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Sharing Images Across a Community

October 29, 2012
by Mark Hagland
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Leaders at Northeast Georgia Health System achieve health information exchange for images

Northeast Georgia Health System (NGHS) is a one-hospital, 557-bed health system based in Gainesville, Ga. The health system is planning on opening a second community hospital in 2015. The system includes an affiliated medical group, Northeast Georgia Physicians group, with 142 providers (of whom 116 are physicians), as well as a behavioral healthcare unit, home healthcare, and long-term care facilities. NGHS serves 700,000 people across northeast Georgia. The health system’s core PACS (picture archiving and communications system) solution is from the Alpharetta, Ga.-based McKesson Corporation (as is NGHS’s inpatient electronic health record), while it has achieved health information exchange for images through the use of the iConnect solution from the Chicago-based Merge Healthcare.

Recently, several NGHS executives—Allana Cummings, CIO; Devin Matthews, IT clinical integration officer; and James Bailey, M.D., CMIO—spoke with HCI Editor-in-Chief Mark Hagland, regarding the advances they and their colleagues have been making in the imaging informatics arena. Below are excerpts from that interview.

Where are you in terms of meaningful use?

Allana Cummings: We have attested to stage 1 in August, and have received our incentive payment from the federal government, and the physician group also attested in August on behalf of the physicians in the group, and payments for both were disbursed last month.

How much was the first payment for the hospital?

It was over $3 million.

What have been the biggest challenges in achieving Stage 1 of meaningful use?

In general, the readiness of the software and the data systems. There’s a lot of detailed work involved in terms of connectivity.

James Bailey, M.D.: We started our implementation of CPOE [computerized physician order entry] approximately a year ago, through a staged rollout. And we found that in meeting the medication requirements, we didn’t struggle with that so much, but the problem list requirement was something we were concerned about, because the software implementation was somewhat late in the game; so once we had the functionality going, we had a relatively short period of time.

Cummings: It was a challenge, but we were able to address that challenge relatively quickly.

When did your organization go live on CPOE?

Bailey: It was in the first two weeks of September of last year.

Cummings: And it was a staged rollout, and we started with our hospitalists first, and rolled out gradually, through to the specialists. And we just came live with physician notes and CPOE for the cardiologists late this summer.

What kinds of issues emerged in the CPOE and physician documentation rollout?

Bailey: The issues were around the training of the physicians, and also the fact that the entry of a problem is actually part of the order entry. And for physicians, that’s not where you think of putting problems; you put problems in with your documentation, your assessment. Fortunately, our ER doctors were more used to codified entry in the ED. But that was probably the biggest impediment, the idea that you would enter a problem in with the order.

Was it an issue with the design from the vendor?

Cummings: There aren’t any software products that I’m aware of that do it a different way. The main issue becomes the maintenance of the active problem list to drive the documentation; that’s something I think all the vendors are working towards making easier for the physicians.

Bailey: And we had been used to, in the paper world, we knew that when we were admitting patients, we had to have an admitting diagnosis just to get a bed. So that whole admission order set was easier there. And we’re now seeing patients with large numbers of problems being entered, so I think that managing the problem list going forward will be a challenge.

What is your core EHR vendor?

Cummings: McKesson, using their Horizon platform.

You’re a Merge customer organization in terms of health information exchange, correct?

Cummings:  For the image exchange, yes; our community HIE is with a different vendor. We also have their products for cardiology as well, though our core PACS is from McKesson. The image exchange came out of a collaboration with the Longstreet Clinic, Northeast Georgia Heart Center and Northeast Georgia Diagnostic Clinic; those groups came together as a part of a community collaborative, to address the problem of duplicative radiologic studies. So we came together around trying to exchange images seamlessly, so that when the physicians log in, they can have a one-stop shop; and that was our highest priority in terms of image exchange. And we found that the Merge tool met those needs. So in September of last year, we went live with that tool, with iConnect. And we’re sharing images from our PACS databases. There’s another component of that tool called iShare, which we’re using to connect with Emory Health System and Grady Hospital, for electronic sharing.

iConnect is the more intensive exchange, then?

Yes, that's correct.

How many images are being shared?

We’ve had about 400 providers using the system, and over 200,000 images shared so far.

How many images have been shared so far through iShare?

That’s a small number, because it’s more for the sharing of individual exams and images, but the groups involved have noticed a significant reduction in courier costs and in the costs of DVDs and CDs. We didn’t go into it with that mindset; we went into it with the idea of connectivity.

What kinds of lessons have been learned so far around image-sharing strategy development?

Devin Matthews: What we learned was that images were a very distinct part of the physicians’ workflow; and creating an environment with ready access, especially remote access—we made it available to them where they wanted. And knowing that images were at the top of their priority list, and we worked on that first—we learned to listened to the physicians and what they wanted.

Bailey: I would say that the growth in image sophistication is the single biggest trend in this area in medicine. So for physicians, imaging is far more valuable for completing the diagnostic process than many other forms of data. That’s across the board, and is probably one of the single biggest areas of rising costs for Medicare has been for imaging.

So the technology has advanced so rapidly and significantly, that imaging has become a core part of the diagnostic process, then?

Bailey: Absolutely.

Cummings: And to be honest, when we first looked at this and listened to our physicians, most people were starting out with general results- sharing and notes-sharing; but the thing is, if we don’t have a lab test result readily available, we can repeat that lab test, and yes, someone might have to be stuck with a needle a second time. But when you look at the issue of concern around re-radiating patients, that emerged as an important safety issue. And I’m glad that the physicians pushed that issue for us, because this was the right thing to do.

Might your advice to CIOs and CMIOs be, then, that you’d encourage other organizations to do this in the order you’ve done it?

Cummings: If that’s what the need is in the community, then, yes. And I think this sequencing really encouraged information exchange in the community.

Matthews: To be honest with you, we looked at 60 days, end to end from when we started, until the time it came up, and it came up smoothly. And we were able to connect five PACS systems seamlessly in a federated model.

Cummings: And that’s been one of the great pieces about Merge; Merge is more of an integrating technology. Obviously, they have PACS systems, and one of our primary partners in this exchange uses Merge for their PACS. But with their domain expertise, Merge is able to provide a true virtual integration of our images across the community.

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