From the silo and basement of radiology, to their acknowledged place now at the enterprise level, diagnostic images have come a long way since they were digitized more than 30 years ago. Today, CIOs are starting to recognize that they need to take ownership of imaging and deliver multi-disciplinary imaging in patient-centric context via the electronic medical record (EMR). But until recently, the question has remained how this could be done efficiently and effectively.
The need for diagnostic images has made great demands on information systems in healthcare. Homegrown image-management systems utilized in academic radiology departments became essential to the practice of radiology. These preliminary systems that became the picture archiving and communications systems (PACS) that we know today have evolved to handle the explosion in radiology images and associated data the healthcare system handles on a daily basis. For instance, medical image archives are increasing by 20 to 40 percent each year, and it is estimated that in 2012 there were 1 billion medical images stored in the U.S. Additionally, nearly 400 million healthcare procedures a year in the U.S. – beyond those just in radiology – now involve at least one medical image.
The last decade saw an incredible uptick in the adoption of digital imaging technologies that in the last several years have been further fueled by legislation. Despite reports that note a maturing in the PACS market, healthcare continues to demand an evolution to the path previously paved by image sharing in radiology and cardiology departments. As there continues to be a rapid expansion of digital images in dermatology, pathology, wound care and other areas to diagnose, treat and monitor patients, another wave of innovation is needed to bring these care areas into the realm of multimedia tools that assist in the delivery of care.
Departments such as ophthalmology, pathology, endoscopy and dermatology are now also moving from their hard copy, analog files and embracing digital imaging to further aid diagnosis, workflow and patient care outcomes. As these departments look to expand the use of digital imaging, hospital executives are searching for a solution to store these images and integrate them with the rest of the patient history. Although many previously thought a vendor-neutral archive (VNA) was the end-all solution for their imaging needs, they are quickly realizing that much more than storage is needed. The key is in the workflow to acquire, report, share and distribute images – and the data and information that corresponds with those images. And as meaningful use includes imaging, the requirements to integrate imaging workflows will only expand. It is expected that Stage 3 will require that as many as 50 percent of images be shared across the enterprise, putting further demands on systems to integrate imaging workflows.
So, where does that lead us? The obvious answer is that imaging needs to be managed at the enterprise level. But how do we best accomplish this? In the delivery of care today, health systems across the U.S. and around the world find themselves struggling to bring together data from various departments around the enterprise. Electronic health records (EHRs) are attempting to solve this problem for data that resides in a patient chart, but that solution still leaves images behind. As more departments generate imaging data, simply consolidating storage does not solve the problem. Clinical workflow is needed to acquire, distribute and review these images.
Technologies that provide a comprehensive framework that enable flexible workflows to bring images into every step of the care continuum are needed. Only when clinicians have a single point of access for all imaging data, integrated into the EHR, can health systems truly reduce duplicate procedures and enable a highly efficient care process. The patient care process is thus not only improved by the physician having a complete centralized picture of the patient’s health record, but by also allowing for the physician to more readily engage with the patients about their prior studies and historical patient record. Enrichment of the physician-patient relationship with the sharing of these images during the care process leads to a better patient understanding of their care and compliance of the patient treatment plans. For example, a dermatologist and pathologist sharing live images during a procedure allows the dermatologist to know if the procedure has been successful, or if another layer of tissue needs to be removed.
In addition, image-enabling the EMR leads to increased productivity and efficiencies. The ordering and result-distribution process today is inclined to result in errors. Most processes today require manual intervention and result in workflows that are inefficient and costly. With image and result access via the EMR, these processes are streamlined and become more effective. Image ordering mechanisms can be standardized, and the referring community is further satisfied with direct access to patient images and results.
In this era of increasing regulatory pressures and efficiency focus, freeing images from departmental silos and putting them in front of the physicians who need them just makes sense. Adding an imaging layer to the EMR can deliver far-reaching benefits that go above and beyond expedited delivery of care and improved clinical confidence. Redundant studies can be eliminated, and primary-care physicians can leverage it to deliver more detailed, image-rich patient consultations, also leading to a reduction in care cost and an increase in productivity with more efficient workflows.
The future vision of an image-enabled EMR includes a continued evolution in the number of departments that are integrated into enterprise imaging. The complexity of integrations the market sees today will be reduced by providing single-access image data points, thus resulting in a single enterprise imaging workflow for non-specialists across all imaging departments. Providers in departments that do not readily use images within their workflow today will be able to expand their diagnosis techniques to a visual empire of patient images and historical image records.
This move to enterprise-wide imaging access will drive us out of departmental silos. Hospital CIOs will no longer request information based upon departmental imaging needs. They will look to evaluate imaging repositories from an enterprise assessment. Non-episodic care and disease management will benefit from the sharing of clinical data through health information exchanges (HIEs). The end result will drive the market to deep diagnostic imaging systems with advanced algorithms that will expand far beyond traditional radiology, with more improved workflow and diagnosis techniques.
About the Author
James Jay is vice president, imaging informatics, Agfa HealthCare. For more on Agfa HealthCare: www.rsleads.com/305ht-203