“Clinical imaging” used to mean whatever technologies radiology was using and some miscellaneous diagnostics a few other specialties implemented. That is not the case today. In fact, surveying a six-month swath of our network usage earlier this year – spanning 3 million images exchanged – neurology topped the list of specialties sharing clinical images, followed by surgery and internal medicine. Radiology still commands enough bandwidth to rank fourth out of a total of 57 specialties that use imaging in one way or another.
This year, federal health IT leaders and payers alike are incentivizing health data interoperability to eliminate unnecessary duplicate exams. Medical imaging exams are a big target, because MRIs and CT scans are costly, and the lack of interoperability is no longer an excuse to create another test and bill for it.
Integrating clinical images with the imaging report in the electronic medical record – enterprise-wide, and not just organic, peer-to-peer networks – has become the next emerging CIO project as the tenets of Meaningful Use and its successors move from the implementation of data systems to the flow of interoperable data to locations inside and outside the firewall. It’s outgrown the radiology department and its data farm.
Image exchange now the CIO’s implementation project
Hospital and health system CIOs are taking notice, as their informaticists in the different specialties tap them to organize and implement enterprise-grade image sharing. This either falls directly on the CIO or is a joint project of the CIO and radiology department, according to 86 percent of the respondents to a survey of 100 CIOs conducted by the College of Healthcare Information Executives (CHIME) and sponsored by lifeIMAGE.
Yet, only half the respondents indicated that clinical images can be exchanged between data systems and applications, indicating that enterprise imaging strategies are a work in progress for many hospitals and health systems.
Patients, providers, and payers may not understand how back-end systems support image exchange or even care about “interoperability” as a concept. However, they immediately understand the principle when they need it to work for seeking second opinions on diagnostics, getting referrals to specialists outside their usual physician network, or when they are shopping around for lower cost imaging tests at stand-alone imaging centers – especially when they can’t access an image or have to “sneakernet” CDs from one provider to another.
The hospital and health system finance department are more likely to take notice, too: One in three CIOs indicated their facility might be losing revenue because of image data interoperability challenges. How do they know? Overall, the survey responses tell the story of how payers are incentivizing interoperable health data through bundled payments and other programs that reward health providers who do not re-image patients when it is clinically unnecessary.
Enterprise architecture: Image exchange built to last
Overall, an enterprise imaging strategy moves beyond storage. It comprises the right tools for each “-ology” to do its work, interpretation, and review of images, with a user interface that gives them the quick access, resolution, and perspective covering the needs of those specialists on a given network.
Each hospital and health system has a different network topology, different clinical needs, and are all scaled to their particular patient base. But all successful imaging strategies have the following processes in common:
- Inventory all provider needs. Where are the specialists who read images? Radiology, cardiology, and oncology are the usual suspects for those, among others, and then emergency medicine, intensivists, and referring physicians. The latter groups might not need deep-featured imaging tools, but they still need access to images and the interpreting providers’ reports to make clinical care decisions.
- Give the experts their due. The IT staff, in the end, executes the solutions for clinical problems. Talk to the specialists who are using the imaging systems and tailor an enterprise-wide implementation that solves their specific problems so they can deliver better, more efficient care.
- Choose a hybrid network-and-cloud model. One side facilitates sharing within the network firewall, and the cloud component gives providers outside the firewall secure access to needed imaging studies. This enables physician collaboration outside of a network for referrals and second-opinion reviews.
- Select a partner with the most usable tools. Whatever technology vendor your organization selects, carefully choose the standard interface physicians will be using to interpret and review clinical images, and make sure not only that the correct features are built in, but that it’s intuitive to use in all of the clinical workflows. Usability isn’t a nice-to-have feature, it’s a got-to-have one.
- Roll out first to the specialties that need it most. Chances are, if IT staff has not set up a formal imaging workflow for emergency medicine and the stroke neurologists, those specialists probably have devised an ad-hoc workflow to share images. Clinicians for which treatment time is crucial will benefit the most.
Radiology no longer has the exclusive rights to imaging like it did in the 1990s with its locked-down PACS or telerad systems. But like cardiology, oncology, and the other imaging-intensive specialties, such as endoscopy, radiology remains a key entry point for images on a network. Orthopedics, pediatrics, oncology, cardiology, and urology also placed in the top 10 most image-intensive specialties during the period of network usage we examined earlier this year. Understanding this dynamic is a crucial facet of the enterprise imaging strategy. It’s incumbent upon IT to support medical imaging’s needs. But there is a shift where there are dozens more specialties whose imaging needs must be addressed, too.
