As the power of information technology expands, the healthcare system has begun to shrink. Integrated IT systems are allowing providers to communicate across an enterprise like never before.
Nowhere is this more true than in medical imaging. Radiology is, of course, traditionally thought of as the generator of life-saving diagnostic imaging, but departments across the enterprise have been capturing visual data for years. Now, these various imaging silos are starting to come together as the concept of enterprise imaging becomes more widely understood and valued.
Enterprise imaging deals with the storage, management and viewing of all imaging—DICOM or otherwise—across all departments. From traditional high-end imaging hubs like radiology and cardiology to dermatology, pathology, surgery, the ED and more.
Providers should take notice. An enterprise imaging strategy can generate value by bridging the gaps in the care continuum, creating a ladder up from an individual department and connecting physicians across a health system—and beyond.
Here are six use cases for enterprise imaging that can be implemented today:
1. Engage Patients
Patients want control of their health data. When it comes to images, they want to be able to share them with their loved ones and with the provider of their choice. An image-enabled patient portal can increase usage and value.
Surveys have shown that patients place a high value on such capabilities. A poll conducted in 2013 by international marketing consultancy IDR Medical, on behalf of Carestream Health, asked 1,000 patients about their preferences regarding obtaining images.
More than 86 percent said they want access to both their images and the written report via an online portal, with nearly half wanting immediate access even if they would receive the imaging before their physician. The most common advantages, in the eyes of these patients, include the ability to easily share and maintain their imaging history, improved quality of care and avoidance of repeat imaging. Security was the common concern.
It would keep patients coming back, too. Nearly four out of five patients surveyed said they would return to a facility for future imaging if they offered a patient portal.
Real-world tests have shown portals deliver on their promises. Carestream’s MyVue patient portal was deployed in Ferrara, Italy and found a portal enhanced the relationship between patient and provider, with patients reporting the technology was easy to use and understand.
“The most significant outcome was that more than 98 percent of the patients who participated in the early trial were so enthusiastic about the product that they decided to continue using it in the future,” says Giorgio Benea, MD, radiologist at Delta Hospital in Ferrara.
“On one hand, we have been given the possibility of making the diagnostic medical imaging pathway more efficient in our radiology department. While on the other, we have the potential for some extremely significant advantages for our patients.”
Similar success was seen at Houston Medical Imaging (HMI) when a private radiology practice that reports over 300,000 procedures annually launched the MyVue portal in 2012. After implementing the portal, more than half of incoming patients signed up and were active in using the application to download or share their images.
The practice estimates that the portal could wind up saving HMI nearly $15,000 per year by using electronic transfer of images in lieu of burning and shipping CDs. There was also hardly any additional burden to HMI’s IT department in terms of assisting patients with the portal: in the first three months after implementation, despite more than 2,600 patients registering on the application, the IT department received just 47 phone calls asking for assistance, the majority of which were simple password resets.
2. Improve Department Workflow
The first thing that comes to mind when thinking about medical imaging is probably x-ray, CT or MRI. True, these workhorse modalities capturing images in standardized DICOM format are the backbone of the radiology department, but across an enterprise, other image formats may, in fact, be more numerous.
Take the case of Reggio Emilia Hospital. In recent years it began efforts to centralize information management, yet when it came to imaging, they realized that across the facility, less than 50,000 images per year were DICOM while more than 160,000 were other formats that are not DICOM standard.
“What we realized at the end of the exercise was that up to 79 percent of our non-DICOM images were not properly or securely archived. This meant that they were not necessarily part of the full patient clinical portfolio,” says Marco Foracchia, PhD, IT Medical Systems Manager at Reggio Emilia.
In the fall of 2013, Reggio Emilia integrated the Carestream Vue Archive as their clinical data repository. The hospital began the project in endoscopy because of the department’s high clinical value and significant volume endoscopy videos which averages 10MB/minute, though these exams were previously only stored on the equipment in the department itself.
“Enterprise distribution is a huge challenge here,” says Romano Sassatelli, MD, Director of Gastroenterology and the Digestive Endoscopy Unit. “Having concurrent image access with report distribution is providing physicians the relevant clinical evidence they need for diagnosis.”
A robust enterprise imaging strategy can also impact billing. Order-based imaging in radiology is much easier to track and bill for, though other types of imaging, such as visible light photography from wound care or surgery, is encounter-based and more difficult to account for without being able to integrate into a wider enterprise system.
3. Image enabled EMR
The EMR has changed the practice of healthcare, but up till now, it’s lacked a key component: images.
“The EMR handles text data really well, but it does not know how to handle diagnostic images very well. It’s not a medical image management system,” says Paul G. Nagy, PhD, Co-Director of the Johns Hopkins Medicine Technology Innovation Center and Associate Professor of Radiology.
The game is changing with the concept of the image-enabled EMR. This means that anyone logging into the EMR can see that an imaging procedure was done for a patient, read the report and be able to launch some form of viewer embedded within the EMR to actually view the images themselves.
Embedding the viewer within the EMR benefits the user, who does not have to quit the application they are using to see images. Web-based HTML 5 viewers that are truly zero-footprint are not confined to a single system or facility, and are compatible with Windows or Mac platforms. By leveraging the viewer to pull data from PACS, VNA, or XDS repositories and other archives to be displayed without leaving the EMR, referring physicians gain quick access to important data.
