• November 2008 FEATURE ARTICLES •
PACS/RIS/Imaging
Toward a Unified View
Can the convergence of PACS with clinical systems accomplish true clinical data consolidation?
By Rex Osborn
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.
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
rex.osborn@fujimed.com.
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.
