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For nearly four years, physicians at George Washington University Medical Associates, a 300-member multi-specialty group practice in Washington, D.C., have had access to some diagnostic imaging examinations from their electronic health records system. The project, using Web portal technology to connect radiology systems with the EHR, was done with the help of a consultant and took just two days.

Available in the EHR from Chicago-based Allscripts are images from ultrasounds and echocardiograms, which are videos of a functioning heart. The practice, for instance, uses the Heartlab cardiology system of Agfa Healthcare, Greenville, S.C., which houses echocardiograms. Both the EHR and cardiology system support Web portal access, what CIO Praveen Toteja calls the ability of a system to make an external call.

Allscripts' access function, called Image Link, enables a physician to click on an icon that opens a portal to Heartlab to view a specific study. "Any system that has Web portal access can be used to access any report, as long as there is a way identify the study, such as a session number," Toteja explains. Similarly, ultrasound images are saved as PDF documents and attached to reports, accessed via ImageLink in the EHR.

Access to the ultrasound images was a hit when the feature went live this past spring. While OB/GYN specialists always had access, there was a big "Wow!" effect with other physicians who previously could not view the reports and images from the EHR, Toteja recalls. "Primary care physicians could show the images and discuss them with patients on their next visit. I didn't know things like this make doctors happy."

Physicians at George Washington University Medical Associates also have access to nuclear camera images via a separate, manual process. The camera doesn't have portal capability, so snap shots of images are saved to a folder in the EHR. The folder and report are presented as attachments when a physician goes into the documents module of a patient's chart.

Asked if these low-tech initiatives are "true" integration, Toteja replies, "As good as we feel about the integration we've done, there is much work remaining."

He'd really like to see hospitals make it easy for local physicians to connect to their picture archiving and communication systems, "but the hospitals don't see it as a priority."

Technology that Allscripts is developing might offer enhanced integration for the group practice because it could serve as a viewer for all types of images, Toteja says. It will enable image access via any computing device, at little expense, the company has told Toteja.

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