WHITEPAPER How Intelligent Indexing & Workflow Empower An Image-Enabled EHR
How Intelligent Indexing & Workflow Empower An Image-Enabled EHR The value of enterprise imaging a centralized system that integrates images from any clinical specialty into a patient s EHR and makes that comprehensive information available to any clinician in the enterprise is increasingly understood and appreciated by forward-thinking hospital CIOs and healthcare executives. As these leaders recognize, the modern hospital enterprise is a dynamic and complex environment where patient care is often managed by an array of specialists from numerous departments, each of whom is responsible for a specific piece of the patient s diagnosis and treatment plan. Combine this with the additional clinical and financial demands of healthcare reform legislation, including Health Information Technology for Economic Clinical Health Act (HITECH) and initiatives of the Center for Medicare Advocacy (CMA), as well as the Affordable Care Act (ACA), and it is clear that hospitals are forced to contend with a variety of sometimes competing elements to ultimately provide the best patient care possible. To help manage these challenges, the majority of hospitals have adopted EHR systems that enable observational and diagnostic data, such as blood pressure, presenting symptoms, and medical history, to be readily accessible and connected directly with a patient s administrative record. However, in today s increasingly visual world, medical images, such as CT scans, x-rays, ultrasound exams, and ophthalmology studies, as well as digital images of wounds, surgery, and dermatology, have become critical to the treatment regimen, providing physicians with the ability to examine a patient thoroughly and efficiently over time. The adoption of EHRs, combined with the clinical importance of imaging data, have presented a natural and necessary directive for hospitals to align observational and diagnostic data with corresponding medical images, thereby improving physician-tophysician consult capabilities and strengthening evidence-based decision making. Further, revenue pressures from revenue entitlement reform, including new models for care delivery and payment, such as accountable care organizations (ACOs), are driving the need for improved imaging efficiency to help decrease costs and improve care. And though not yet mandated, the inclusion of imaging as a component of Meaningful Use criteria is making enterprise imaging increasingly essential. Given this backdrop, many hospital CIOs and IT specialists are seeking solutions that will enable their organization to implement an any image, any time, from any location strategy. There is no better example of this than Cleveland Clinic. Recognized as one of the country s most forward-thinking hospitals, Cleveland Clinic is a fully integrated health system comprised of 1,440 beds at its main campus and more than 4,450 total beds throughout its system of family health centers, community hospitals and regional and international hospitals. Distinguishing the network further, its MyPractice Imaging program recently initiated an EHR optimization project that provides physicians access to medical images generated by any participating Cleveland Clinic imaging service line. This innovative service redefines the electronic health record by making virtually all medical data, including most images, regardless of capture modality, available to the clinician at the point-of-care. 2
Cleveland Clinic s Visual Healthcare Evolution Like most hospitals, the roots of enterprise imaging at Cleveland Clinic can be traced to radiology. Its radiology department was among the first to adopt digital technology for capturing and storing imaging data and was also among the first to adopt a picture archiving and communication systems, or PACS, for managing the files and a radiology information system, or RIS, to manage workflow. As other specialties developed their own image capture devices, the systems remained siloed within the specific department or group. Clinicians outside of radiology or cardiology, for instance, were unable to access those patient images at their own departmental workstations. Rather, they had to go physically to the department to connect to the system or request that the data be shared, originally via film, and eventually CDs. As enterprise-wide, text-based EHRs became standard tools within Cleveland Clinic, the hospital s IT leadership, led by Chief Information Officer Dr. C. Martin Harris and his team including Medical Director of MyPractice Imaging Dr. Cheryl Petersilge, and Louis M. Lannum, Director of Enterprise Imaging began to consider the value of aligning the vast troves of medical images being generated at the hospital and its affiliates into a centralized system. As Dr. Petersilge recalled, For Cleveland Clinic and MyPractice Imaging, the enterprise imaging opportunity was recognized when we had to replace our PACS. At that time the opportunity to have and the value of having an enterprise archive were recognized. Similar to other hospitals embarking on an enterprise imaging strategy, the team at Cleveland Clinic began to evaluate vendor neutral archive (VNA) technologies because of their ability to store images from a variety of imaging formats, including DICOM, non-dicom, and digital photos, and serve them up to software-based or web-enabled viewers accessible from workstations throughout a hospital. However, as the team weighed available VNA options more closely, it became clear that providing enterprise storage was but a piece of the enterprise imaging puzzle. To truly deliver the power and value of an enterprise-wide image platform, the MyPractice Imaging team realized that workflow and indexing standards had to be established across all departments and clinicians who utilize the system. What we needed was a thinking VNA, which could do several things. It had to manage, in one place, the context of all the images, their indexing, where they came from, and where they should appear in the EHR. There would thus be only one connection back to the EHR, remarked Dr. Petersilge. The thinking VNA we selected was the Enterprise Imaging Suite developed by Agfa HealthCare. 3
