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Enterprise Imaging: Beyond Cloud-based Image Sharing

Published on the April 8, 2013 DiagnosticImaging.com website

By Whitney L.J. Howell

Zero-footprint viewers. Vendor-neutral archives. Image mobility. Individually, they are helpful tools to radiology and becoming more ubiquitous. But together, they help create a cohesive enterprise imaging strategy.

Enterprise imaging (EI) isn’t a particularly new idea, but to date, it has been largely misunderstood, industry experts say. It’s more than simply implementing new technology. And, achieving the full benefits EI can provide will require both sophisticated software and provider engagement.

“Enterprise imaging is a hot topic, but there’s a big misconception around what we mean by it,” said Paul Chang, MD, University of Chicago School of Medicine’s enterprise imaging medical director. “Enterprise imaging is a much broader, more complex problem when you take the enterprise perspective rather than the silo perspective.”

What is EI?

Put simply, the goal of an EI strategy is to ensure the correct image is delivered to the right place at the appropriate time. It has the potential to fundamentally change how facilities, providers, and patients interact with diagnostic images. Reaching that goal, however, requires a great deal of collaboration, Chang said.

According to a 2012 KLAS report, many facilities are already moving in that direction. Of the 134 providers surveyed, most reported being in early EI stages. To create a fully integrated EI system, Chang said, these facilities and others must address five factors that affect how the healthcare system currently views and uses diagnostic images.

1. Archive architecture. For many providers, EI simply means implementing a vendor neutral archive (VNA), an archive-neutral vendor, or using a zero-footprint viewer, all methods for easily sharing images within the facility and off-site. However, the archive is only one part of a successful EI strategy, albeit an important component. It’s important, Chang said, to free radiology departments and practices from being tethered to one PACS, but identifying and employing an effective VNA is largely an IT responsibility.

“VNAs and zero-footprint viewers are just the middle wear that links commodity storage to the application layer,” he said. “We’ll do it, and we’ll go to the cloud. But it’s all buzzwords and plumbing. That’s designing the car. Now radiologists have to learn how to drive it.”

2. Multiple creators and consumers. Radiologists are no longer the only specialty that produces and uses diagnostic images. Today, cardiology, gastroenterology, pathology, and several other departments rely on imaging to provide proper patient care, so facilities must have a streamlined way to distribute scans throughout the health system.

“To do this right, you do need the architecture of a VNA or archive-neutral vendor, but there’s a bigger concept behind enterprise imaging,” Chang said. “This view is the realization of the modern enterprise that it must deal with both consumers and producers of images simultaneously throughout the hospital — not just radiology.”

 3. Ubiquitous electronic health records (EHR). The concept of an EHR isn’t new to radiology, an industry that has used PACS and RIS for many years. But now, meaningful use requirements are calling upon the specialty to interface seamlessly with patients’ records through an entire health system. Consequently, according to KLAS imaging research director Ben Brown, all new systems must be interoperable. It will be up to a facility’s IT department, Brown said, to create an infrastructure that manages and stores PACS, maintain a patient index to ensure proper patient identification, and determine how long images are stored.

4. The enterprise concept. Years ago, when radiologists discussed “the enterprise,” the term referred to anyone outside the department who still worked within the hospital’s firewall. But as health systems have expanded and more specialties have become image producers and consumers, the definition of “enterprise” has expanded, Chang said. Radiology groups have consolidated, many facilities within the same system are separated by hundreds of miles, and providers are now required to read scans for multiple hospitals.

The logistics of moving images from one facility to another aren’t difficult — the real challenge comes in coordinating the workflow needed to properly use transferred scans. According to Rasu Shrestha, MD, MBA, a University of Pittsburg Medical Center radiologist, however, the potential exists, for EI to have a significant positive impact on work  flow management.

“[EI] allows for a patient-centric approach to care versus an image- or application-centric approach,” he wrote in a 2012 Applied Radiology article. “It allows for the possibility of true collaboration among care teams, which would bring the value of imagers back into the spotlight.”

5. Tying it all together. The real challenge behind effective EI, Chang said, is to fuse the needed technology with the proper workflow perspectives. But it can be helpful, he said, to consider that EI is less about imaging and more about radiology’s need to re-invent itself as healthcare enters a new chapter of value-based purchasing.

“The concept of enterprise imaging is a proxy or code word for having to re-engineer a more useful, comprehensive workflow solution for a more complex enterprise,” he said. “It’s better not to talk about enterprise imaging but talk about re-engineering ourselves so we can continue to add value.”

How can you plan?

It’s no longer a question of whether EI is right for your practice or department. Radiology’s move toward EI is clear, and it’s up to you to determine how you will navigate these new waters. There are many moving parts with this imaging strategy, Chang said, but you can outline your course of action by remembering one question: “What is the role of radiology or the radiologist in this decision?”

For example, as the end-user, you can — and should —tell your IT department what you need out of a VNA, but don’t expect to be included in any purchasing decisions. The facility’s chief financial officer and chief information officer will make that determination, he said.