Nagy says he has seen providers using innovative vendor solutions to take mobile based visual light photos from their smartphones. “You need to ensure security and data integrity when using a phone to take a photo of a patient” says Nagy. This can be done utilizing technologies such as Quick Response (QR) codes that can integrate with an EMR and apps that ensure no photos remain on the phone and are encrypted during transmission. This creative use of IT can bring added efficiency and improve care while ensuring patient privacy.
Another site that saw productivity and clinical quality benefits from viewer consolidation is Spire Healthcare, a 37-hospital private system in the U.K. Spire enabled viewing from standard workstations and mobile devices across a multi-PACS vendor environment using a zero-download clinical viewer that leverages this concept of neutrality.
“We were aware of the importance of unifying clinical viewing to improve physician productivity and differentiate our services from those of our competitors,” says Stephen Hayward, IT Director at Spire Healthcare. “We constantly look at how we can use technology to provide a better service to both patients and physicians.”
Spire’s new clinical viewer allows radiologists to discuss findings with offsite clinicians in real-time with everyone viewing the images simultaneously. Preliminary reports can be given from any location, giving clinicians a precious head start on treatment.
“The fact that this works across different platforms is a great advantage, as many of our physicians work at multiple sites,” says Andrew Milne, Imaging Manager at Spire Hartswood Hospital. “Our unified clinical viewing solution enables physicians to access needed information from any Spire hospital.”
4. Connect Disparate Image Archives with VNA
Integrating an enterprise comes with a host of interoperability challenges, which is why many sites are looking to a vendor neutral archive (VNA) as a storage and workflow solution.
A VNA stores data in standards-based, interchangeable formats in order to integrate with other systems across the enterprise. As providers set their sights on an enterprise imaging strategy, the large storage requirements dictated by the addition of DICOM images, videos, photos, PDFs, and other data must be satisfied with robust enterprise storage.
Among the great benefits of a VNA is the reduction in costs and demands upon system admins that comes with consolidation. Reducing the number of clinical storage systems simplifies future expansions and is a boon to disaster recovery plans. It also opens up the possibility of leveraging cloud-based infrastructure for further cost savings and management benefits. In the case of Andalusian Health Service (SAS) in Spain, the enterprise imaging platform has resulted in savings of €1.58M during the first 15 months of the project. In addition the platform has improved access to clinical data for 16,000 physicians in its 80 hospital network.
5. Expand Remote Care
Telemedicine is another trending topic in healthcare, and an enterprise imaging strategy that allows remote digital access to clinical data has benefits for both patients and providers.
Back at Reggio Emilia Hospital, quality of care was improved at outpatient environments once they were integrated into the clinical repository. The Epilepsy Center at the hospital, for example, cares for roughly 800 patients who need recurrent EEG examinations. While each exam is performed at the hospital, non-critical cases could be followed up at satellite centers in the surrounding area as EEG data could be easily shared from the main center. This reduced the need for patient transport by having patients follow up at a location more convenient for patients. The staff also saw a reduction in wait times at the main center allowing more patient treatment time.
In trauma situations, providers could leverage such technology by having paramedics send images from mobile devices while still on the way to the hospital. Or providers can expand its dermatology practice whereby a patient can be seen at a remote site while clinical data is transferred digitally to the specialist at a main hospital prior to patient taking a potentially long and un-necessary trip.
6. Health Information Exchange (HIE)
Even as providers work to connect departments across a single enterprise, the future of healthcare will involve wider exchange of data between health systems using an HIE. Fortunately, an enterprise imaging strategy using standards-based workflows can be a stepping stone to HIE integration.
What are the benefits of HIE? In addition to improving care by allowing patient data to more easily be shared among providers, the providers themselves—and healthcare in general—could see a great benefit in terms of cost savings.
Take a recent study out of the University of Michigan, published in the journal Medical Care, that determined adoption of HIE is associated with a decrease in repeat imaging in EDs. Authors Eric J. Lammers, PhD, and colleagues looked at data from early adopters of HIE in California and Florida that compared 37 HIE-affiliated EDs with 410 unaffiliated EDs.
When patients had visits at two unaffiliated hospitals that took part in an HIE, they were 59 percent less likely to have a redundant CT scan, 44 percent less likely to get a duplicate ultrasound and 67 percent less likely to undergo duplicate chest x-ray.
Lammers and colleagues suggested that if all hospital-based EDs in California and Florida participated in HIE, it would result in nearly $3 million in annual savings from potentially unnecessary ED ultrasounds, chest x-rays and CT scans. Many more savings could come from sharing of data from other places across the enterprise.
Most recently the Shared Regional Medical Imaging Services (S-PRIM) project in the Île-de-France region is implementing a cloud-based shared medical imaging and treatment framework that will maintain unique patient folders at the regional hospital level, adding the ability to create treatment plans and share them across specialties and the capacity to share imaging results with referring doctors and patients. 39 organizations, which manage 19 percent of the patient population in France, will first migrate 10 million archived exams to the new framework, and 2 million more exams are expected to be added each year to the cloud infrastructure.
An eye on the future
These six use cases merely scratch the surface of what can be achieved with an enterprise imaging strategy. Analytics and business intelligence insights could be gained from being able to more easily track image-based data. High-risk patient groups can be identified based on this information, with more proactive population management strategies being implemented to tackle chronic disease.
One thing is clear: the era of thinking about individual departments is over, and the big picture view of the enterprise is here to stay in health IT.