Images & the Health Information Exchange: A Work in Progress

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 - HIE interoperability

Some five dozen health information exchange (HIE) initiatives have cropped up across the nation enabling clinicians to share critical patient information with other caregivers in a timely fashion to allow swift, more-informed care. Currently, the sharing of medical images and radiology reports is very limited through HIEs, but forward-thinking clinicians and IT leaders are working to make seamless image sharing a radiological reality.

Looking towards the future

Health information exchange stands at the threshold of realizing its capabilities. The National Health Information Network (NHIN), an initiative spearheaded by the Office of the National Coordinator for Health IT (ONC), is poised to expand in scope and functionalities to establish standards, security and trust mechanisms for HIE. NHIN specifications were published at the end of January and implemented in March.

For example, the NHIN Limited Production Exchange (LPE) is one of the first instantiations used by the NHIN Cooperative, a private/public collaborate organization that builds, tests and demonstrates core capabilities to enable basic exchange of health information between different HIE networks, patients and other stakeholders.

The NHIN Cooperative—which includes Kaiser Permanente, the Department of Veterans Affairs and the Department of Defense, among others—established and implemented NHIN specifications and signed the Data Use and Reciprocal Support Agreement (DURSA) that allocates responsibilities and accountability to protect the information that is exchanged.

In April, the North Carolina Healthcare Information and Communication Alliance (NCHICA) partnered with health IT company Mirth to deploy Mirth Meaningful Use Exchange (Mirth MUx) to achieve NHIN connectivity. Funded through NCHICA’s contract with ONC, the project will enable the Western North Carolina (WNC) Health Network’s Data Link to connect to the NHIN to demonstrate how an established health information organization (HIO) can become a node on the NHIN and use the NHIN for connectivity with federal partners.

Watching the progress of this effort closely is NCHICA-member Wake Radiology, which employs 60 full-time radiologists among 11 imaging centers spread throughout the Raleigh, N.C., area. Wake Radiology currently makes radiology images available online through a portal supported by ImageCast RIS/PACS (GE Healthcare) to referring physicians, but for the most part it is still sending out radiology report requests by fax, according to Wake CIO Ronald B. Mitchell, MD.

“We’ve had requests for reports to go directly into an EMR system. However, unlike a hospital, we don’t have a large number of doctors using the same [EMR] system,” says Mitchell. “They’re all using different EMR systems and they’re outside our network firewall, which makes our lives a little more difficult.”

If a report is to be sent to an EMR, a one-to-one secure channel must be configured. “Each time you do this, you have to re-customize the HL7 feed, which can be very expensive,” says Mitchell.

“One of the big barriers to exchange is the uncertainty created by variation in state laws and organizational policies,” says W. Holt Anderson, executive director for the Research Triangle Park-based NCHICA. The organization is currently working with its broad membership to adopt standards to effectively exchange clinical information across disparate systems.

“A HIE will enable Wake to provide one secure channel to the HIE, then all the different EHR systems out there will be able to access the reports and images through the HIE,” says Mitchell.

One state, one vision

An area of HIE development for radiology lies in yet another ONC-funded project, the newly announced Beacon Community Awards. In May, the agency awarded $220 million to 15 “Beacon Communities,” which will serve as models for the widespread use of health IT. The Eastern Maine Healthcare Systems in Brewer, Maine, received $12.7 million to expand community connectivity to existing HIEs.

“The most important things a radiologist needs are the relevant prior studies,” says Robert Coleman, director of radiology informatics at Maine Medical Center (MMC), part of MaineHealth. The state has worked hard to advance and standardize its image-exchanging properties for the benefit of the state’s community. In 2001, MaineHealth, the 600-bed MMC and other healthcare providers developed the Consolidated Imaging Initiative (CI-PACS) to explore ways to allow multiple organizations to