Benefits of Image-Enabling the EHR

Transcription

1 Benefits of Image-Enabling the EHR MU2 Implications for Hospitals, Imaging Providers and EHR Vendors A Merge Healthcare Whitepaper

2 Introduction Meaningful Use (MU) Stage 2 has new requirements for imaging that need to be implemented by One of the core requirements mandates that electronic health records (EHRs) must enable computerized physician order entry (CPOE) for 30% of radiology exam orders. In addition, eligible professionals and hospitals must select and implement three items from a menu of six options. One option is a requirement to provide access to imaging results and information through certified Electronic Health Record technology (CERHT) for at least 10% of all images a physician accesses. Since physicians are only required to implement three of six menu items to comply with MU Stage 2, not all will choose to image-enable their EHRs. However, EHR vendors, hospitals and imaging centers must be prepared to support those physicians who do select this option. To meet MU Stage 2 image requirements: Hospitals and independent imaging centers will need to be able to: > Distribute imaging results to referring physicians EHRs > allow referring physicians to view images directly from their certified EHRs > share images from their various imaging systems with all of the certified EHRs used by referring physicians EHR vendors must enable their systems to: > support CPOE for radiology exams > Provide access to images and results (i.e. radiology and cardiology reports) This paper provides an overview of how organizations can benefit from image-enabling EHRs, what capabilities to look for when planning for image-enablement, and how Merge Healthcare s solutions are already helping hospitals, imaging centers and EHR vendors image-enable EHRs. Benefits of Image-Enabling the EHR In addition to helping hospitals, imaging centers and physicians comply with MU Stage 2 requirements, image-enabling EHRs offers additional benefits such as increasing referrals and productivity, optimizing operational efficiency, improving patient safety, enhancing the quality of care and reducing costs. Below are more details on how organizations can benefit. Since each referring physician contributes about $1.5 million in annual revenue to an imaging center, a critical business objective of most imaging centers is to retain and build a solid base of referring physicians. Growing or Maintaining Physician Referrals By integrating imaging systems and processes with image-enabled EHRs, hospital-based and independent imaging centers can help to ensure that referring physicians are satisfied with the level of service they and their patients are receiving. Since each referring physician contributes about $1.5 million in annual revenue to an imaging center, a critical business objective of most imaging centers is to retain and build a solid base of referring physicians. Increasing Productivity and Efficiencies Most physicians refer patients to several imaging providers and each provider has their own method for receiving orders, delivering results and providing access to images. Some require physicians to place orders via electronic message, others want orders faxed in a variety of formats and a few use handwritten requests. The variations in image ordering and report distribution workflows result in management processes that are error prone, require expensive manual methods, and introduce operational inefficiencies for both imaging providers and referring physicians. Image-enabling EHRs increases productivity and efficiencies by Benefits of Image-Enabling the EHR A MERGE HEALTHCARE WHITEPAPER 2

