Let Enterprise Imaging Tell the Whole Patient Story

2017-11-29
 

Radiologist reviewing a brain scanEvery picture tells a story. That may be true. But when it comes to diagnostic imaging, one picture tells one aspect of the story. Radiologists and radiology departments need enterprise imaging to get the entire story. And only by getting the whole story can they create more value for clinicians, patients, and payers.

As radiologists attend educational sessions and keynote speeches and walk the massive exhibit halls at RSNA 2017, they will be hearing a lot about enterprise imaging. The concept is simple, but putting it together and making it work is a little more complex, albeit worth the effort.

Enterprise imaging connects radiologists to a patient care team

An enterprise imaging system is a unified health IT system that connects imaging to all major health IT systems across an entire health care operation or delivery system. That means that the imaging systems radiologists are using to access, interpret, store and share diagnostic images are connected to other IT systems, including but not limited to:

  • Clinical data systems like EHR, surgical, laboratory and telemedicine systems
  • Clinical operations systems like order entry, coding and billing systems

Enterprise imaging facilitates a bidirectional connection with these systems to offer more information for the radiologists and increases the value of imaging within these other systems.

Just as important, enterprise imaging enables studies from other departments to be managed leveraging this connected system. No longer are images from Cardiology, Oncology, Orthopedics, Dermatology, etc., managed and viewed in isolation. Instead the care team is assured easy access to the full imaging story for each patient.

Holistic view of the patient drives clinical and business benefits

When radiologists have access to the patient information from all those other systems, it can transform their work. They’re no longer just receiving orders and providing interpretations blind of the patient’s condition and repeating that cycle in isolation throughout their day. Instead, they’re getting a holistic view of the patient to guide their diagnostic work.

For example, by having easy access to the EHR data, they’ll know the details of the patient’s condition, prognosis and ultimately why the imaging study was ordered. By being connected to other departments, they’ll know what other tests have been done or ordered. They’ll know who on the care team needs the results and why. They’ll know what other treatments or medications have been provided and may need to be provided.

The net effect is ordering the right exams for the right medical conditions, avoiding unnecessary and costly exams and getting patients the treatment they need as soon as possible. Radiologists are adding value beyond just creating the imaging report.

The value created continues after an imaging study and report is completed. With the full imaging context available within the EMR, clinicians can use the full imaging story to better assess treatment options. Additionally, with ease of access, clinicians can leverage images further by using them as an effective communication vehicle for the care team and patients directly. Broader yet, healthcare organizations can begin to consolidate and simplify the management of systems across the entire operation. All of this benefits the patient clinically and the healthcare system financially. In a value-based reimbursement world, where achieving the best outcome at the lowest possible cost is nirvana, it enables imaging to play an even more critical role in the care of the patient.

Three common challenges to implementing enterprise imaging

Even with the obvious clinical and financial benefits it does not mean that implementing an effective enterprise imaging system is simple. There are three common challenges:

  1. Interoperability. Because most medical departments within a hospital or health system have grown and operated independently, they’ve likely purchased or built their own IT systems. While over time, these systems performed well for their independent function, these systems haven’t evolved with the idea of easily integrating them with other health IT systems throughout an enterprise. These legacy systems can be difficult to plug into a unified imaging solution.
  2. Scale. One hospital can have dozens of departments. One health system can have multiple facilities.. The thought of connecting a unified imaging system to all of the other health IT systems in each and every other department across an entire operation can be overwhelming, if not paralyzing. It can stop an enterprise imaging system before it starts.
  3. Change. Most radiologists have practiced the same way for most of their careers, and they’ve been compensated the same way for most of their careers — based on volume of images read. Having more patient data from an enterprise imaging system that puts their work in context may sound great in theory but not in practice. There will there be too much information to sift through and too much back-and-forth with other clinicians, cutting into their productivity. Additionally, clinicians have practiced for years without expecting simple access to an imaging system. When implemented and integrated into the EMR, it does mean that the care team can leverage this data in new ways. These changes can sometimes be difficult to implement culturally.

Strategies to overcome challenges to adopting enterprise imaging

As with all these challenges, fortunately there are solutions. The key first step is to truly lay out a plan which accounts for these challenges. Such a plan will both leverage existing technology, and strategically implement new enterprise technologies. Every healthcare system is in a unique position, therefore, partnering with experienced industry experts can help organizations layout a roadmap and assess tradeoffs.

Interoperability challenges can be overcome with a well-planned roadmap following key integration standards (DICOM, HL-7, IHE, etc.), supplemented with new compliant components. Agnostic integration technologies can take disparate and proprietary health IT systems and make them work in concert.

Additionally, the challenge of scale can also be overcome with expert planning. Connecting an enterprise system to other healthcare systems shouldn’t happen all at once. It must happen in phases. Creating a roadmap with milestones can make this seemingly unmanageable project very manageable over time.

Perhaps the most underestimated challenge is managing the changes that an enterprise system requires and will continue to require as an organization adjusts its practices. Implementing an enterprise imaging system, and connecting radiology and cardiology systems is just the first step. Assuring physicians have the know how to use it effectively is just as, if not more, important. When these users, radiologists and clinicians, experience the full value that this type of system can bring to patient care, they will become believers.

Another key to help encourage change is to measure the impact of change. Processes and procedures should be supported tangible metrics used to track whether the enterprise imaging system is producing the value expected. For example, by leveraging KPIs (Key Performance Indicators) within an imaging analytics solution, improvements such as radiologist turnaround time, duplicate study avoidance, or the effectiveness of clinical communication can all be quantified with trend analysis.

On the IT side, expect to gain cost advantages from an enterprise imaging solution over the long run. With an enterprise imaging system, a hospital or health system is consolidating once siloed systems, with overlapping capabilities with a single unified system. Many of these legacy systems share storage, viewing and integration capabilities that have to be independently maintained and managed. Enterprise imaging enables a convergence, therefore reaping the cost benefits.

The theme of RSNA 2017 is “Explore. Invent. Transform.” All attending the conference should explore the promise of enterprise imaging, as it promises to transform the way they practice. If you are at RSNA today, you can find me in Change Healthcare booth 7313 or contact us to schedule a meeting to discuss your enterprise imaging needs.

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Todd Johnson is executive director, product development, radiology for Change Healthcare

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