As the adoption of EHRs begins to plateau in terms of widespread acceptance, the imaging sector is ripe for innovation. Cybersecurity risks, the need for specialized workflows, and intelligent sharing of data (interoperability) remain moving targets on which the industry should focus to get the most value from an imaging solution.
Security
Cybersecurity continues to impact healthcare providers of all sizes and from all regions. The industry is trying to figure out how to secure personal health information while protecting against breaches. According to recent research on the topic, there is a high probability that almost any company can have a data breach in the next 24 months.1 As the costs associated with these incidents usually average about $4 million per data breach, providers can no longer ignore the risk of being connected to the outside world. Unfortunately, many organizations think that a “fortress mentality” will eliminate the need to prepare for a data breach. While prevention is essential, it is only a part of an adequate risk assessment and management strategy.
Identifying vulnerabilities goes hand in hand with quantifying their exploitability. Timely access to patient data is often a matter of life or death; therefore there is a fine balance between building strong data protection and “break-the-glass” access to critical data.
An organization’s culture is the most powerful weapon that can be leveraged to keep personal medical information secure and, at the same time, available. The necessary awareness and training needs to be a top priority to maintain so-called “essential” clinical performance without risking patient data. This is especially important when adopting any new storage technology, such as an image storage and sharing solution.
Workflow
A workflow that supports the access and sharing of medical images is different than what one might find elsewhere in a provider organization. Typically, hospitals and health systems implement a big EHR system into their organization and then roll out a general workflow tool to the clinical departments. It is possible to implement a simple workflow system that will manage the common workflows, but this might result in providers missing out on the expertise of unique departmental workflows.
Departments such as pharmacy, laboratory, and radiology all have different and very specific workflows. Providers are now realizing that they need to take a step back from the initial generic workflow implementation and re-evaluate what is needed to support departmental workflows. One example in radiology is the closed-loop communication of critical results. Emergency room (ER) physicians have become increasingly dependent on imaging to rapidly diagnose ER patients, and radiology departments are under greater pressure to prioritize reads, turn around reports, and keep patients moving in overcrowded conditions. Using a smart workflow engine will allow providers to better prioritize incoming results, and notify the care physicians about a diagnosis in a timelier manner. This is particularly valuable with stroke cases, as images from stroke cases should be read within 30 minutes. An intelligent workflow system would monitor this and, if the case had not been read within 15 minutes, all of the neuroradiologists on the team would receive an alert for an increased urgency of the case evaluation.
A workflow system that also monitors the outcome of diagnostic interpretations can even serve as an optimization tool by routing studies to the specialist who is most efficient in reading the specific type of exam and/or the specific clinical problem. Such a system would enable care teams to work more effectively across departmental boundaries and involve the right specialist at the right time. This way, radiology can also play a part in the revised workflow that is required for a provider’s transition to value-based care.
Interoperability
Properly integrating images within the EHR system, utilizing web-based access to medical images, and adopting a vendor-neutral archive will greatly reduce medical imaging silos and improve data sharing. But providers should not just throw technology in as a solution to achieve interoperability; this will not drive success by itself. Best practices for image exchange and sharing exist, but departments must demand technical platforms where interoperability is built-in by design rather than being an after-thought.
Simplifying the data-sharing environment makes data easier to secure. It also gives customers fewer vendors and systems and less hardware to manage, which results in a lower cost of ownership. But more importantly, as we move beyond the imaging department to the enterprise and even across the enterprise, imaging information becomes a precious source to derive medical insights and knowledge that help improve diagnostic precision. Imaging analytics and quantitative imaging are still new areas, but they are unlocking a potential and very different “value” of medical images.
As RSNA is just around the corner, it will be interesting to learn how the industry has evolved as it relates to these key issues. There will no doubt be progress, but there is still much more work to be done. As the industry shifts from volume to value, providers and vendors must brace themselves for more change and flexibility in order to pivot their data sharing, data security, and workflows in the coming year.
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