3 eliminating operational variations through streamlined imaging workflows and standardized processes for ordering imaging procedures, distributing reports and viewing images. Enhancing Patient Care An image-enabled EHR helps to improve the quality of patient care and makes it easier for physicians to diagnose conditions. By providing access to all images and image information within the EHR at the point of care, workflow is simplified because physicians can view a more complete picture of each patient s health report in one central location, including prior imaging studies that may help them more easily identify trends. Better Information Sharing with Patients and Across Organizations The value a physician places on an EHR deployment increases when the system makes it easier for them to interact with patients while showing them their images. Image-enabling the EHR can enrich the physician-patient relationship, help provide patients with a better understanding of their condition, and improve patient compliance with treatment recommendations. Reducing Duplication Costs and Radiation Exposure The ability to easily access imaging studies from multiple sources from within a physician s EHR system can reduce the number of duplicate tests ordered. This ultimately lowers the cost of care and decreases patients radiation exposure. Duplicate test rates can be reduced further when a cloud-based archive is deployed that enables authorized providers across organizations to easily access all existing imaging studies conducted on their patients, not just the images they ordered. Image-enabling EHRs as part of MU Stage 2 compliance provides many advantages. Nevertheless the implementation process can be quite complex for everyone involved: EHR vendors, imaging providers and physicians. The next section discusses the capabilities that organizations should look for to support imageenabled EHRs in the easiest and most costeffective way. Capabilities Needed for Image-Enabling EHRs As EHR vendors, hospitals and imaging centers plan to image-enable EHRs, they should look for solutions that are easy to deploy and manage and partners who can help them streamline their image-enablement processes. The ability to easily access imaging studies from multiple sources from within a physician s EHR can reduce the number of duplicate tests ordered, ultimately lowering the cost of care and decreasing patients radiation exposure. Technology solutions and services should include the following capabilities: Rapid, Cost-Effective Deployment Hospital-based and independent imaging centers and physician offices should be able to communicate cost effectively and with minimal effort. Therefore, the integration of imaging systems and EHRs must leverage existing investments and be nondisruptive to ongoing operations. Implementation times and costs for integration can vary widely depending on whether a central hub or point-to-point architecture is selected. The best approach is usually a central hub that routes orders and reports between imaging providers and referring physicians, and directs viewing requests to the viewer that is closest to where the images reside. Central hubs can be easier, faster and far less inexpensive to implement because they dramatically reduce the number of interfaces needed to connect imaging systems and EHRs. Benefits of Image-Enabling the EHR A MERGE HEALTHCARE WHITEPAPER 3

4 A point-to-point approach is more costly and time-consuming because of the numerous Health Level Seven (HL7) connections that must be built to address all possible connections between imaging providers and all the various EHRs in the community. In addition, a point-to-point architecture often requires virtual private networks (VPNs) to enable messages to move back and forth securely. For example, in a city with 100 imaging centers and 10,000 physician offices, one million connections would need to be built to support image access and information exchange between these systems, compared to thousands of connections for a central hub approach. Easy Image Viewing and Archiving Image-enabled EHR solutions should allow archiving and viewing of any image or image type, regardless of where the image is stored or where the study was conducted. One important solution component is a true zero-client viewer that reduces deployment, maintenance and support costs because no software has to be installed on the device used to view the images and information. Some EHRs already enable viewing of images for a particular type of specialty, such as OB/GYN ultrasounds, but do not support all of the image types needed for compliance with MU Stage 2. Scaling these single-purpose solutions to support all image types and standards is an extremely complex process due to the wide range of image types: radiology, cardiology, orthopedics, ophthalmology, OB/GYN, pathology, dermatology, etc. A better approach for most organizations that want to comply with MU Stage 2 image access rules is to adopt a centralized method to archive and view images and provide complete patient information, including priors. Security and HIPAA Compliance Cloud-based storage solutions can deliver a number of benefits, including: Providing physicians with access to images and reports from their offices or other offsite locations Meeting HIPAA mandates that require imaging centers to maintain a second copy of images in the event of a disaster Enabling community physicians to access images without allowing their EHRs to penetrate the security firewalls of imaging providers Despite the many benefits, multiple regulatory and compliance issues are introduced when images are moved to the cloud for storage and viewing, or when the EHRs of referring physicians can view exams using viewers installed on the imaging providers network. However, these issues can be addressed with the deployment of technologies that encrypt data in motion and at rest, and provide strong authentication processes. Industry Standards: DICOM, HL7 and IHE The technologies used to image-enable EHRs should support industry standards such as Digital Imaging and Communications in Medicine (DICOM), HL7 and Integrating the Health Enterprise (IHE). > DICOM: Storing images from multiple modalities and systems, accepting and cleansing all variations of DICOM, and providing EHRs with DICOM formats they can view > HL7: Messaging for ordering images, sending image results, and updating patient demographic information > IHE: Consistent Time Integration Profile (CT), Cross-enterprise Imaging Information Sharing (XDS-i) and Audit Trail and Node Authentication (ATNA), etc. Scalable System and Strategy The system should accommodate all image types and rapid growth in the number of images and users. These capabilities are especially important as the healthcare industry continues to consolidate through mergers and acquisitions and health information exchange (HIE) becomes more prevalent. Implementing a vendor-neutral archive Benefits of Image-Enabling the EHR A MERGE HEALTHCARE WHITEPAPER 4

