Tapping into Open Systems and Interoperability to Connect Disparate IT Systems
The healthcare enterprise houses scores of disparate clinical IT systems. A precious few systems talk to each other, but many others don’t communicate readily. Connecting disparate IT systems can streamline clinical workflow and improve patient care. But how?

“Everyone is trying to glue disparate systems together,” says Kerra Guffey, vice president of information systems and CIO at Meriter Hospital in Madison, Wis. Achieving interoperability among clinical systems is a challenge. This month, Health Imaging & IT visits with a few enterprises that have overcome the challenge to learn more about how they did it and the success they’re realizing.

Solving the (multi) PACS problem

Like many of their imaging center colleagues who read for outside hospitals and clinics, the 24 radiologists at Medical Imaging Northwest in Puyallup, Wash., contend with multiple PACS. The center uses one system, and each of the two hospitals uses PACS from separate vendors. “There is network connectivity among all the systems, but they don’t talk to each other,” explains Annette Simmons, IT manager/network administrator. The various RIS and HIS applications don’t communicate with each other. PACS communication is limited to manual transmission of studies. The disconnect poses operational, IT and business challenges.

The MEDxConnect system management dashboard (SMD) from Compressus is an administrative software tool that enables ef? cient management of enterprise IT components. It provides customers such as Medical Imaging Northwest in Puyallup, Wash., with a graphic overview of enterprise work? ow operations. The bird’s eye view enables a manager the ability to monitor the network and address bottlenecks in an attempt to improve productivity and work?ow.

The digital-based system remains a labor burden because technologists must either make phone requests for manual data pushes or manually pull data from other sites. On the IT side, the center must replicate and store hospital image data locally to allow radiologists to perform true historical comparisons and maximize efficiency. Currently, hospital data consume 10 percent of the archive, says Simmons. Scanned documents also burdened the center; with the disparate systems staff needed to print and re-scan every document into its RIS, resulting in an additional hard copy of each document. Finally, the center would like to add other hospital clients, but the prospect of managing another PACS is too overwhelming.

Enter the solution. Early in 2009, Medical Imaging Northwest deployed Compressus’ MEDxConnect software to connect the various PACS. The vendor-neutral software resides on top of every PACS and serves as the driving worklist. MEDxConnect serves as the central point for all current and prior studies. The software combines HL7, DICOM and other standards to help control the flow of images, reports and other patient data among independent software systems.

How does it work? Once a patient is scheduled, the software searches all systems to pre-fetch priors, reports and scanned documents. “It’s like a single-stop dashboard for radiologists,” says Simmons. The new software also automatically load levels by specialty, which streamlines the current manual approach to specialty reads. MEDxConnect ports scanned documents into the system to eliminate the need to print a document and re-scan into the local RIS. Equally important, on the business side, the new software will help the center meet its goal of increasing volume from 350,000 studies annually to 550,000 by connecting PACS, RIS and voice recognition systems from remote imaging organizations.

The big picture: Viewing images in the EMR

Two years ago, the IT department at Meriter Hospital scored a home run with clinicians by linking its TeraMedica Healthcare Technology Evercore Clinical Enterprise Suite and Epic Systems Corporation EMR. The hospital invested in two TeraMedica licenses, Evercore-Univision and Evercore-Smartstore. The first creates a JPEG image link to the EMR that allows clinicians to access images in the EMR; the second is a standard DICOM data-management license. “The JPEGs are not diagnostic quality images,” cautions Guffey, “but they work for the majority of users. It’s a real physician pleaser.”

Meriter staff and physicians access the lightweight JPEG digital images throughout the enterprise on workstations, laptops and tablet computers for multiple purposes. Some use the link for a quick review in conjunction with the radiology report; others share images with patients to better educate them.

The hospital recently started another project to replicate its radiology/EMR success with its cardiology PACS, linking its McKesson Corporation Cardiology ECG module with the Epic EMR in the third quarter of 2008. (Meriter limited the cardiology link to ECGs since the EMR is unable to display dynamic images.) 

The connection delivers other advantages as well, says Guffey. The solution is ideal for remote users who can use their home or office workstation via Citrix to access the EMR to view the JPEGs. It eliminates the need for IS staff to support remote workstations and minimizes the IT effort dedicated to off-campus workstations.

The data chase: Driving process improvement

Data, particularly from disparate sources, presents many conundrums. One challenge, says Jake Nunn, enterprise director of radiology for Aurora Health Care in Milwaukee, Wis., is pulling, aggregating and reporting on data to improve processes. “Until last year, we spent [a lot of] time chasing data, with a lag time between the data and the report, so our actions were retrospective,” explains Nunn. The department dedicated one FTE to manual data mining and reporting.

In the summer of 2008, the radiology department deployed Exogen Healthcare Blue Ocean software to aggregate data from disparate sources in real time to improve quality indicators prospectively. The department established two goals: to decrease the time pulling data while increasing the effort acting on data.     

The premise is simple. The hospital’s IT department sends data streams from a variety of systems—registration, RIS, PACS, scheduling—through the Blue Ocean interface. The software aggregates the various information to present real-time “views” customized to various users: radiologists, managers and technologists. Unlike the previous model, users can act in real-time. For example, as a stroke center, the hospital is required to complete a CT within 45 minutes of patient arrival in the ER. The portal tracks each CT/Level 1/stroke case with an indicator light changing from green to yellow to red in the first 30 minutes. “We have the information we need to go help the ER before the 45-minute window expires,” shares Nunn. 

Early into the project, Aurora Health Care is seeing results at two hospitals that deployed Blue Ocean. For example, both saw a 10 percent improvement, in early implementation data, in the amount of time patients waited more than 15 minutes from their appointment time for their exam. As other sites within the organization add the software, Nunn anticipates using it to develop system-wide best practices benchmarks and ongoing process improvements.

Leveraging storage infrastructure

Five years after deploying PACS, Mercy Medical Center in Des Moines, Iowa, realized it needed better redundancy, availability and security for the mission critical application. In 2007, the center expanded its SAN with Carestream Enterprise Information Management (EIM) software and two IBM XIV Storage systems. The EIM software helps automate data duplication and replication between the production server and offsite backup at a separate site.

After the hospital invested in the solution, it decided to store Visicu eICU data in its re-engineered SAN. The eICU application allows clinical staff to remotely track vital signs, lab results and other clinical data. The decision to leverage the SAN to support eICU helps the hospital better leverage highly skilled clinical staff, says Roger Wilson, manager, technical services. “eICU pertains to higher acuity care, so we can’t afford to be down,” notes Wilson. Currently, Mercy Medical Center uses the system to monitor patients at two of its hospitals and plans to deploy remote ICU monitoring at a third site later this year. Current and historical imaging data also are readily available to eICU staff with the high availability EIM streamlining access.

Expert input

Specify the clinical or business goal, and use that information to inform the IT investment, says Nunn. There are multiple connectivity options and solutions; a clear goal points the hospital in the right direction and ups the odds of a successful project.

“Do your due diligence and talk to other people who have done what you are trying to accomplish,” says Guffey. Be sure to include specific language in the contract with the vendor. He recommends milestone-based contracts that tie payments to outcomes. Specifically, hospitals can tie partial payments to clearly definable points in the project including contract signing, first live patient use, 30 days post live and at the first and final image migrations. The end results are well worth the wait, users agree.