Having attested to Stage 1 in 2013, what are you and your colleagues doing in 2014 and 2015?
In 2014, we will have attested to Stage 1, and we will then begin our Stage 2 work beginning on January 1, 2015, with a full 365-day testing period. We’re working with all the physicians to obtain the appropriate interface feeds to use the correct technology; we’ve been successful with that so far. Merge RIS [radiology information system, from the Chicago-based Merge Healthcare] is our electronic health record, and PowerScribe 360 [from the Burlington, Mass.-based Nuance Communications] is our voice recognition solution.
Just to be clear, are there PACS [picture archiving and communications systems] and RIS solutions that are being certified?
For Stage 1, PACS really didn’t need a certification. Merge RIS was certified as a specialty EHR. Usually, the RIS is the certified technology from the radiology side. Now, for Stage 2, the PACS can be certified for the viewing and sharing of images, because the EHR has to have a link to certified technology to view images, so the PACS system sometimes gets certified. And Merge RIS has already been certified for Stage 2.
Were there any particular challenges in Stage 1?
The biggest challenge was being able to get all the data from different systems we work on, and consolidate that into our certified technology. And that’s going to continue to be an issue for Stage 2 going forward, making sure the additional data elements are included in the data feeds we get, and the challenge of the patient portal and secure communication required with patients. Now, for radiologists, we will probably take an exemption on those measures, because we don’t have direct patient contact, and the radiology reports we write don’t have to be included in the CCD [continuity of care document] or CDA [clinical document architecture], so we will most likely be exempted from that.
As has often been noted, federal officials, in designing the meaningful use program, didn’t really didn’t think about what radiologists do, or how they do it.
No, they did not. And we could absolutely have taken a hardship exemption, but we wanted to get onto certified technology, and we ultimately believed in the principles of meaningful use—improving communication and care quality—even though some of the regulations don’t make sense for the radiologists, we believe in the intent of it. And we read for multiple organizations in a fairly tight area, there is patient overlap, and we have had cases where we’ve been able to share patient images, averting duplicative tests, on behalf of the physicians and patients. We believe in it; we’ve already seen the benefit from it. We’ve seen in action how it can improve the quality of care and reduce the time to be able to react to information. We’ve already seen where that’s benefited the patient, for example, when a diagnostic imaging procedure has already occurred.
What would your advice be for fellow IT leaders at specialist medical groups?
They have to have a very strong relationship with the facilities they work with and read for, and the CIOs and other healthcare IT leaders at the radiology groups need someone on staff or on contract to help build those HL7 interfaces; they need an interface development team or staff. The hospitals don’t have the resources to do that HL7 development work on behalf of the practice-based specialists. The practices are going to have to have their own interface engine and their own team on staff or contract to do this integration work; the hospitals, with all their initiatives around meaningful use and software upgrade work, etc., they do not have the resources to do that.
They can turn on an existing feed, but it will be up to the practices to integrate it into their certified EHR or other technology. Once that’s done, though, you can use it to attest to MU; and also to fuel analytics for ACOs or population health. It gives you access to data that you wouldn’t normally have. There are days it can be challenging, but for the most part, it’s very rewarding. And in the end, it improves our relationships with the hospitals in the area, and makes for an all-around improved patient experience.