Radiology IT in the EHR Era

Transcription

1 Radiology IT in the EHR Era Jim Noga, VP & CIO Partners HealthCare September 2015

2 Radiology in the EHR Era Centralized (Enterprise) Solutions Enterprise Visualization Enterprise Storage Distributed (Departmental) Solutions Imaging Informatics ACR Imaging 3.0 Beyond the Enterprise Summary 2

3 Radiology in the EHR Era Centralized (Enterprise) Solutions Enterprise Visualization Enterprise Storage Distributed (Departmental) Solutions Imaging Informatics ACR Imaging 3.0 Beyond the Enterprise Summary 3

4 Centralized (Enterprise) Solutions From RIS to EHR What else? - Centralization Consideration IT Management of Imaging Enterprise Visualization Enterprise Image Storage CMS Regulations Imaging Sharing 4

5 From RIS to EHR Radiology related EHR components Radiology Module Ordering Module Scheduling Module Decision Support Module Critical Alerts Module 5

6 Centralization Considerations What is unique to departments Departmental imaging workflow Departmental imaging visualization What is common across imaging departments Image storage Image management, Disaster recovery, Business continuity Enterprise image visualization EHR image integration 6

7 IT Management of Imaging Enterprise Image Management Enterprise visualization Enterprise storage EHR integration End user support Departmental IT Management PACS, Workflow, Visualization Image Interpretation and Reporting Overall operational and financial management 7

8 Radiology in the EHR Era Centralized (Enterprise) Solutions Enterprise Visualization Enterprise Storage Distributed (Departmental) Solutions Imaging Informatics ACR Imaging 3.0 Beyond the Enterprise Summary 8

9 Enterprise Visualization Thin client visualization for general user Images can remain in departmental PACS WADO (Web Access to DICOM Objects) Centralized cache for faster retrieval Prefetching using schedule if necessary Single EHR integration Single EHR visualization EHR, Citrix, External Portal, Patient Portals 9

10 MYVIEW IMAGE ROUTER Controls All Image Visualization in Epic (2015) Leverage existing AMC visualization infrastructures (GE, Agfa) Archive all PHS image data at AMCs (Next) Leverage existing AMC archive infrastructures (GE, Agfa) DFH Imaging MVH Imaging SSH Imaging FH Imaging NWH Imaging SRH Imaging MVH Imaging ARCHIVES BWH - GE MYVIEW MGH - AGFA ARCHIVES EPIC EHR 10

11 MyView - Architecture Common Entry point for all Partners EHRs. Requests will be routed to the appropriate viewer based on site of study BWH, DFCI, FH, SSH Fully integrated solution LMR WebResults CAS Results Research MyView Router MGH, NSMC, NWH, MEEI 100TB Buffer MGH NSMC NWH MEEI Long term transient cache Federated Queries - Exams are retrieved in real-time based on user requests. 11

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13 MyView/MGH Family Logical Architecture

14 MyView Image Router Three Key Perspectives/Advantages Patients, Departments and Hospitals Patient access remains conveniently located in their community Radiologists continue to use their familiar PACS systems Improved IS infrastructure provided by economies of scale All PHS Physicians and Medical Professionals Unified access to ALL PHS patients images via Epic PHS IS A single point for Epic-Image integration management Centralized visualization and storage solutions Leverage AMC Imaging Informatics knowledge and investments

15 Radiology in the EHR Era Centralized (Enterprise) Solutions Enterprise Visualization Enterprise Storage Distributed (Departmental) Solutions Imaging Informatics ACR Imaging 3.0 Beyond the Enterprise Summary 15

16 Enterprise Storage Storage functionality DICOM, other formats, video Departmental workflow retrieval Disaster recovery Business continuity Enterprise visualization cache Vendor Neutral Archive Evolving marketplace Evolving product features 16

17 Radiology in the EHR Era Centralized (Enterprise) Solutions Enterprise Visualization Enterprise Storage Distributed (Departmental) Solutions Imaging Informatics ACR Imaging 3.0 Beyond the Enterprise Summary 17

18 Distributed (Departmental) Solutions Image Acquisition Import, Quality Control Radiology Workflow Worklists, Unread cases, Productivity Radiology Visualization Optimized for productivity, Advanced visualization Radiology Interpretation Speech Recognition and Reporting 18

19 Radiology in the EHR Era Centralized (Enterprise) Solutions Enterprise Visualization Enterprise Storage Distributed (Departmental) Solutions Imaging Informatics ACR Imaging 3.0 Beyond the Enterprise Summary 19

20 Imaging Informatics ACR Imaging 3.0 National ACR movement, resonating with the Feds Board of Directors, Chairman of the Informatics Commission Radiologists bring more value to healthcare than interpretation Utilized technology to provide and demonstrate value Legislators have responded to our advocacy efforts HR 4302 (SGR Patch) - Inclusion of Imaging Clinical Decision Support Requires the use of Imaging CDS for CMS pts by Jan, 2017 ACRSelect is 1,000 national guidelines (6,000 references) Integrated into Epic 2014 order entry system 20 PHS currently uses internally developed guidelines Will need to implement CMS approved solution by 2017

21 Radiology in the EHR Era Centralized (Enterprise) Solutions Enterprise Visualization Enterprise Storage Distributed (Departmental) Solutions Imaging Informatics ACR Imaging 3.0 Beyond the Enterprise Summary 21

22 Beyond the Enterprise Import of images from outside the enterprise Providing imaging services outside the enterprise 22

23 Importing Images from Outside the Enterprise (Image Sharing) Provide mechanisms for image data import At physician s offices (CDs) From patients home (CDs) To/From remote facilities (CDs & Direct transfer) Purpose Physician viewing Permanent storage with EHR integration Request for radiology interpretation 23

24 Providing Imaging Services Outside the Enterprise Imaging for Non-affiliated Physicians Must have secure access to EHR Ordering, Scheduling, Reporting, Alerts, CDS Interpretation of Imaging Performed Elsewhere Importing Images Image Sharing solutions Workflow consideration Integrated vs. external worklist Interpretation process Common speech recognition system Reporting Intelligent routing of HL7 data back to source destination 24

25 25 HIE???

26 Radiology in the EHR Era Centralized (Enterprise) Solutions Enterprise Visualization Enterprise Storage Distributed (Departmental) Solutions Imaging Informatics ACR Imaging 3.0 Beyond the Enterprise Summary 26

27 Summary Enterprise management of imaging IT is challenging Variety of imaging departments Variety imaging types Centralize all common functionality over time Some are easier, bigger wins, than others Keep logically unique functionality distributed Evolving journey from film to digital at PHS hospitals Epic implementation has driven us toward centralization Centrally managed visualization will occur first (2015) Centrally managed storage will occur next (funding) Distributed acquisition with centralized management Single, federally-approved CDS solution (2017) Strategic preparation for Population Health Management HIE The next frontier 27

28 28 Radiology selfie

29 29 Discussion