Closing Technology Gaps

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Acquiring new technology and linking it to existing systems is often plagued with problems. Gaps certainly exist, but integration can be accomplished with a combination of standards, technical know-how and willpower. See how some forward-thinking facilities are bridging the technology gaps with the EMR, uniting radiology across the healthcare enterprise, wireless security and decision support.

New imaging and information technologies are hitting the market at a rapid clip, with healthcare facilities everywhere implementing electronic medical records (EMRs), computerized physician order entry (CPOE), wireless technologies and PACS to enhance patient care and improve workflow. Although state-of-the-art solutions certainly benefit healthcare providers and their patients, there are some significant technology gaps that need to be closed to more fully realize their potential.

Many gaps relate to technology integration. Thomas Berg, director of clinical information services for Marshfield Clinic (Marshfield, Wis.), explains, "In most cases, we don't necessarily need to invest in new technology. We need to integrate the existing technology." This requires communication and collaboration among vendors, which is a critical step in fulfilling the mission of the Integrating the Healthcare Enterprise (IHE) initiative from RSNA and HIMSS.

In other cases, the solution may be right around the corner. Paul Chang, MD, director of the Division of Radiology Informatics at University of Pittsburgh Medical Center (Pittsburgh, Pa.), contends that other industries have developed solutions to overcome the interoperability and security issues that plague healthcare, but healthcare has been slow to learn from its IT colleagues outside of medicine.


The EMR is a great breakthrough in consolidating patient information, but the lack of integration between the EMR and the imaging department tops many technology wish lists. Take Evanston Northwestern Healthcare in Chicago. The system is at the forefront of the electronic patient record system. Its three hospitals and 50 outpatient sites rely on a single system to integrate computerized physician order entry (CPOE) and electronic health records (EHRs) with all patient charting; ordering of tests, procedures and medications; registration, scheduling and physician billing.

On the plus side, the single clinical information system is expected to improve patient safety and quality of care while saving the organization $10 million a year. Integrating imaging equipment into the EMR system, however, is proving to be a major challenge.

Mary Ann Cardello, director of clinical applications, points out, "We have achieved partial success with an API [application protocol interface] from our PACS to the EMR. But it's an all-or-nothing proposition that gives physicians access to all patients, which is a HIPAA and a workflow issue. We're at a stalemate where the technology is able to bring us to this point, but isn't able to focus on a single patient."

One attempt to overcome the disconnect focused on cardiac images and fetal and cardiac ultrasound studies. The hospital printed and scanned studies back into its Epic (Madison, Wis.) EMR system for easy access; however, the resulting images weren't diagnostic quality, forcing clinicians to sign off Epic and onto the native system to view studies or track radiologists for results.

Currently, the hospital's internal web system provides access to all PACS images, but users must leave the EMR application to go to the image viewing application. To date, only 12-lead EKG is easily accessed through the EMR; a simple link on the Epic Systems' EMR allows physicians to view EKG images. CIO Tom Smith explains, "We would like to use the 12-lead EKG model for all images. We don't want to store images in both the native system and in Epic."

Smith predicts that eventually Evanston Northwestern will integrate the EMR and imaging technology. The process, however, is somewhat lengthy. The hospital is working with one of its primary vendors, GE Healthcare (Waukesha, Wis.), to provide a link in Epic reports to the PACS web server, but it may take 18 months to develop.

Smith says other sites can learn from Evanston Northwestern's experience. "Our focus on using the EMR to remove patient charts has been successful, but we didn't pay enough attention to ancillary imaging systems when we implemented the EMR. Most vendors are willing to talk to us, but now there is a time