You will, however, have a greater role — alongside cardiologists and other providers — in determining how the VNA architecture will support your needs and workflow. In addition, you must make it clear to your hospital administrators and IT department that any EI system must offer interoperability for the strategy to succeed, said Robert Barr, MD, president of Mecklenburg Radiology Associates in Charlotte, N.C.

Through interoperability, he said, his practice — which has been using EI for several years — is able to quickly migrate images between all subspecialties, streamlining patient care and facilitating greater access to patient records.

Your biggest role, however, will be in providing evidence that supports the true value you bring to your facility. Your worth is no longer tied solely to the number of interpretations you produce daily, Chang said. You must now demonstrate your impact on patient outcomes, population management, and down-stream resource utilization and cost control.

“In the fee-for-service environment, we could be selfish and insular in our thinking. We floated everyone else’s boat,” he said. “But now we’re a cost center, and every CT you order better be worth it. Justify it, and demonstrate its positive impact.”

To read the remainder of the article at its original location: http://www.diagnosticimaging.com/enterprise-imaging-beyond-cloud-based-image-sharing/page/0/1

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April 10, 2013 Posted by | Healthcare | , , , , , , , , , , , , , , , , , , , | Leave a comment

Mobile Computing in Radiology: the Challenges and Benefits

Published on the Feb. 12, 2013, Diagnostic Imaging website

By Whitney L.J. Howell

Hospitals and physician practices are full of electronic sounds. The whir and clunks of imaging equipment. The quiet hum of patient monitors. The background buzz of computers. In recent years, though, a new sound has become ubiquitous: the ding of the text message or mobile email. Smart device technology has come, full-throttle, to radiology.

More than 80 percent of physicians own and use mobile devices, according to recent surveys, and, a 2011 Jackson & Coker Associates study reported nearly 25 percent of radiologists were already using them clinically. That number has only grown in the past two years, said Jon DeVries, vice president of product solutions at Merge Healthcare.

“At any industry event or session, every single radiologist comes in with some sort of handheld device. Every single one of them is using mobile technology to some extent. It’s a massive trend,” he said. “It’s changing the way people practice. Diagnostics are still done at work stations, but it’s changed how they collaborate, form partnerships, and provide care.”

A Culture Shift

Radiology has always been the early adopter of technology in health care. But, even among this forward-thinking specialty, introducing and incorporating mobile devices into everyday use required a cultural shift. The biggest factor, said Rasu Shrestha, MD, vice president of medical information technology at the University of Pittsburg Medical Center (UPMC), has been provider age.

“One of the key things we’re seeing is an entirely new generation of clinicians that has always been used to technology, and they’re developing a level of comfort and acceptance of mobile devices in the industry,” he said. “Even other clinicians are getting accustomed to this notion of always being ‘on.’”

The ready-made access to colleagues that mobile devices provide has also helped nurture the spirit of collaboration within the specialty. As mobile devices and apps move from being novelties into mature technologies, Shrestha said, radiologists and other clinicians are more easily able to work together as a clinical care teams. Being mobile has gone from being trendy to being a necessity.

“A little more than a year ago, ‘apps’ and ‘mobile’ were buzzwords,” he said. “Now they’re accepted as part of workflow, and they’re well integrated.”

One of the greatest outcomes of increased provider comfort with mobile technology has been improved communication between provider and patient. Providers can now display images on a tablet for patients to see, and viewing the studies on a smaller, more familiar device — rather than a large, clinical screen — can be less intimidating for the patient.

Improving Communication

Perhaps the biggest way smartphone and mobile device technology has touched radiology is through enhanced provider communication, DeVries said. Whether it’s with critical care or emergency patients, mobile technology has streamlined the way radiologists and referring physicians discuss patient care.

“The big area where we see radiologists using smartphones and tablets is in the way they interact with colleagues,” he said. “These devices give them the freedom to get out of the reading room and out onto the floor so they can have face-to-face interactions with co-workers and patients. It’s enabled them to build better relationships.”

Mobile technology can even help you stay connected when you’re away from your hospital or practice. Various apps for the iPhone, Blackberry, or Android let you quickly look at scans so you can discharge patients or initially evaluate a trauma case. These apps aren’t intended to be used for true diagnostic reads, DeVries said, but they do keep the process of patient care flowing.

Herman Oosterwijk, president of Texas-based health care technology training and consulting firm Otech, agreed that mobile devices are the lynchpin of prompt communication and timely patient care. While reaction time to an email might be slow — often more than an hour — responses to text messages are frequently instantaneous.

“Texting and communication between smart devices is incredible,” he said. “People are always listening for that ‘beep’ or ‘ding-dong’ that alerts them that someone wants to tell them something.”

According to DeVries, Merge’s iConnect product offers you this kind of immediate access. The zero-client viewer can be launched through any electronic medical record system and can pull images from any PACS. Carestream’s Vue Motion software also offers similar capabilities, presenting you with patient information quickly to avoid any slow-down in care.

To read the remainder of the article at its original location: http://www.diagnosticimaging.com/practice-management/content/article/113619/2128049

February 26, 2013 Posted by | Healthcare | , , , , , , , , , , , , , , , , | Leave a comment

   

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