Integrating a PACS/Imaging System into an EHR Anwar Motan John Riggs, MD

Transcription

1 Integrating a PACS/Imaging System into an EHR Anwar Motan John Riggs, MD DISCLAIMER: The views and opinions expressed in this presentation are those of the author and do not necessarily represent official policy or position of HIMSS.

2 Conflict of Interest Disclosure Anwar Motan, BS John Riggs, MD Have no real or apparent conflicts of interest to report HIMSS

3 Learning Objectives Integrating Imaging applications with EHR orders, results and images Use of interface engine for the integration Use of HL7 and DICOMM standards

4 Harris County Hospital District Houston metropolitan area Integrated Delivery System 3 Hospitals Ben Taub, LBJ, Quentin Mease 45k Annual Admissions 40+ various community primary care centers and services >1.2 million outpatient and ER visits/year Largest public primary health care system in Texas CPOE/Clinical Documentation Ambulatory Live since 2006, Inpatient Live Since 2010 HIMSS Level Most Wired

5 HCHD - Vital Statistics Ben Taub General Hospital Level 1 Trauma Center 650 Beds Quentin Mease Community Hospital 65 Beds Rehab and geriatrics 5

6 HCHD - Vital Statistics Lyndon B. Johnson General Hospital 332 Beds Level 3 Trauma Center 6

7 HCHD - Ambulatory Care Services Established community health centers, including nation s first free-standing HIV/AIDS treatment center 1 free-standing dental center 9 school-based clinics 13 homeless shelter clinics Riverside Dialysis Center Immunization and medical outreach program with 5 mobile health units New Martin Luther King, Jr. Health Center 7

8 HCHD Health Record Extension Referral Management External Clinical Records Interface to case management Affiliate Read-only Access to full EMR Area FQHCs (10) County Jail 8

9 HCHD Health Record Exchange Peer-to-Peer Exchange Continuity of Care Document Exchange Integrated into existing EMR workflow Not required to Log-in to separate system Note: can not transmit radiology images yet 9

10 Steps Diagnostic Result Availability 1. CDR (Clinical Data Repository) 2. PACS (Picture Archiving and Communication System) 3. EMR (integrate information) 4. EHR (extended) 5. EHR (interoperable) future state

11 Key Goals Standard for Patient-specific display: original order, result report images Standard for Diagnostic imaging connection: Modality Interface EMR

12 What has made this possible: Workflow based EMR design Healthcare Industry adoption of HL7 and DICOM standards

13 Ordering, Performing, Result Creation and Result Clinical Reading RADIOLOGIST TECHNOLOGIST FRONT DESK PHYSICIAN Yes Places order through EHR Is the patient an inpatient? Begins the exam on the patient, asks appropriate questions No Does the order need to be modified? Yes No Performs the exam and acquires images Is the change a reduction of service OP Ordering and Scheduling Workflow Order and Images Can be viewed Ends the exam on the patient Calls physician to place new order, Protocoling Workflow Yes Modifies the order Protocoling Workflow Yes Does this exam need to be protocoled? Completes End Exam navigator documentation and answers any additional questions Call informatics to have them fix it. No No Navigator issues questionnaires and checks patient in Are images in correct PACS folder? Scan documents into PACS, and call transportation to move patient. Exam can be read by a radiologist Yes Epic Systems Corporation. Confidential.

14 CT Ultrasound Mammo Electronic Medical Record Interface Engine I I S GI Lab Pulmonary Lab EKG Echo Others IIS = Imaging information systems

15 Image Hyperlinks PACS Image request Image view

16 What is Health Level VII (HL7) The term Level 7 refers to the highest level of Open System Interconnection (OSI) model of the International Standards Organization (OSI). HL7 conforms to the conceptual definition of an application-to-application interface placed in the seventh layer of the OSI model.

17 What is Health Level VII (HL7) Here is an example of a typical HL7 order record MSH ^~\& PACS Y ORU^R P 2.2 ^MPID ^^^^MR Test^Patient F ^MPV ^MORC RE ^MOBR G0202^MAMMOGRAM BILAT SCREEN DIGITAL)^SMS P ^^^ MSH ^~\& INST-MCAR SMC MCAR- INST VISTA ORU^R P 2.2^MPID ^^^^MR Xxxxx^test M Hispanic^MOBR 94010^Spiro metry^pulmonary \\server\folder\pd ffiles\ _ _000.pdf F^MOBX 1 RP 94010^Spirometry 1 \\bt apps01\vidata\pdffiles\ _ _000.pdf

18 Integrating with PACS

19 PACS Technically Speaking PMIS RIS LIS CIS Interface Engine Radiology Web PACS EHR Clinical Data Repository EHR USER INTERFACE SSL OR VPN Slide 19 Physician Access

20 How HL7 is used to achieve goal: In EHR we have two components for viewing the image or a result in pdf: Static component This is setup on a global level path=/all%20studies/accessionnumber= Dynamic component This is sent in every outbound result

21 Results Diagnostic tests included: Radiology: e.g. CT, MRI, Flouro, DI, NM Cardiology: e.g. Cath, Echo, ECG, NC GI Lab Pulmonary Lab Diagnostic tests not yet included (vendor DICOM limitations): EMG EEG Neurophysiology Electrophysiology

22 Extending information Image Hyperlinks PACS Image view Image request

23 Impact Clinical Common access to diagnostic results and images Faster turnaround for final reports Diagnostic result with image link can be routed in EHR to ordering provider Revenue Cycle Vastly reduced time to submit charges Increased charge accuracy/completeness Technical Faster IT integration of new modalities Streamlined maintenance of interfaces Reduced effort in RIS system replacement project

24 Modality Integration (Since 2006) Integration average time Decrease from several days to 24 hours Applications with HL7 interfaces and DICOMM standards From 6 months to 60 days

25 Study Performed to Study Signed 300 Average Hours Data not available

26 Lessons Learned Never use UNC path in Windows environment for authentication. Use URL with Secured connection to display your images and pdfs using virtual directories through web server Set expectation of provider workflow integration for all result review (images or text)

27 Questions?