Next-generation Image Viewing: The Vision for Value-based Medicine

Physicians’ needs are simple: intuitive, immediate access to the most comprehensive patient information and multimodality images, including priors and associated clinical content such as reports and consents. But the difficult task of locating all this information can require too much time to be practical. Only recently has prevailing opinion shifted away from the centralization of information toward the importance of the viewer as the key driver to delivering an outstanding and complete clinical experience.

What if the viewer itself was better in­formed about the clinical context of the interpretation than the EMR that launched it? It has historically been impossible to accomplish this goal—even when leveraging scores of complex and costly custom integrations. A new era is dawning with a new breed of advanced universal viewers that combine the workflow of a health information exchange with the image management capabilities of a vendor neutral archive to achieve a new level of viewing automation and intelligence right out of the box. These new capabilities are naturally extended to future use cases such as image sharing, referral management and even revenue cycle optimization workflows—just in time for health systems, hospitals and group practices which are morphing and migrating business processes to thrive in the new world of accountable care. 

“The first step to move from volume to value is changing the way people think and work, which starts with the way physicians search for and order images,” says cardiologist Vinay Malhotra, MD, of The Cardiac Study Center, a large group practice in Tacoma, Wash. The group is the largest independent single specialty practice in the area with 15 cardiologists who attend to 70,000 patient visits per year.

“When we see a new patient with a new or existing problem, we turn to the EMR to find images that may help us,” Malhotra notes. “Sometimes we find some images, sometimes they exist but we don’t know that they do. Even if patients bring us images, we wonder what else is missing. Most often, we must start over again by ordering more tests.  Physicians need to move beyond this kind of thinking as they must now manage populations. Ordering more tests increases costs and actually decreases the quality of service.”

A Next-gen Universal Viewer Can Support:
  • DICOM and non DICOM images
  • Unstructured clinical content with and without an ECM (need a security model)
  • Concise and clinically relevant clinical views when launched from within or outside the EMR
  • Inclusion of clinical content from disparate systems that are not integrated to a VNA or ECM
  • Incorporated image sharing and clinical content collaboration
  • Referral workflow including clinical content transfer and health information exchange

Right now the roadblocks to widespread data and image access are many. There are often multiple PACS and advanced visualization systems storing images that are of interest, with various links being sent to the EMR in numerous places depending upon the type of image or the location in which the image link is found within the EMR. Next-generation viewers solve these problems by independently informing themselves to build an understanding of the available clinical content and the location of relevant images.

A key characteristic of a next-generation advanced medical image viewer is the ability to provide a convergent, inclusive view of data across disparate data silos, including image and non-image data when used outside of the EMR. Like the Apple mantra that no one should need to learn their technology device to use it—TeraRecon is debuting a solution called iNteract+ that allows physicians to sign in directly and take off running outside of the EMR. With a content-rich informed universal viewer, a better physician experience is launched from within the EMR, too. 

The added intelligence makes the implementation of viewing technology practical, rather than requiring months of expensive and time-consuming integration and testing. The presentation of clinical information and diagnostic images occur simultaneously without searching. Support for a cloud-based health information registry allows searches to include HIE content within the common view.  Each patient study is presented with related multimodality studies, priors, and relevant clinical data such as ECG tracings and discharge reports. Data can be mined for presentation and individualized by practice, physician or radiologist. The next-generation viewer also can empower physician referral workflow, image sharing, mobility and diagnostic interpretation—even with integration to voice dictation and reporting solutions.

Today, image enablement of the EMR is focused primarily on basic viewing without consideration for the end-to-end lifecycle of clinical images in particular.  For this reason, there is an emerging trend to deploy the universal viewer first and the vendor neutral archive (VNA) second—a recent reversal of practice. In such cases, the viewer’s ability to bring data together and deliver a great clinical experience will become a primary focus.

The notion of embedded viewers in which one type of viewer launches within another viewer is impractical and limited. Plus, only about half of new EMR installations currently have some form of an enterprise content management system (ECM) or VNA.

“This [new model of image viewing] will reduce costs as population management becomes key,” Malhotra says, “As a practice, we are embracing this before the hospitals because we see the increases in patient outcomes, value and quality that will come, too. Having the complete information we need will allow us to see and treat a patient in three visits versus 10, giving us more time to see new patients and allow us to focus on the practice of medicine. This is a vision a lot of us have had and now the technology to achieve it has finally become accessible.”