In my continuing saga of researching imaging’s impact on Meaningful Use, I wanted input from those that might be directly affected by ARRA/Meaningful Use. I reached out to several state and private HIE’s to get their perspective on imaging and the impact of ARRA/Meaningful Use.
Overall, I have to conclude that HIE’s are not focused on imaging – except as it pertains to results. This may be a function of priorities, and it is hard to argue with a strategy that emphasizes formation of a platform that supports all results including lab, radiology, cardiology, etc. In the case of most imaging services, the report still represents the legal document, so imaging in support of the report seems to be the rule of thumb.
Another key aspect of HIE’s current efforts seems to be decision support. A prime example comes from Devore Culver, Executive Director of HealthInfoNet, a non-profit HIE in the State of Maine. As Culver explained, there is significant cost savings associated with being able to query a database to determine if a type of test has already been performed, and is still within a valid time frame. If those results are readily accessible to the physician, they may be able to avoid repeating the exam, thereby generating a cost savings, estimated as a 13-20 percent redundancy. Similar sentiment was expressed by Mike Murphy, Director of Cattails Business Development at the Marshfield Clinic in Marshfield WI. The Marshfield Clinic has developed an EMR application (Cattails) that it markets to outside as well as inside physician services. Communication of aggregated results is critical to the success of their initiative, and is the value-add proposition.
The notion of the “value-add” proposition seems to be key to the question of the addition of image to both results communication, as well as other imaging applications. Mr. Culver was adamant that imaging offers good potential for expansion, but only if their users perceive added value to current applications. Maine has many rural areas that would benefit from improved image accessibility, but a key factor in their application is the necessary bandwidth for communication. Given the rural nature, many areas do not have sufficient bandwidth to support the value proposition for imaging. Similar sentiment was expressed by Perry Yastrov, Executive Director of the Arizona Medical Information Exchange, who believes that any HIE needs to generate value to exist.
In the case of The Marshfield Clinic, a separate Information Systems initiative has implemented a TeraMedica application for an Enterprise Image Archive. While separate from the Cattails application, Cattails does include an image viewing capability that supports image accessibility, thereby adding value to the Cattails application. A similar situation of an HIE with a separate initiative for imaging is Inland Northwest Health Services in Spokane, WA, according to Mike Smily, Senior Director of Information Resource Management. Inland’s HIE focus is on results delivery, but similar to The Marshfield Clinic, a separate initiative in Radiology provides access to images. The Philips Medical Systems supplied regional archive supports multiple PACS in the region, and provides a common image repository that can be accessed for image review.
A common thread throughout all of these examples is that the initial HIE effort is focused on results delivery, but the solutions support image access if imaging is available. Similarly, the imaging efforts seem to have evolved independently for other reasons, such as in the case of Inland, for radiologist image accessibility. The HIE initiatives emphasize “outside” image accessibility in support of results, while the imaging initiatives seem to support “inside” image access for diagnostic purposes. In those instances, there is value-add from the diagnostic perspective, but to date, less value has been placed on having image available for results. This seems counter to current ARRA/Meaningful Use definitions, and would suggest that it is diagnostic applications that provide sufficient value-add to warrant their development. Given that there may be more value-add to diagnostic applications, one wonders why Meaningful Use has not encompassed this aspect of imaging. What might be the value proposition for diagnostic imaging applications?
As previously described, a decision support system that reduces the need to repeat an exam could be extended to diagnostic imaging as well. If a patient has had a prior CT scan, and it falls within an appropriate time interval, could it result in the avoidance of another CT exam? Similarly, if an ER physician has access to prior imaging exams, might it expedite their diagnosis and avoid other exams? And, given a potential shortage of radiologists, might the ability to remotely access and read a radiographic exam both save costs and improve diagnostic quality?
So, what have I learned from my studies?
1. Current emphasis is directed at results accessibility, and there is high value derived from more timely access and potential cost reduction.
2. Current Meaningful Use definition emphasizes results accessibility to images, and not diagnostic use, and diagnostic applications have a tougher sell in terms of value-add.
3. From the diagnostic perspective, there is potential value-add opportunity associated with image accessibility.
4. Current ARRA/Meaningful Use efforts do not seem to take diagnostic imaging opportunities into account, and need to be reassessed based on the value-add they might provide.
I would welcome your perspective to the value-add preposition, and other examples of where imaging can be demonstrated to be of value to Meaningful Use. In subsequent blogs, I will delve into other aspects of how Meaningful Use could be enhanced.