Most observers would agree that radiology has done an excellent job of managing medical imaging workflow within the department and extending image access to referring physicians wherever they practice. Nonetheless, as the observations and experiences of the four experts who participated in this roundtable demonstrate, a department-centric image management solution is no longer sufficient.
As hospitals merge, systems grow and EHRs achieve widespread implementation, it has become increasingly clear that the walls of healthcare data silos must come tumbling down. All medical image data being produced in every department must be reportable and accessible, preferably from a single interface.
Getting there will not be easy, but all of the experts who participated in this roundtable have begun taking steps to get there. Radiology Business Journal shares the first part of this roundtable discussion in this issue, focusing on goals and strategy. Part II, focusing on the ideal PACS–EHR relationship, will be published in the August/September issue.
- Louis Lannum, Director of Enterprise Imaging, Cleveland Clinic
- Kevin McEnery, MD, Director of Innovation and Imaging Informatics and Professor of Radiology, University of Texas, MD Anderson Cancer Center
- Rasu Shrestha, MD, Chief Innovation Officer of University of Pittsburgh Medical Center, Executive Vice President of UPMC Enterprises
- Chris C. Tomlinson, MBA, CRA, FAHRA, Senior Director of Radiology, Children’s Hospital of Philadelphia, and Executive Director of Radiology Associates of the Children’s Hospital of Philadelphia
For those who have tried to get their arms around enterprise imaging, its scope has been eye opening to say the least. What have you learned about who is imaging and how it is being stored that has surprised you?
Lannum: Today, we’re storing and providing access to images from about 30 different specialties or departments at the Cleveland Clinic. What surprised me the most is how much point-of-care ultrasound is out there, and how many actual departments—orthopedics, rheumatology, ED, anesthesiology, intensivists—are using point-of-care ultrasound that the images never reach our radiology PACS. They’re stored locally. They’re stored in silos inside of each of the departments and they were never shared.
What surprised us the most, I think, was the lack of workflow in each of these departments compared to radiology, where they manage the workflow very, very well, and associate all the images with the EMR records.
Dr. McEnery, what are you seeing?
McEnery: At MD Anderson, the big centerpiece is the PACS, in terms of all the diagnostic imaging that’s being done. We’ve attempted over the years to look at integrating other “ologies”, endoscopy and digital light, but the workflow became too onerous.
In radiology, there was a tight coupling, whether it was between the EMR and RIS or the PACS with billing. The imaging being done in non-radiology sites seems not to have that strict linkage, which continues to be a hindrance. Thus far, the strategy has been to create individual archives to meet the individual needs of the business owner, with the intention in the near future to bring them into a single archive as best can be achieved.
I guess what surprised me is that the number of ologies continues to grow. We now have pathology digital images online in our EMR. That has been quite interesting to view. Overall, the demand at our institution is for access to outside images that are being brought in by patients from a variety of different sources.
What has been your experience at UPMC, Dr Shrestha?
Shrestha: Imaging has definitely evolved from being a departmental solution, a very local solution, to now being an enterprise asset. We—enterprise imaging or radiology—were the first to embrace digital, but in many ways, we’ve almost been left on the wayside of being an afterthought, at least in things like meaningful use—we were pretty much left off of the party invite list.
In the mad rush to move from analog to digital, the value of radiologists and radiology services seems to have been sidelined, and we’ve been (in many ways) commoditized as well. We’ve gone from being the center of the universe, which is what we were in the days of film and even the early days of PACS, to being a generous mention, if that. That was surprising.
I think it was very much driven by the volume-based approach that has been the definition of how healthcare has been delivered