Toward a Unified View

Nov. 1, 2008

Can the convergence of PACS with clinical systems accomplish true clinical data consolidation?

Today’s enterprise-based applications are dramatically changing the business of healthcare, from streamlining information flow to redefining how patients and healthcare organizations interact. The new technology spans basic business processes to the measurement of the quality of patient care provided. Since care is provided across multiple entities (e.g., hospitals, imaging centers, physician offices), what’s needed to make the delivery of care as efficient and effective as possible are healthcare information solutions that parallel each patient’s continuum of care.

Can the convergence of PACS with clinical systems accomplish true clinical data consolidation?

Today’s enterprise-based applications are dramatically changing the business of healthcare, from streamlining information flow to redefining how patients and healthcare organizations interact. The new technology spans basic business processes to the measurement of the quality of patient care provided. Since care is provided across multiple entities (e.g., hospitals, imaging centers, physician offices), what’s needed to make the delivery of care as efficient and effective as possible are healthcare information solutions that parallel each patient’s continuum of care.

Each patient’s condition dictates the path they follow and, at each step, care givers record critical clinical data. No matter where the patient ventures within the confines of the healthcare enterprise, clinicians need timely, accurate and credible information. The challenge for healthcare IT professionals is to identify the best ways to enter, manage, store and distribute this data, so that whether it’s needed by the GPs or the specialty services in ambulatory or acute care, the necessary information is readily available for critical decision making.

Historically, disparate systems have created an artificial barrier between the two spheres of ambulatory and acute care. The IT solutions typically are broken down by market vertical — ambulatory or acute — and then by segment; small, medium or large. Within these are niche services, clinical disciplines and departmental systems and solutions. Today, however, new ways exist that can bridge these two distinct data camps and simplify administration, improve the flow and accessibility of patient information, and maintain continuity of care to empower clinicians and patients by giving them more choices and greater access to clinical information.

Convergence

Though information systems traditionally have been closed, proprietary and difficult to administer, many of today’s solutions now leverage the Internet for its unique ability to transparently communicate across all boundaries, making the transformation easier for all parties involved — those implementing them and those using them. They are also more user friendly, enabling healthcare IT professionals to deploy applications that support a range of functionality. Patient care options can be entered, modified, canceled or discontinued all within a ubiquitous view supplying physicians with relevant clinical data at the point of care.

By image-enabling the EHR, PACS solutions have broken down barriers that existed between imaging specialists and clinicians. Imagine what could be accomplished if carried another step forward, linking disparate clinical data from across the enterprise to a unified view at the physician’s desktop via the EHR.

For example, one need only look as far as the picture archive and communication system (PACS) to achieve true clinical data consolidation and to leverage modern information management technologies. The convergence of PACS provides a foundation that goes beyond viewing, redundancy, business continuity computing, high availability and archiving of images. PACS also have become clinical data repositories with the capacity to archive, manage and distribute not only images but also audio and video, live images, structured/unstructured data, visible light (pictures) and native format files, such as Microsoft Word documents and Excel spreadsheets — all collectively referred to as “multimedia.” For healthcare facilities, the ability to manage multimedia, the associated results and clinical documentation, provides the necessary flexibility to use the PACS as the core data center for all clinical data.

While this may sound futuristic, in reality the day when a PACS can achieve this is not far off. Continuum-based patient management requires linking disparate systems and this linkage exists in PACS in the form of DICOM, a standard for digital imaging data transfer that is the foundation of many PACS solutions.

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Fujifilm Medical Systems PACS

Today’s PACS are department-centric, capable of bidirectional integration to feeder systems, and are driven by clinical systems that provide the PACS with orders that spark activity. PACS solutions for radiology have succeeded so well that the market is stable and is showing signs of saturation.

In the long run, however, more than just exchange of images between departments will be needed; the ability to manage data from all source systems across the healthcare enterprise also will be critical. While DICOM is the standard PACS conduit to manage images, to successfully distribute data elements across the globe and outside the healthcare industry itself other standards may be necessary. The answer is the Internet: Everyday we download a range of media; we fill our iPods with it, and we read articles that contain embedded multimedia, all from the Internet. So, while today’s PACS simply image-enable the electronic health record (EHR), tomorrow they could also consolidate clinical data and then share that data transparently to clinical information systems (CIS) across the enterprise.

Transformation

While PACS could be the future repository for consolidated clinical data, some requirements have yet to be defined. Currently, PACS solutions do not possess the tools for standardizing nomenclature from disparate systems and lack the capability to dynamically link exams within an episode of care. Until now, PACS solutions were not considered to be clinical-based but, instead, a technical component of a larger CIS. However, healthcare enterprises need critical clinical multimedia data to be kept safe and stored in a logical context that can be queried or retrieved to assist clinicians and administrators in making key decisions. PACS solutions can meet this need, because they utilize technologies specifically designed for complex data management, storage and distribution.

