* At least two vendors, Merge Healthcare, Chicago, and Vital Images, Minnetonka, Minn., a Toshiba subsidiary, have introduced "zero footprint" Web-based viewers that can incorporate images from a picture archiving and communications system (PACS) directly into an inpatient or ambulatory EHR, or even a health information exchange, without using ActiveX controls or other performance-slowing plug-ins.
* VRad, Minneapolis, the largest teleradiology practice in the country, allows referring physicians to access the images in its PACS, and is developing a method of integrating those images into its client providers' EHR systems.
* This year's meeting of the Radiological Society of North America (happening at the end of the month in Chicago) will feature a demonstration of ImageShare, designed to be a HIPAA-compliant method of letting patients access their images and radiology reports from their providers' EHRs or PACS and forward them to members of their healthcare team.
Many providers are seeking tighter integration between their imaging information systems and their EHRs, so that physicians no longer have to log into a separate system to see images and can access them from the hospital, their offices, or their homes-or even on mobile devices.
Physician satisfaction
"Radiology integration with the EHR is a very important issue for our clinicians and their workflow," says Pat Johnston, vice president of EHR for Texas Health Resources, which owns or operates 16 acute-care hospitals in north central Texas.
"When they're integrated, they use the same database and there's no lag time, so we can save both time and money. It's a big satisfier for our physicians."
The organization is implementing image integration between its Fuji PACS and Epic Systems EHR. Physicians can click on a link and go directly to an image from within the EHR.
Johnston says the main challenge is to make sure both vendors are ready to exchange information using specific standards.
"If vendors aren't on the same timeline, it can take a long time," she says.
Next steps: Providing images on mobile devices and incorporating them into a planned health information exchange.
"That's when we'll really save time and money-when we can prevent duplication of procedures," Johnston says.
Increasingly, larger health systems are choosing to manage radiology information through their EHRs rather than their PACS if their EHR vendor offers the option of radiology functionality, says Ben Brown, general manager of imaging and medical equipment research at KLAS Research, Orem, Utah. "It's pretty clear that standalone radiology systems aren't a great business to be in," he adds.
For standalone hospitals or smaller systems where radiology groups carry more influence, KLAS's studies show that radiology information system functionality is likely to be provided by the PACS vendor.
Lee Memorial Health System, Fort Myers, Fla., is planning to replace both its EHR and its PACS with integration in mind, says CIO Mike Smith.
Two-sided coin
Balancing the needs of radiologists and referring physicians entails using radiology information system capabilities on both sides. "Many PACS don't have the role-based security you need for HIPAA, because they're designed for the radiologist rather than the referring physicians," he says.
"EHR-based systems tend to be very role-based and have great audit trails and good remote support tools. But those systems are not what the radiologists want-they're very focused and high-volume and they do nothing but read images all day. And some specialists, like surgeons, are somewhere in the middle."
Reliability worries
But Smith worries about system reliability. "With EHRs delivering near real-time information, if you have the PACS and the radiology modalities connected to the EHR, the expectation is that you're delivering those in real-time as well," he says.
"That implies that they have the same reliability that the EHR has and that's not necessarily the case. All of this connection to EHR is raising the bar for all components of the information delivery stream."
North Memorial Health Care, a 518-bed hospital in the Twin Cities suburb of Robbinsdale, Minn., has been testing VitreaView, from Vital Images, whose primary product is image analysis and management software that works with a variety of PACS and imaging equipment.
The new offering can pull images from any modality, displaying both DICOM and non-DICOM images (such as JPEG or MPEG files) within North Memorial's Epic Systems EHR, says Jeffrey Stai, North Memorial's enterprise PACS administrator. He appreciates that the viewer functions entirely within the patient's record, rather than opening a separate window.
"Almost every other image-viewing implementation I've seen pops up some other client," Stai says. The viewer was scheduled to go live this month.
Asking for tools
Stai says North Memorial's referring physicians have been asking for an image-viewing tool that can be used within its EHR.
As a Level 1 trauma center, the hospital routinely receives images from 10 to 15 other area hospitals, and also generates a relatively large number of images that community physicians need to access. "We could have connected them directly to the PACS, but we held off because we knew this other product was coming," he says.
The viewer will be able to take care of most physicians' needs and Stai says PACS support should become less expensive and time-consuming because only radiologists and cardiologists will need to access those systems directly.
VRad provides teleradiology services to 2,700 hospitals and reads more than 7 million studies per year, says Rick Jennings, chief technology officer.
Currently the company offers referring physicians access to both images and reports through the Web or a mobile application, and they can communicate with the reporting radiologist the same way.
