Moving Forward on Image-Sharing in Colorado—CORHIO’s New Thrust

Sept. 22, 2014
The Colorado Regional Health Information Organization (CORHIO) has been moving forward on numerous fronts, including with regard to building a statewide platform for diagnostic image-sharing

The Colorado Regional Health Information Organization (CORHIO) has been moving forward on numerous fronts. Already, more than 1,900 office-based providers, 47 hospitals, and 126 long-term and post-acute care facilities are now connected to each other  via the Denver-based health information exchange (HIE).

What’s more, CORHIO was one of 16 HIEs in the Midwest and Rocky Mountain States announcing in February that they were coming together as the Mid-States Consortium of Health Information Organizations.

As the Feb. 19 press release noted, “A key premise in the establishment of the Mid-States Consortium of HIOs [health information organizations] is that critical health information must be available to physicians and other healthcare providers at the point of care, regardless of the location where a patient needs care.” And in that collaboration, CORHIO has been a key player. Indeed, Jeff Messer, director of outreach and development for CORHIO, said in a statement in the press release, “The members of the Mid-States Consortium are committed to addressing the most difficult data exchange issues confronting health information organizations today.”

Back in Colorado, CORHIO leaders continue to move forward in their core work, including work to go live with the sharing of diagnostic images across the HIE. In this, they have been partnering with professionals at the Atlanta-based GNAX Health, to facilitate diagnostic image exchange. Recently, Brian Braun, CORHIO’s chief financial officer and corporate operations officer, spoke with HCI Editor-in-Chief Mark Hagland regarding the progress being made at CORHIO on a number of fronts. Below are excerpts from that interview.

What’s the latest in terms of the reach of CORHIO’s activities?

Right now, we have 47 hospitals that are part of the network; a little over 1,900 office-based providers associated with hospitals; about 126 long-term care facilities connected to our network; and about 3.2 million unique patients’ data is in the HIE.

Brian Braun

How long has CORHIO now been live and operating?

We started in full force started in 2010. As far as connecting, we started connecting in 2011.

What kind of volume of data exchange are you at now?

Since 2011, over 125 million messages have been exchanged. That encompasses ADT messages, lab reports, radiology reports, transcribed notes, anything.

Are you live yet with diagnostic images?

We’re not live quite yet. Of course, we get the radiology reports and the study numbers, but our goal was to connect radiology reports and images, and allow physicians to stay within their workflow and click on a link in GNAX. That’s the project we’ve been working on with GNAX. We are finalizing the technological structure for that. Our vendor is [the Salt Lake City-based] Medicity, and Medicity is working on the technical solution for that, so it’s in process.

How long will the process have been for bringing this live?

We started on this probably last summer; and in terms of imaging, the imaging project was just getting kicked off. And GNAX has started putting images into the VNA [vendor-neutral archive] that are accessible for exchange and sharing. No sharing is going on yet.

When will the sharing begin?

Our goal is to be up and running on the actual sharing, where an office-based provider can basically link to an image in the VNA, based on a radiology report that we’re already sharing from the hospital, by late this summer. That’s the solution we’re working on for late summer.

So, this is complicated?

Yes, definitely. We did some high-level architecture work with Medicity and GNAX last summer; but we put it on the back burner a bit until GNAX got live on images in the VNA, but they had images flowing into the VNA by January of this year.

What are the challenges involved in creating links like this?

That’s a good question. We have a community health record through Medicity; and like any software platform, it requires special linkages. So building that link into the platform so there can be a call-up to an image repository and a viewer, that’s the challenge. It’s not highly technical, but it requires workflow work with teams. Technically, it’s very feasible; the real challenge is the project management element in this, getting this built into a platform, that’s always a bigger project.

What have the preliminary learnings been so far around how one optimizes the sharing of images?

Part of it is getting both technical teams from both organizations—in this case, Medicity and GNAX, plus us as the managing this—so it’s really four teams involved—Medicity, GNAX, CORHIO, and the Colorado Telehealth Network—it’s really about getting all the people concerned in the same place, and talking together. And there’s nothing earth-shattering about that, is there? Also, getting the technical teams to get a grip on what needs to happen. And I believe that the key to all this is making it easy for that provider, the end-user, to do this, so they don’t have to go to a separate system, so it stays within their workflow—that’s the essence of it. And what we’re trying to do is to leverage our infrastructures.

So leveraging our HIE’s connectivity with the providers, and allowing the VNA to connect those images themselves. So we had to figure out, do you create a separate image-sharing portal for this, or do you leverage an existing sharing mechanism, the HIE, versus creating a new portal. And we decided to leverage the HIE for sharing these images to providers.

In other words, you don’t want to create separate mechanisms or platforms, if it’s not necessary?

Yes, that’s right.

Could the mechanisms of the Direct program help at all?

We support the Direct program here, too, though our main way of sharing information is a query-based, community health-based mechanism. Because of that desire to tie an image to a patient’s record and indeed community health record, it was more efficient for us in utilizing that query-based community health record in exchange for calling up those images. Is there a use case for Direct here? There possibly is, when a hospital wants to send an image or a link directly to a provider, there’s certainly a possible use for that; but for our situation, it was best utilize our query-based, community health record-based methodology. And there are good use cases for Direct, and maybe some not-so-good use cases for it, but that’s a different discussion.

What will happen in the next year?

What we’d like to see happen is that, a year from now, we will have that linkage between a patient’s radiology report that’s in the HIE—have a linkage between that report and the actual image itself, so they’ll be able to call up that image and view it through the GNAX image viewer, with diagnostic-quality viewing, as opposed to just a PDF reference image. That’s the big picture, and that’s where we’d like to be in a year from now. And that would be for any image in the VNA collected by GNAX for the Colorado Telehealth Network [CTN]. And until all the images are in the VNA from all the hospitals and imaging centers, there will still be reports out there that won’t yet have images to call up. That’s going to take time, and that’s more on the Colorado Telehealth Network’s side.

What is your relationship with CTN?

They’re a separate not-for-profit organization; we work closely together. They provide the structural basis, as far as the infrastructure—the pipeline for data. And they’re also the lead on this VNA storage for hospitals. That’s a side-product of the Colorado Telehealth Network. They’re the ones working directly with GNAX.

Is there anything else you’d like to add that our readers should understand?

The key for us, as an HIE, and probably for a lot of HIEs at this point, is really getting that data-sharing with the providers moving, and making it as easy as possible and integrating it into their workflow. That’s our overriding purpose at CORHIO.

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