Charting a Course for Interoperability: Connecting Data, Connecting Patients

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With the feds brandishing more than $20 billion dollars to encourage health IT adoption and usher in a new era of streamlined healthcare, interest in integration stands at an all-time high.  The ability to integrate, share and route data among disparate systems is essential. And the rationale extends beyond dollars. “This isn’t just another way to deliver information. It’s a way to stay connected to the communities where you do business, so patients can get the best possible care,” says Susan Hollabaugh, project manager, clinical information at RadNet, Inc., in Los Angeles.

The road to interoperability is riddled with obstacles. For starters, there is the sheer universality of integration; it is an ongoing enterprise and cross-enterprise project that comprises hundreds of imaging and IT systems including the EMR, PACS and much more. Current priorities range from image access in the EMR to the deployment of a vendor-neutral archive. It’s no surprise that stakeholders’ understanding of integration is uneven; many may not have a clear picture of their needs. In addition to appreciating the enormity of the undertaking, facility teams should anticipate logistical, leadership and communication challenges. On the plus side, vendors’ openness to interoperability has improved in the last few years.

This month, Health Imaging & IT visits a few pioneers to learn more about the process of integrating data among disparate IT systems.

Customers first

RadNet is a massive outpatient imaging network and integration powerhouse. The 188 imaging center practice currently relies on two dozen separate outbound interfaces to share data among disparate EMRs and health information exchanges (HIEs) and aims to complete close to 100 by the end of 2011.

Current RadNet integration solutions run the gamut from radiology reports and image exchange to a pilot order entry project. About 90 percent of the company’s integration requests center on electronic results distribution. But every provider has unique needs, and their needs evolve as they comprehend the potential of a mere interface. Some providers want a link to the PACS viewer in the report; others ask for key images embedded in the report. Finally, image-intense specialists, like radiation oncologists, want DICOM images routed directly into the treatment planning system.

RadNet’s Hollabaugh preaches provider-centered flexibility. “We want to be the easiest people to do business with. We are open to trying anything that might meet our customers’ needs.”

In each case, RadNet aims to determine the provider’s specific goals by asking physicians how they plan to use the data and when and where in the care stream they need access. The best approach, says Hollabaugh, begins with meeting providers to help them become more informed. “Many times they don’t know what questions to ask; the provider may not understand implications of a workflow.”

Asking providers and vendors probing questions often produces interesting answers, says Hollabaugh, and RadNet finds the pat answer isn’t always right. For example, HL7 isn’t necessarily the best way to share reports because the text-based standard does not generate a crisp presentation in the EMR. Sometimes, a PDF or mime-encoded file better meets users’ needs, she explains.

In other cases, users haven’t fully grasped their needs. For example, although RadNet developed multiple options to give many radiation oncologists what they thought they wanted—DICOM images—none of the initial solutions quite met the clinicians’ needs. Ultimately, after RadNet staff met with radiation oncologists, they realized the physicians wanted to log into RadNet sites and pick images to load into treatment planning systems. A pilot project that securely transmits DICOM images into treatment planning systems is “very promising.”

After meeting with the provider, Hollabaugh and her team work with the vendor to craft a solution. Hollabaugh tosses a fair amount of vendor finesse into the process. Recognizing that vendors are busy with meeting meaningful use requirements, recertifying systems and handling an ever-growing numbers of requests for interfaces, Hollabaugh tries to begin the interface process by partnering with a practice that has a very good relationship with the vendor. When the target interface works, it can be transferred to other customers.

The universal patient

Cleveland Clinic epitomizes the connected enterprise. Its core EHR provides physicians at any of