The Health-system Challenge: Strategic Deployment of Imaging IT

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 - Tightrope

As health systems prepare for value-based health care, CIOs walk a tightrope between consolidating enterprise IT and providing the functionality that radiologists require

One of the first commercial image-management systems, in its advertising slogan, promoted its ability to deliver any image, anywhere, anytime—throughout the health-care enterprise. That continues to represent the primary objective of imaging informatics: to increase the accessibility and availability of diagnostic imaging for clinical use. 

The RIS and PACS, however, are no longer at the center of this universe. Electronic medical record (EMR) systems are assuming this role, consolidating department-based information systems and providing a single portal to patient records. 

Centralized archives are replacing specialized archive silos. Hospital enterprises are investing millions of dollars to consolidate their IT systems and make them as productive as possible: as interoperable as possible (to exchange information transparently) and as cost effective as possible to operate. 

How are radiology IT departments being affected by changes in a world where the EHR is dominant and the HIE is emerging? Radiology Business Journal discussed this topic with two CIOs and two chairs of imaging informatics. 

They represent a coast-to-coast mix of integrated delivery networks (IDNs). In addition, they understand (and stand on) the cutting edge of health-care IT adoption.

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  • As health systems rationalize IT infrastructure, individual departments—including radiology—are feeling the repercussions.
  • Imaging IT personnel have tighter ties to enterprise information departments (if not direct reporting), providing more complete coverage of the imaging chain.
  • Departmental information systems, including PACS and RIS, are being disassembled—and in some cases, replaced by enterprise electronic health records (EHRs).
  • Both enterprise and imaging IT experts anticipate that health information exchanges (HIEs) will be used to solve their image-exchange problems—soon.

NorthShore University HealthSystem 

Greater Chicago, Illinois, has one of the most wired clusters of hospital enterprises in the nation. As CIO of NorthShore University HealthSystem (Evanston, Illinois), Steve Smith oversees the IT activities of one of these. This IDN includes four hospitals in the northern suburbs, and its multispecialty NorthShore Medical Group has more than 100 office locations. 

NorthShore implemented an EMR across its entire system in 2003. All of its hospitals and clinics are fully electronic and fully integrated. It has attained stage 7, the highest level of the HIMSS Analytics® Electronic Medical Record Adoption Model (EMRAM), achieved by only 2.9% of hospitals in the United States.

The work doesn’t stop, though, for this IT–expert IDN. During the past five years, the IT department has continued to enhance functionality and improve interoperability. Smith says, “We have been building an enterprise data warehouse because use of data from our EMR is the key to improving the quality of patient care and patient safety.” He points out that the growth of accountable-care organizations (ACOs) requires data input (ideally) from all possible sources—so that the data can be analyzed and used meaningfully, and so that best-practice patterns of care and treatment can be developed from them.

“With the movement toward health-care reform and meaningful use, as well as the eventual proliferation of HIEs during this decade, the ability to manage patients and data to deliver total population health, across the continuum, is very important,” he says. “This presumes interoperability. If I have an ACO that covers 10,000 lives, NorthShore will need to manage each patient’s care and acquire the patient’s data, regardless of where the patient was seen or treated.”

He adds, “It is important that when a patient comes in for treatment, we know about that patient. This will enhance the overall experience, both for the patient and for our providers. Our clinicians need to have data about that patient—his or her history and images—if they are relevant for treatment. We are investigating solutions to make this possible.”

He continues, “I do see the need for a tighter integration between radiology applications and EMR applications, so that we can have more data available. It is no longer enough to place orders for radiology exams electronically and receive reports. Imaging informatics needs to present data in