Now that HIMSS 2010 is history, I thought it would be helpful to “compare notes” in terms of attention-getters from vendor exhibits. Given my focus on imaging integration, I have concentrated on imaging technologies of interest. The following are my top picks.
HIE’s/EMR’s As A Service
Clearly, there was a lot of focus on HIE and EMR integration, given ARRA/Meaningful Use. I thought one of the more novel concepts was Dell’s Business Process Outsourcing model to HIE/EMR. In the case of the HIE, communities continue to struggle with the establishment of the HIE, in particular the operating entity and relationships, as well as the business model. Putting it on a managed use model could be a game-changer for implementation. Similarly, in the case of the EMR, IT departments wrestle with building the infrastructure to support a full-scale implementation – particularly how to address the user management of the EMR. Adding support for physician offices adds a level of complexity that many IT organizations would rather not assume.
The concept of a managed service could simplify the implementation, management, and justification of both the HIE and EMR. Coupling Dell’s hardware solutions with Perot’s implementation and management expertise seems like a novel approach, and a winner!
HIE’s vs. Image Sharing
A growing number of companies are beginning to capitalize on the emergence of cloud storage and readily available internet connectivity for image sharing. It seems one of the first applications companies have gone after is the replacement of the use of CD’s for communicating image results. For example, a patient is referred to a specialist at a tertiary care facility, and is requested to bring along their imaging exam. Either the requesting facility or the patient ends up getting a CD with the study content, which then needs to be accessed by the specialist. Having evolved without a strict set of standards, there can be a multitude of different viewing protocols, and the data may or may not be stored on the CD in the industry-standard DICOM format. For large facilities, this can be a productivity bottleneck to capture all that CD data. Also, information on CD’s is like film – it’s difficult to simultaneously share with other specialists.
The emerging concept involves uploading the study to a cloud storage facility and then granting access to specific users. Access is accomplished via secure communication, usually over the internet (if users are remote). On the surface, this sounds like a sound concept, so the question is what’s wrong with it? I had several people suggest that perhaps it would be frivolous to invest in such a solution, given the advent of the HIE. In other words, why would I need it if the HIE could manage images and be directly accessible? Good point! It could be that prospective vendors see this application as the key to building the HIE imaging resource – sort of walk before you run. Perhaps they feel they can leverage their way into becoming the de facto HIE. Or, perhaps, as some vendors have stated as an initiative, to become the federalized HIE.
I think the larger established vendors may be able to sustain such arguments, but smaller vendors may be threatened. Realistically, this sounds like a defensive posture by certain vendors, as there are legitimate applications for image sharing. Food for thought, though.
Identifying Patient-Centric Studies
Imaging is rapidly moving beyond classic radiology and cardiology venues. As it does, vendors are wrestling with how to universally identify the patient study to an enterprise image repository. This is complicated by the fact that many imaging areas do not have the same information system application that radiology has. For example, say I have a camera-based application for dermatology and need to capture images for a specific patient. Short of typing the information in, there may not be an associated way to identify the patient. Manual entry will most likely lead to errors and mismatches. Radiology has the advantage of associating images with a study order using patient identification from the primary ADT application.
An interesting development in this area comes from Agfa Healthcare. Agfa has developed a way to enable the use of the EMR as the origin of the patient demographics, or “metadata.” As described, the imaging area would look up the patient in the EMR, input the images, select those they want, and complete the acquisition. The application would capture the demographics from the EMR and use them to populate the study metadata.