Workflow & Indexing - The AGFA Difference Agfa HealthCare developed its enterprise imaging platform with the understanding that without flexible clinical workflow and advanced indexing capabilities, a VNA cannot provide the tools required for the delivery of quality, contemporary, reform-driven healthcare. However, giving physicians access to the aggregate of images associated with a particular patient is not a simple task. Most departments have their own solutions for capturing images, and their own strategies for managing patient imaging workflow, indexing, storing, and distributing those images vary greatly. Agfa HealthCare developed its enterprise-level platform based on its own extensive PACS and VNA experience. Agfa HealthCare recognized that PACS are effective departmental solutions, but are not enterprise systems able to handle the ever-increasing image data volume from different departments and multiple systems. Similarly, VNAs are optimized for storage, but not for enterprise imaging workflows, such as department-specific image acquisition, electronic ordering, clinical metadata creation, and billing automation. In today s modern hospital, nearly every department generates clinical images. Radiology and cardiology remain the most prolific, but departments as disparate as obstetrics and gastroenterology also produce images and are doing so on a more frequent basis, stated Lenny J. Reznik, Vice President, Marketing North America, Agfa HealthCare. As such, a true enterprise imaging strategy must account for thousands of potential workflows. Recognizing this challenge and seizing the opportunity for innovation, Agfa HealthCare developed a workflow-centric platform, able to meet departmental and enterprise requirements. In designing its Enterprise Imaging Suite, Agfa HealthCare understood that image-enabling the EHR is not just about viewing, archiving, and distribution. Instead, it must align these services with workflows that meet specific department requirements, and also integrate them throughout an entire hospital or health system. Interoperability and flexibility were key design goals. A true enterprise imaging strategy must account for thousands of potential workflows 4
Cleveland Clinic & AGFA HealthCare - Innovating Together In implementing its enterprise imaging strategy, the MyPractice Imaging team prioritized the order in which departments would be integrated into the system. Radiology was the first to go online, given its importance as an imaging leader within the hospital. Following radiology, the MyPractice Imaging team deliberately chose to get other departments involved rapidly, as it did not want the new system to be perceived incorrectly as radiology-only. The rationale was clear to Dr. Petersilge and the MyPractice Imaging team. An enterprise imaging system, much like a system-wide EHR, is intended to be used across multiple departments and medical disciplines. If there are significant disconnects or disagreements in how the system will function, then it will never operate as intended. As a result, cross-departmental support is a must for an enterprise imaging strategy to succeed. Cleveland Clinic s gastroenterology service was next in line, due to its position as one of the largest and most highly rated departments in this field in the United States. Additionally, with endoscopy, colonoscopy, and other imagerich procedures, the gastroenterology service line would particularly benefit from increased collaboration between their clinicians and referring physicians. After that, women s health imaging was connected along with its trove of images, including fetal ultrasounds. The pulmonary function and ophthalmology service lines soon followed. Dermatology was a noteworthy addition, as it necessitated the implementation of workflows for relatively simple, but prolific, digital cameras. As more departments were integrated, the value of Agfa HealthCare s workflow and indexing capabilities became even more pronounced. 5
Cleveland Clinic & AGFA HealthCare - Innovating Together (cont d) Dr. Petersilge noted, Developing a foundation for indexing was a big challenge. New types of orders and reports would be coming into the EHR, and this incorporation needed to be done in a thoughtful and systematic fashion. Workflows needed to be developed for each new department that was brought on board. We did not want to use a one-size-fits-all approach. Agfa HealthCare s enterprise workflow engine is designed to accommodate these challenges by coordinating the individual department workflows (where images are generated) with enterprise and regional workflows (where images are accessed and collaboration occurs). In doing so, the technology drives automated management of activities of the department, not only at the desktop but also at the backend, allowing for integration into other systems to bring patient-centric data into the workflow. that can lead to failure to properly store images or failure to properly index images. Reznik added, Understanding that most health systems need to drive doctors to use the EHR as the primary interface to patient information, Agfa HealthCare designed a workflow-centric platform that enables physicians to use native EHR terms and functionality to access and store images. Our mission is to help health organizations improve the delivery of quality care by optimizing their EHR investment. Moreover, the workflow engine can be adapted as needs change throughout the enterprise or within a department. As activities and new processes occur, the Agfa HealthCare Enterprise Imaging Suite is able to connect the dots from an image to a report, building a reference that feeds back into the EHR and is understandable across the entire enterprise. Workflow encompasses everything from creating a work list on a modality, to order generation, to notification to the EHR that a study exists, remarked Dr. Petersilge. It is critical that the workflow fits into the operational foundation established at the enterprise level. It is also important that the workflow enhances and does not encumber the work of the person generating the image. Otherwise, they are likely to find workarounds It is critical that the workflow fits into the operational foundation established at the enterprise level 6
