Use standards-based approach for integration

March 23, 2010

Blending with custom interfaces can yield efficiencies and shorten the time required to deliver diagnostic information to care providers.

Standards-based connectivity and open W`eb architecture form a robust foundation for work flow-optimizing solutions and diagnostic results sharing.

Getting accurate information about imaging procedures to clinicians at various points of care can enable a healthcare organization to optimize the value of radiology studies, many of which incur significant costs. In the context of patient-centered care, participants across the care continuum should be able to effectively access, use and share information derived from radiology studies.

Integrating various patient information-management systems into a continuous flow enables not only cost-effective infrastructure, but also minimizes delays in waiting for information. A delay in the delivery of diagnostic results can create bottlenecks in waiting rooms or force reordering of imaging procedures already done, leading to increased costs for duplicate medical procedures and unnecessary radiation exposure for the patient.

The Integrated Healthcare Enterprise (IHE) initiative has created a comprehensive set of integration framework documents that outline the end-to-end care work flow in terms of key integration points and information-exchange transactions.

A successful integration between an enterprise electronic health record (EHR) or a network of ambulatory electronic medical record (EMR), and radiology information systems and picture archive and communication systems (RIS/PACS) can shorten the time required to deliver diagnostic information to care providers. With diagnostic results available as radiology studies are completed, care planning and delivery can be accelerated to the point of virtually eliminating patient wait time.

All participants in the care cycle, from the family physician to treatment specialists, can be empowered to make informed decisions based on a complete set of diagnostic results. Those decisions, in turn, allow clinicians to deliver care in a timely and accurate fashion. Medical professionals can increase time spent with patients, leading to a higher patient throughput in any type of practice. A fully integrated work flow also minimizes operating costs and provides an optimized reimbursement cost structure.

When choosing to integrate RIS/PACS work flow with a patient record system, organizations often choose to develop custom interfaces between the RIS and/or PACS and the EMR/EHR systems. While this approach can offer performance and customization capabilities, it also creates a costly infrastructure that can be difficult to maintain or extend.

The problems with proprietary software

Proprietary interfaces often require dedicated IT professionals and demand a significant amount of effort when changes are required. Routine software upgrades to related systems, EHRs or RIS/PACS, can cause long projects focused on revalidation of the customized interface. Since custom interfaces are always vendor-to-vendor and often site specific, this work is not reusable. An individual hospital or clinic bears the total cost of the effort.

Standards-based integration is an alternative to the customized-integration approach. The Integrated Healthcare Enterprise (IHE) initiative, sponsored by RSNA, HIMSS and other leading associations, has created a comprehensive set of integration framework documents that outline the end-to-end care work flow in terms of key integration points and information-exchange transactions. Relying on well-established HL7 and DICOM communication standards, the IHE uses industry-wide experience in the most-common, best-practices information work flow.

IHE integration frameworks provide a foundation for solving many types of systems integration problems. Attempting a delivery of IHE-based integration in a plug-and-play manner in an actual site, however, presents some practical challenges. An integrator and/or IT department leader would need to ensure that all vendor systems maintain the same level of HL7 and DICOM compliance, and that they have all successfully completed relevant integration-framework tests at a recent IHE Connectathon.

This assumption may not be practical since most information systems at a hospital, clinic or an imaging facility move on separate lifecycle phases. Instances where a healthcare institution can upgrade all of its systems to the latest release or install the entire IT infrastructure in a single project are rare — if non-existent. Such comprehensive IT implementations require significant work-flow change, which disrupts care delivery. Efficiencies are lost and costs associated with the disruption often invalidate the financial benefits of the information system.

Integrators should not, however, give up on standards-based integration, but consider an approach that provides an optimal use of existing levels of HL7 and DICOM compliance, while using IHE integration frameworks as a referencable, best-practices foundation.

Consider DICOM, HL7 compliance

An integration should address the organization's need to maintain an existing-care work flow, minimize changes to proven care-delivery flow, use existing standards-based compliance, and optimize the value of systems already installed at the facility. Current levels of compliance with DICOM and HL7, along with support from the IHE's integration frameworks, deliver a key set of building blocks for connectivity. To successfully use these connectivity building blocks, an integrator, vendor or an internal IT department should have a technical architecture that is conducive to customization.

Modern integration architectures, such as the Web-services paradigm often referred to as service-based architecture allow for this type of flexible implementation. Rapid-development tools for the Web and robust network infrastructure in both hospitals and regional-care networks provide the final element in delivering this balanced technology foundation.

Connectivity building blocks allow for the reuse of diagnostic information that is already in place, captured by systems already installed. Web services-based architecture enables the delivery of this information, in a secure and safe way, to any participant in the continuum of care, either through a customized portal application or through information delivery direct to the “home” system.

Finally, the availability of high-bandwidth network access eliminates the need to duplicate and/or migrate data by allowing on-demand access in the context of an immediate care episode or request. Clinicians have new capabilities to make informed decisions when they are given full access to diagnostic information, including data-heavy radiology, cardiology and pathology results. For radiology, this information includes not only baseline diagnostic images, but also image annotations and report text.

A fully connected model allows providers to use existing systems and work flow, gives CIOs optimal operational infrastructure, ensures timely and accurate care for the patient, and assures payers that care is provided in a cost-effective manner.

Standards-based connectivity, open architecture and rapid development capability offer a quick way to integrate existing systems without necessitating any duplication of information, changes in established work flow or costly upgrades to any individual system. In this scenario, all the benefits of a standards-based interoperability model are combined with site- and diagnosis-specific work-flow requirements. The result: streamlined information flow without imposing costly changes on existing systems and work processes — an approach that yields cost-effective information exchange and increased relevance for existing systems.

Toni Skokovic is vice president of product management for Merge Healthcare's OEM division.

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March 2010

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