Chang presents roadmap to the enterprise image-enabled EHR
HIMSS tackled the multimedia, image-enabled EMR implementation process during Tuesday’s Enterprise Integration Strategies toward the Image-Enabled EHR educational session, co-sponsored by the Society for Imaging Informatics in Medicine (SIIM).
Successful implementations hinge on close cooperation between radiology, cardiology and IT, said Paul Chang, MD, medical director, enterprise imaging at University of Chicago Medical Center in Chicago. Other essential criteria, said Chang, focus on IT and the enterprise. That is, IT has to play a dominant role in electronic health record implementation, and an enterprise perspective that takes the needs of all users into account is required.

A site with reasonably functional EHR building blocks can achieve true integration and interoperability by adhering to certain objectives:
  • The image-enabled EHR must be a completely acceptable substitute that does not sacrifice functionality, fidelity or accuracy;
  • The image-enabled EHR must support all multimedia objects including visible light, video and waveforms;
  • Presentation and functionality must be optimized for a diverse array of users and workflows. A single common interface is a non-starter, said Chang; and
  • The EHR must leverage existing IT infrastructure.
The building blocks, or steps, of the image-enabled EHR are PACS, an enterprise image distribution strategy, incorporation of non-DICOM image objects, a viable integration model and interface/workflow optimization.
PACS has become ubiquitous and economically viable, and the infrastructure — networks, archives, workstations – has improved to the point necessary for image distribution via the EHR. In addition, better integration models reduce dependence on RIS-PACS broker agents.
But challenges remain, says Chang. PACS is only one component of the fully-leveraged solution. Image size continues to grow exponentially, and more clinicians require advanced visualization functionality, which means advanced visualization functionality must be a component of the image-enabled EHR.
The next challenges to overcome are the development of a strategy for enterprise distribution of images and incorporation of non-DICOM images in the PACS archive, which can be achieved via a DICOM “wrapper.” What’s more, specialties outside of radiology need a RIS-like workflow and information management systems.
The integration model gathers the bits and pieces of the EHR. Chang shared two classes of integration: context sharing and true interoperability that shares information. The context sharing model is coordination — not true interoperability, Chang said. This model centers on a common desktop, CCOW or instantiation of the image viewer client by the EHR client. Despite some drawbacks, context sharing may serve the integration needs of many users. Advanced or true interoperability allows users to instantiate and orchestrate business logic and decision support.
The end goal of the enterprise image-enabled EHR is optimized, customized workflow and user experiences, said Chang. Advanced integration approaches that can meet the goal include IHE and service oriented architecture such as web services.
Ultimately, the image-enabled EHR is not a mere outgrowth of PACS-RIS workflow. A truly successful implementation is based on an enterprise perspective and user-centric workflows, said Chang.