The Enterprise Imaging Difference For modern hospitals, the ability to maximize data usage efficiency is becoming a competitive advantage. Not only can it vastly improve the operational and fiscal performance of a hospital, but it can also foster an environment of collaborative and informed patient management, supporting today s model of shared decision making, accountable care. With greater access to data (in its many forms), physicians are able to consult easily with one another, and patients and their caregivers can take a more active role in the treatment process. Since its implementation, Cleveland Clinic s enterprise imaging solution has benefited the hospital in a number of areas. Most striking, it has enabled significantly greater efficiencies in turn-around time (how quickly information gets back into the hands of the physician who ordered the tests). The results have been dramatic. A process that used to take hours is now accomplished in minutes. Image acquisition the process by which an image is initially acquired has also witnessed marked improvement. Now, the primary ratelimiting factor is the time it takes for the patient to physically travel to and from the department where the images are taken. The image enters the shared system immediately. Less easy to measure, but no less significant, is the time gained by the physicians who would otherwise have to engage in hunt and search activities to locate images. Now every user knows exactly where the images are located. Additionally, Cleveland Clinic has virtually eliminated the physical delivery of paper-based medical records, and the physical delivery of films or CDs, creating both cost and efficiency benefits. An additional notable result of the Enterprise Imaging Platform is its effect not only on the delivery of clinical services, but on back-office concerns such as risk mitigation. By providing auto-indexing of patient images at the point of image capture, and providing access to any clinician, the likelihood of medical errors is reduced. Centralized visual documentation of medical status in the form of digital camera images provides a HIPAA-compliant, traceable care history for immediate and future viewing. The Platform allows the hospital enterprise to take control of protecting medical imaging information in a secure, vendor neutral environment, enabling business continuity and disaster recovery services. By executing its enterprise imaging strategy, Cleveland Clinic is now able to increase value of its medical imaging by removing the barriers that confined images to the department that created them. 7
Why Agfa HealthCare? FORWARD THINKING HEALTHCARE ORGANIZATIONS ARE MOVING AHEAD AND INVESTING IN TECHNOLOGIES THAT ENRICH THEIR MEDICAL DOCUMENTATION WITH CLINICALLY RELEVANT IMAGING DATA. We, the specialists at Agfa HealthCare, have been in the imaging industry for over 100 years and have been in the forefront of medical imaging since 1947. Our deep collective understanding of clinical combined with our breadth of information technology experience, sets us apart. Our customers rely on our commitment to quality patient care to deliver interoperable, forward-thinking strategies for systems of all sizes. One out of two hospitals worldwide use our medical imaging systems. With a consolidated Enterprise Imaging solution and future proof approach, now is the time to invest in introducing a Value-Based Care centric model to your operations To dicuss how Agfa HealthCare can bring value to your care organization, contact us today and let s develop the right strategic plan to enrich your health system. Agfa and the Agfa rhombus are trademarks of Agfa HealthCare Corp., or its affiliates. All other trademarks are held by their 2014 2015 Agfa HealthCare by Agfa HealthCare NV respective trademarks owners areheldby and are used theirespective in an editorial ownersand fashion with areusedinan no intention of editorial infringement. fashionwithno The data in this intention publication are All rights reserved for ofinfringement. illustration purposes The only datainthispublication and do not necessarily areforillustration represent standards purposesonlyand or specifications, which do notnecessarily must be met by Agfa Corporation HealthCare. All information contained herein is intended for guidance purposes only, and characteristics of the products and Published by Agfa HealthCare NV services described in this publication can be changed at any time without notice. Products and services may not be available 10 South Academy Street herein intended is guidance for purposes only,and characteristics the products of and services described B-2640 Mortsel - Belgium for your local area. Please contact your local sales representative at agfa.com for availability information. Agfa HealthCare inthispublication canbe changedatanytimewithoutnotice. Products and services may notbe available GB 00201411 Greenville, SC, 29601 diligently strives to provide as accurate information as possible, but shall not be responsible for any typographical error. foryourlocalarea.pleasecontactyourlocalsalesrepresentative atagfa.comforavailability information. All rights reserved AgfaHealthCare diligently strives toprovideasaccurateinformation aspossible, butshallnotbe responsible for any typographical r. erro 8