5 as part of the underlying solution is often the best approach to ensure a scalable solution and the ability to meet real-world demands over time. Extensive Clinical Workflow and DICOM Experience The process of image-enabling the EHR can be extremely complex for those EHR vendors and imaging centers that decide to implement these capabilities using internal resources. Not only must the internal team have expertise in the EHR systems deployed in local markets and all of the various imaging systems and formats, but they must also have a thorough understanding of regulatory compliance requirements, industry standards and how proprietary solutions deviate from industry standards. Merge s iconnect Enterprise Clinical Platform is an integrated solution suite that delivers complete image interoperability while also serving as a foundation for a comprehensive enterprise imaging strategy. In addition, the job of an internal team doesn t end once an image-enabled EHR solution has been integrated and tested. They must also maintain and upgrade systems over time and continuously ensure they are in compliance with MU requirements. Due to the many complexities involved when image-enabling the EHR, most organizations will be better served by partnering with an imaging expert that can support their image-enablement efforts. It is important for organizations to select a partner that understands all aspects of imaging modalities and workflows, has the bandwidth and resources to address their issues and has a proven track record of implementing projects that support MU Stage 2 image access requirements. Image-enabling EHRs can be accomplished easily and cost effectively when technology solutions and services with the capabilities recommended above are selected. Once deployed, these solutions will ensure that organizations are in compliance with MU Stage 2 and provide many other cost, efficiency and quality of care benefits. Merge Healthcare: Market Leader and Expert at Image-Enabling EHRs Merge is a leading provider of enterprise image management solutions, radiology information systems (RIS) and picture archiving and communication systems (PACS) and services that enable MU compliance, increase efficiencies, decrease costs and accelerate patient care. Merge customers include more than 6,000 clinics and labs and 1,500 hospitals with installations spanning radiology, cardiology, orthopedics and ophthalmology. The Merge professional services team has a deep understanding of the issues and requirements of enterprise-wide imaging environments and image-enabling EHRs, and a proven track record of planning and implementing more than 5,000 successful deployments. Merge has a range of solutions that enable hospitals to qualify to receive Meaningful Use incentives, and allow referring physicians, who are not based at or affiliated with a hospital or imaging center, to view images and information created at those facilities from image-enabled EHRs in their offices. Merge s iconnect Enterprise Clinical Platform is an integrated solution suite that delivers complete image interoperability while also serving as a foundation for a comprehensive enterprise imaging strategy. The platform includes: iconnect Access: A zero-download DICOM and XDS viewer that supports image viewing from any browser-based device. iconnect Access can be embedded within an EHR or hospital health information system to deliver immediate access to images, improve physician workflow and patient interaction, and help hospitals and imaging centers Benefits of Image-Enabling the EHR A MERGE HEALTHCARE WHITEPAPER 5

6 expand their valuable referral networks iconnect Share: An intelligent Internet DICOM gateway for image sharing between enterprises. iconnect Share shares and stores images and information in real time over the Internet, converts images into local formats for easy exchange and archiving, reduces time to treatment, and increases compatibility with existing technology investments iconnect Enterprise Archive: A vendorneutral archive (VNA) that was named the global market leader in VNAs in a 2012 InMedica Report. iconnect Enterprise Archive consolidates, standardizes and archives images and data from disparate PACS, specialties and sites to provide a patientcentric view of all diagnostic images, enable trend analysis and reduce duplicate tests. Merge is a co-founder and the number one provider of DICOM solutions globally, actively participates in IHE Connectathons, and has over 90 patents in imaging and health information technology. With over 20 years of experience and the broadest solutions in the industry, Merge is the partner organizations can depend on to meet their current and future imaging requirements. For more information, visit merge.com. 200 E. Randolph St. Chicago, IL x3 merge.com 2012 Merge Healthcare Benefits of Image-Enabling the EHR A MERGE HEALTHCARE WHITEPAPER 6