Executive Snapshot: Steve Fischer, CIO at Center for Diagnostic Imaging

The Center for Diagnostic Imaging (CDI), which operates 59 imaging centers in nine states, is custom-developing an electronic health record with Merge Healthcare, and hoping to be ready by October 2011 to start a 90-day meaningful use reporting period. Following is a Q&A with CIO Steve Fischer:

Question: The Center is custom-developing an EHR using baseline technology from its radiology information systems vendor, Merge Healthcare. Please explain this--is the organization building an EHR in-house on top of the RIS, or heavily customizing a third-party EHR that will integrate with the RIS, or doing something else?

Answer: Before meaningful use was on the scene, Merge provided the base product of our RIS system, but CDI had also enhanced the product in the areas of radiologist workspace, transcription/editing and mammography tracking. The RIS application contains the majority of the feature sets of an electronic health record system. However, it is missing functionality generally not associated with the practice of radiology.  So what CDI is doing is extending the functionality of the system to meet the EHR certification criteria such as: computer based pharmacy order entry; drug/drug interaction; structured recording of patient allergies, blood pressure and lab results; and expanded demographics such as preferred language and ethnicity.

Merge is now developing Merge RIS to qualify as a certified EHR. This includes significant development and the addition of new feature sets into its system. An example is the bundling of Surescripts' network for e-prescribing.  However, because CDI implemented extensions and feature sets into our existing RIS, we are unable to efficiently migrate to that RIS platform and simultaneously meet MU timelines.  Instead, CDI opted to work with Merge in a co-development relationship.  We are using a meaningful use software "bundle" from Merge and integrating it into our solution, as this is the most efficient way for us to meet the certification requirements. 

Question: How far along is the initiative and will you make the Oct. 3, 2011, deadline for eligible providers to begin a 90-day reporting period during 2011?

Answer: We are on a very tight schedule with an 80% probability we will make the October 3rd date.  The good news is if we miss it, we have until Oct 3, 2012, to attain certification without loss of incentive dollars.

Question: So far in this initiative, what has gone easier than expected?

Answer: The coordination between Merge and CDI has been remarkable. Merge provided CDI with a next release of our existing RIS that included the necessary application program interfaces for the CDI team to integrate the required functionality.  This release was clean and will be moved into production shortly.

Question: What has been more difficult than expected?

Answer: We didn't anticipate the need to be certified by Surescripts. This has pushed our certification date back by a month. We believe we face forthcoming difficulties as well, specifically the monitoring, care and maintenance of the capture and reporting of the necessary quality metrics. Our MU team is hard at work as they evaluate and plan for new operational procedures to streamline these processes.

Question: What question would you as a CIO want asked and what is the answer?

Answer: Soapbox time: Regulators in Washington need to understand that medical specialties such as urology, orthopedics, or radiology do not regularly use the feature sets mandated. So why force these practices to purchase products and disrupt their practices by installing feature sets that will not be used? At this time, it's unrealistic to expect any change to the regulation around this. My only hope is there is some additional effort to understand the unique needs of various providers and to consider these issues as Stage 2 and 3 reporting requirements are defined and finalized.