LIVE FROM RSNA: The Journey Towards Enterprise-Wide Image Management--and Beyond

The Denver-based Centura Health was formed in 1996 as a management company, bringing together two different Denver-based healthcare organizations; since then, it has grown to become the largest healthcare provider in Colorado, with 15 hospitals and 150 care locations across the Front Range region of the state. It is now expanding into western Kansas as well. Centura Health is an integrated health system with $3 billion in annual gross revenues, 16,000 staff, and about 1,300 beds across its 15 hospitals. It has a corporate IT team of 220 FTEs. Frank Biondolillo, chief technology officer of Centura, sat down during RSNA 2013 at the McCormick Place Convention Center, to discuss with HCI Editor-in-Chief Mark Hagland his organization’s journey around enterprise image management and its participation in the Colorado Telehealth Network and its imaging informatics component, the Colorado Image Exchange. Below are excerpts from that interview.

Tell me about Centura’s journey around diagnostic images and imaging informatics.

Everything that we’ve tried to do has been built around Meditech and Fuji Synpase. As a PACS [picture archiving and communications] system, Fuji Synapse was in there first, and everything has been enterprise-wide. And at any Centura facility, you can get to any image or any medical record. The technology has probably been the easier part; the standardization has been the harder part. The real driver has been our ability to bring the stakeholders together, through steering committees, composed of pharmacy directors, lab directors, imaging directors, everyone who represents stakeholder groups affected by this work. They’ve really steered where us forward in our progress. In fact, doing a lot of this IT work has helped Centura coalesce culturally as a system.

Frank Biondolillo

So what’s happened?

All of our hospitals are HIMSS Stage 6 [according to the electronic health record [EHR] development schematic from HIMSS Analytics, a division of the Chicago-based Health Information and Management Systems Society]; and we now have four hospitals that are HIMSS Stage 7. And we’re documenting the data to show that they’re stage 7-ready. So we’re standardized, and the HIMSS folks came in and did the survey, and awarded Stage 7 status to our first hospital, Mercy Medical Center in Durango, about four months ago.

In terms of the infrastructure you have around image management, do you have a vendor-neutral archive?

Yes, we’re currently implementing a VNA right now, and we’re beginning by implementing that with McKesson Horizon Cardiology. And we felt that was an easy way to move into a VNA. The first pilot site is going live December 19. And they’re doing the end-to-end testing this week.

 And what other elements are involved?

So Fuji Synpase is the most mature that we have; McKesson Horizon Cardiology is next. Where we go after that is going to be very interesting. We have a hybrid configuration with [the Atlanta-based] GNAX; we have our local VNA, and a backup copy, the secondary copy, in the cloud, with GNAX. Not only does that serve as our backup VNA, but also as our participation in the Colorado Image Exchange, which is one part of the Colorado Telehealth Network. When that network was formed five years ago, it received FCC [Federal Communications Commission] funding, and there was the opportunity to bring in rural healthcare organizations, and connect them to the metro providers through a network; a lot of those rural facilities did not have the money for high-speed connections, and the funding helped create those connections.

How long has the Colorado Telehealth Network been live?

About three years. And we’ve been participating those three years. But adoption takes a while. A lot of these smaller organizations not only use it to connect to larger providers, but it’s also their Internet connection as well. When CTN was built, there really wasn’t a plan for sustainability. The imaging exchange was considered one of those ways they could bring in revenue. There’s a portion of that that can now go to CTN. The operating model is a per-study-based subscription fee model.

And the VNA will be increasingly important, as you add in images from more disciplines beyond radiology and cardiology, such as dermatology, pathology, and gastroenterology, correct?

Yes. As we get more and more PACS systems for the various disciplines, how are we going to handle all of those? You can’t afford to have all those PACS systems so disconnected. A certain amount of data/images will always be stored on fast disk for a particular PACS system, but the archive is important. And in terms of our participation at the statewide level, if we can reduce the number of exams statewide, that’s where the value is. It helps to reduce the cost of healthcare and to provide better care for the patient, and then that radiologist has the priors.

In terms of the Colorado Image Exchange, what is live now, at Centura Health?

Our cardiology images are going live this month on CIE. Next budget year, it will be radiology images. It made sense for us to go live first with cardiology images; that area wasn’t as gigantic as radiology. We do a million studies per year between radiology and cardiology; cardiology represents only about 50,000 of those.

Will this image-enable Meditech as well?

We’ve always had a URL within Meditech for images, so that that URL opens the Synapse viewer. In the long run, we’ll replace that with the GNAX universal viewer, so one day, when everything is in the VNA, everyone will be using the universal viewer to view images, from all –ologies. That will take a few years. There are budget issues, and you have to time it, and watch other partners in the metro area, and see what their strategy is. You don’t want to dump a million images in there and then wait for everyone else. We don’t want to compete at the technology level.

What lessons have been learned so far at Centura around all of this?

I think that what makes the Colorado effort so successful is the fact that what would appear to be competing organizations actually get together and talk, and put the patient at the center. And they all get together, and agree on the best way to serve our patients in the state of Colorado, and now Kansas. And that’s really been the key to success.

Has the collaboration with market competitors been at all difficult?

I’ve never detected competition at the technology level; we’re all trying to solve the same problems. Healthcare organizations are always competing on services.

What would your advice be for other healthcare IT leaders around all of this?

My advice would be that it is a journey; don’t give up. You have to have the end goal in mind. And you have to pound away at that goal; continue to move in that direction, and work through the obstacles. Like anything, there are so many distractions. It’s a puzzle that you’re putting together, and you have to keep your primary goal in mind, and you have to chip away at it, piece by piece by piece.