By image-enabling the EHR, PACS solutions have broken down barriers that existed between imaging specialists and clinicians. Imagine what could be accomplished if carried another step forward, linking disparate clinical data from across the enterprise to a unified view at the physician’s desktop via the EHR. In a sense, PACS would make a healthcare organization’s EHR investment more valuable. The future has yet to arrive, though, and interoperability is needed now more than ever.

Continuum

The healthcare industry juggles a plethora of standards developed by multiple organizations that were born out of challenges to integration, interoperability and transparency. Leveraging existing solutions to provide clinicians with a clearer view of a patient’s continuity of care remains an ocean of opportunity, thanks to the complexity of moving data from one disparate system to the next following the healthcare continuum.

As exciting and productive as today’s solutions and applications are, they’re only the first wave of a revolution in healthcare IT that promises to drive levels of care, efficiency and access to new heights, while freeing healthcare professionals to focus on their craft, their patients and their passion.

One path to the next level in healthcare IT could very well be based on today’s PACS. If, by looking beyond the walls of departments and clinical disciplines to, instead, the entire healthcare enterprise, PACS could be extended to manage complex data elements and very well might hold the key to clinical data consolidation.

Rex Osborn is manager, Strategic Planning, FUJIFILM Medical Systems USA. Contact him at [email protected].

Building a Unified View

Consolidating storage in a healthcare enterprise lowers the total costs of ownership and provides a single manageable conduit for data aggregation and mining operations. However, administrators lack effective tools to manage cost accounting, let alone the ability to view their enterprise and verify efficiencies that quantify the quality of patient care being provided.

Coupled with the need to monitor specialty systems that may not be integrated with the enterprise, the result is an incredibly burdened healthcare IT team.

In the PACS arena, the Integrating the Healthcare Enterprise (IHE) initiative is a consortium of radiology and IT experts that has developed communication and interoperability standards for radiology, cardiology, ophthalmology, pathology, laboratory, radiation oncology and patient care devices (monitors).

Efforts are on-going and the results are debatable; however, both organizations should be cornerstones to improving interoperability and communications because the ability to exchange data across disparate systems is a prerequisite to transparency.

 

Removing Barriers

The electronic medical record (EMR), electronic health record (EHR), the lifetime health record (LHR) and the continuity of care record (CCR) are ideas predicated upon the storage, management and communication of patient data. They require standards (both IT and medical) as well as a framework of interoperable and transparent operations that would allow for a unified view of a patient’s record, and perhaps someday a universal health record (UHR), where patients could go anywhere in the U.S. and their medical data would be available to caregivers should the need arise. There is also the personal health record (PHR) — designed for patients and managed by patients — and yet another key component needed for a true UHR. The unification of data can only be achieved with consolidation of clinical data from the source systems that feed these records; and yet today, by many accounts, a unified view cannot be achieved.

Today’s systems do offer much improved communication; however, if we created an infrastructure that fed data from disparate systems to a single location we would, in effect, be creating a redundant system that would receive data as well as provide it. This data would initially be catalogued and marked as being received from a valid source system. It would be associated with a patient by using an Enterprise Master Patient Index, and would resolve any issues with multiple patient identification domains (different medical record numbers). The patient data would be managed in a relational database that would track it from its point of origin and record its type. Then, the nomenclature or medical vocabulary could be standardized to allow disparate systems to communicate through a single conduit.

This is where and when clinical data consolidation takes place. First, categorizing the data and linking the data to a patient (and perhaps in some cases an episode of care); then, confirming the source system’s data and maintaining the integrity of that data by standardizing the terms, so that the data can be shared. Existing systems would require a tool to communicate bidirectionally with an archived master clinical data repository. Theoretically, this would eliminate the barriers between Ambulatory and Acute by creating an infrastructure where data is collected and distributed, rather than by direct integrations between multiple interface engines and point-to-point interfaces that are challenged by real time transactions.

Imagine the value of a unified view of all relevant clinical data coupled with images, flow sheets, formularies and existing protocols. GPs and ambulatory care providers could actually work in unison with acute care providers, with all attributes of that care available via passive or active communications with the clinical data consolidator. The value of having dynamic critical image data and live audio and video, is what the Institute of Medicine envisioned when they introduced the concept of a multimedia enabled EMR in 1996.

Why Centralize Data?

Direct operational savings could be achieved through centralizing and optimizing the management of enterprise clinical and administrative data storage and reporting. What the market is only starting to realize, however, is the importance of the mid- and long-term benefits of implementing an enterprise-aware archive and data warehouse strategy.

Data aggregation can only become a reality when a unified medical language can translate disparate system data output to a common nomenclature. This nomenclature would allow data warehousing, data aggregation and would improve research data access and reporting, promoting continuity of care and solidifying the organization’s core IT investment. Integrating data on a patient-centric basis can constitute a sure first-step towards developing a comprehensive EHR and ultimately improving the efficiency and quality of patient care.

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