Making a case for multimedia EHRs
Multimedia electronic health records (EHRs) are essential, according to a January 2011 workshop examining the role of multimedia images in the EHR. However, the report based on the workshop, which was published in August in Journal of the American Medical Informatics Association, outlined various challenges to the development of fully functional multimedia EHRs.

Co-sponsored by the National Institute of Biomedical Imaging and Bioengineering (NIBIB) and the Office of the National Coordinator for Health Information Technology, the ‘Images, Electronic Health Records, and Meaningful Use’ workshop gathered approximately 100 stakeholders to consider the integration of imaging data in the EHR.

Belinda Seto, PhD, of NIBIB, and Charles P. Friedman, PhD, of University of Michigan in Ann Arbor, noted that the challenges of integrating images into the EHR also extend to other data such as genomics, proteomics, waveforms and sounds.

The stakeholders emphasized the central role of images in screening, diagnosis, surveillance and therapy. “To the extent that imaging data are used in planning and clinical decision making, they should be as accessible as data that are stored in alphanumeric form,” wrote Seto and Friedman.

Workshop attendees described challenges in importing and interpreting imaging data due to a lack of interoperability, which, in turn, results in delayed or incomplete diagnosis or repeated scans. They noted that the NIBIB/RSNA image sharing project, which leverages the Integrating the Healthcare Enterprise (IHE) profiles and DICOM and patient control to share images offers a template for a successful model. “The goal is to ultimately supersede the use of CDs as media for image exchange.”

The authors referred to previous studies detailing referring physicians’ preference for radiology reports with embedded images. The availability of integrated imaging data and addition of decision support could “enable decisions that are based on guidelines, evidence from the literature, medical knowledge and comprehensive patient data.”

During the workshop, stakeholders described the wide variety of image data sets, ranging from dental x-rays to dermatology photographs to pathology slides and MRI scans. They also provided use cases illustrating how different specialists used images during the patient care process.

The participants detailed several multimedia EHR success stories. At the Mayo Clinic, in Rochester, Minn., with providers in five states, enterprise access to images provided by the EHR has reduced costs per study by 40 percent compared with film. Massachusetts General Hospital in Boston has enabled enterprise image distribution via the EHR and integrated computerized order entry and decision support. The systems have resulted in a 19 percent cut in imaging exams from 2005 to 2008.

Key prerequisites to multimedia success include DICOM standards and either adequate bandwidth to exchange images or strategies to overcome limited bandwidth.

Seto and Friedman concluded by noting that most clinicians do not have integrated access to multimedia information in enterprise EHRs and called on rulemaking bodies to consider the role of images in Meaningful Use.