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A Changing "Image" of ARRA/Meaningful Use

November 3, 2009
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In case anyone has been wondering, I’ve sort of taken a hiatus from the blog. This has not been due to a writer’s block, but more to introspection. Following my recent blog on ARRA/Meaning Use (An Open Letter to Dr. Blumenthal, August 28, 2009), I decided to step back and do some additional research into the subject. I wanted to test the premise of the basis for my open letter to Dr. Blumenthal regarding the importance of imaging to the overall design of Meaningful Use. To do so, I thought it would be helpful to seek the opinions of those living with the outcome, and see if their viewpoints had any change on my basic premise regarding imaging.

My intent is to focus my next few installments of the blog on what I have learned during my journey, and see if it fits with the conventional wisdom. What I would like to do with this installment is set the stage by laying out the case for imaging by explaining what is known with respect to Meaningful Use and provider initiatives. I will then share with you in subsequent installments what I have learned in terms of current and anticipated activity.

There is an old expression about being too close to the trees to see the forest. Living within the imaging space for so long, I sometimes feel as if I am among the trees. What I have come to realize through the process is that there are multiple perspectives to “imaging” with respect to the perception of importance to Meaningful Use. The major distinction I would like to draw is the differentiation between thinking of imaging from “within” the imaging service, versus thinking of imaging from “outside” the imaging service.

As someone who comes from within the imaging service, the natural tendency is to relate to image utilization for clinical purposes – the diagnostic image so to speak. The primary function of a Picture Archive and Communications System (PACS) is to acquire images and manage them for diagnostic purposes. From the external perspective, the tendency is to relate to images from a results perspective – how does the image help support the primary diagnostic document, the report?

I have come to the conclusion that in terms of Meaningful Use, the definition is coming from the external perspective in terms of supporting the diagnostic report, and primarily benefits the clinician. This is understandable, since the whole ARRA/Meaningful Use opportunity seems to be around incentivizing the use of electronic information in the treatment of a patient, and the amount of grants associated with Medicare Payments for Electronic Medical Record (EMR) technology. Since the report is the primary results document, imaging in the context of results is supportive information, and that is probably why is has been pegged at the tail end of the Meaningful Use process (2015).

While I can accept this premise, it presents a dilemma with respect to how the image information originates to be associated with the report! One could construct an environment that would extract the key summary images to be associated with the report, and store them for association through the EMR. If all Meaningful Use ever touches is the result, this might be a workable solution. Conversely, it might be better for future applications if one were to consider associating the image from the original dataset acquired into the PACS. This will require that Meaningful Use take into account the origin of the image in its definition. That is what I would like to see happen from a Meaningful Use perspective.

The advantage of taking internal uses of imaging into perspective in Meaningful Use is that there is potentially cost saving and quality improvement opportunities associated with access to images for diagnostic, as well as results uses. For example, would it not be appropriate to be able to access a central image (regional) archive to determine if a similar study on the patient had previously been done, to avoid repeating an exam? Or would it not be beneficial to access prior exams for comparative purposes to improve the quality of the read?

It is for these reasons that I would argue that Meaningful Use should take into account diagnostic as well as results applications as part of the definition. In my next installment, I will delve into what I heard in my research with respect to the way this is currently being thought of amongst HIE’s.

I’m anxious to hear your thoughts! Please feel free to share them.




Thanks for your helful comments. I hope to tackle the question of clinical use of imaging further in my next installment. I continue to find other initiatives that have resulted in the same frustration with the failure to consider the "inside" uses of imaging as part of meaningful use.

Hi Joe

I am excited that you started this discussion. I have been busy convincing my clients that Meaningful Use has both internal and external implications. Is it really acceptable to a patient that presents themself in Cardiology that their (Radiology) chest films from 30 days prior or worse 30 minutes prior can not be accessed? All images are clinically relevant until a physician decides they are not and most health systems can not present physicians with all images because imaging archives are managed in silos.
I strongly believe that Enterprise Image Archives are a foundational requirement for meaningful use!

Additionally EAs will be important for ease of integration to HIEs. Won't it be easier for a health system to integrate 1 single EA to their HIEs than to integrate many silo'd archives?

Thanks again for starting the discussion! Joe