Commentary: With increasing awareness of dangers from excessive radiation exposure and a movement to penalize providers for duplicate tests, chances are your healthcare system will need support to bridge interoperability gaps between electronic medical records and external sources of imaging data.
That’s where clinical image sharing platforms can help: Providing that “last mile” of interoperability for outside exams, and helping create tighter integration for imaging within a health system’s divergent data systems so all physicians can quickly access the studies required to complete their work.
It’s not just for radiology, either: Oncology, Emergency Medicine, Cardiology, Endocrinology, Burn/Wound Care and Neurology are just a few of the specialties whose data footprints probably rival radiology’s on your network. The main difference between radiology and many other specialties is that radiology looks back, comparing current images and videos to priors, to get a read on disease progression; many other “ologies” look forward, examining current images in order to create referrals.
Considerations for implementing an imaging interoperability platform
In our nearly 10 years in healthcare, we have observed the evolution of EMRs and have served healthcare systems of all sizes. The kinds of considerations CIOs need to account for in implementing an imaging interoperability platform might not be obvious up front. But here are three elements that successful implementations have in common:
1. Get the clinical users involved. Radiology does not have a monopoly on imaging; in most health systems there are numerous image-intensive specialties. At the minimum, get Cardiology, Oncology and Neurology involved in the decision-making process, in conjunction with Radiology. Understand their needs, their pain points and what they wish they could be doing better for patients.
2. Use a skilled project manager. This person will oversee both technical and clinical workflows, and will need access to a variety of departments to plug your healthcare system into an imaging platform. Integration will not happen in a vacuum, and it will be tighter and more effectively executed when there’s a single point person coordinating the various clinical specialties, IT teams, compliance and training.
3. Plan for the future. Image sharing is moving through “crawl-walk-run” stages. Standards are evolving, and although imaging is a few years ahead of the Office of the National Coordinator for Health IT’s 10-year interoperability roadmap for EHR data, there are still evolving standards that will make image sharing more seamless and alert-based over time. Getting rid of CD-burners and films and allowing physicians to send imaging back and forth in the equivalent of unsearchable PDFs was the “crawl” stage. “Walking” is now, where we’re implementing EHR integrations, and outside imaging and accompanying data is more actionable. The future “run stage” is an intelligent network that will detect a patient’s new imaging study and alert the appropriate caregivers that it is available for viewing. Ask prospective vendors how they are planning for this future state of clinical imaging network-to-network automation. If they’re not ready, you might be investing and wasting your implementation efforts in an interim, “throwaway” platform forcing you to start over in a few years.
Finally, in every aspect of a purchasing decision, keep the patient in mind. Understand that the technology and workflows you’re setting up have an end-goal of bringing in outside imaging studies for your physicians and letting patients have access to their data away from your network. Doing less than this will risk a future where patients receive their care from more responsive providers.
Next steps after vendor selection
The unfortunate fact is that tight imaging integrations take three to six months for most providers – even those on leading EHR systems such as Epic and Cerner. The state of technology and the development of interoperability will greatly reduce in the future, but at this point integrations take time, regardless of what a sales rep promises you.
What is your vendor doing in those months before go-live? A major piece of integration is getting practitioners authenticated to keep HIPAA logging and tracking in line with a provider’s current setup. There’s also the process of aligning medical record numbers and demographics data between systems. All are necessary steps to meet your workflow needs, patient concerns, and regulatory requirements.
Another part of plugging into an image sharing network is setting up new workflows and training staffers. While these systems typically offer a variety of configuration options to accommodate custom workflows, image sharing introduces new processes for employees. Thankfully, sticky notes, imaging CDs and faxes disappear as utilization of the system expands.
Finally, look at costs in several ways. There are up-front capital costs to setting up a network, ongoing costs related to maintenance and, typically, some cloud storage costs. Think about opportunity costs, too. If an imaging platform is more tuned for radiology, will that negatively affect cardiology referrals because it doesn’t work with those practitioners as well as it does with radiology?
Implementing an imaging interoperability platform has a great many benefits and aligns your practice with the future. While corporate strategies may differ across health systems, the market demand is to require that image data be universally accessible. It supports increased quality of care, adds to HIPAA compliance by opening health data access, satisfies payer mandates and along the way saves costs for the payer, provider and ultimately, the patient.
Given our complex health system, the journey to image interoperability takes dedicated time and collaboration to be successful. The end result will elevate the role of radiology and enables a cultural shift toward more consultative, collaborative care among clinical specialties.
Matthew A. Michela is President & CEO of lifeIMAGE, which offers a platform for secure exchange of medical images and related reports.
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