Enterprise image management can be a moving target, with every enterprise interpreting the term slightly differently. “Enterprise image management goes beyond PACS to incorporate imaging informatics management include workflow, document management, dictation and RIS in addition to images,” offers Ron Cornett, PACS administrator for Radiology Ltd. in Tucson, Ariz. Others tout a PACS-centered view, defining enterprise image management as a single sign-on viewer for referring physicians. Many wrap the “ologies” including radiology, cardiology, radiation oncology and others into a single enterprise archive.
Regardless of the specific definition, enterprise image management carries some complex, unique and variable needs. In some cases, the primary challenges stem from Healthcare Information Protection and Portability Act (HIPPA) and patient confidentiality. In others, technology and integration are the primary barriers. The upside, however, is facilities that successfully navigate the waters of enterprise image management report a number of significant benefits including:
- reduced costs and increased profitability
- improved patient care and safety
- enhanced services to referring physicians
- accelerated diagnosis, report turnaround and treatment.
This month, Health Imaging & IT visits with several enterprises to learn more about the challenges and benefits associated with enterprise image management.
The virtual enterprise
Diagnostic Radiology Consultants (DRC) of Chattanooga, Tenn., may be the future of imaging services. The 10-radiologist practice reads more than 200,000 cases annually for 10 diverse practices in Tennessee and Georgia. The enterprise image management approach is fueling growth and enabling expansion into new locations. For example, the state-of-the-art ‘dayhawk’ practice is negotiating contracts with sites in Florida.
The primary challenge for DRC is that the entities we read for may or may not have a HIPPA relationship with each other, says Director of Informatics James Busch, MD. The practice required a solution that would maintain patient confidentiality across the disparate organizations while allowing DRC radiologists to view the entire patient imaging and report chain across the enterprise without multiple log-ins or passwords. In other words, the radiologist needs access to original x-rays and MRIs acquired at a primary care practice and the follow-up MRI ordered by the affiliated orthopedic group. At the same time, the orthopedic group must be restricted from viewing the prior images and reports unless there is a HIPPA relationship with the initial practice or the patient grants permission. At the same time, each organization requires immediate access to images and reports for its studies.
Two years ago, the need for an enterprise approach led DRC to create Specialty Networks, an IT arm and application service provider. Specialty Networks partnered with Siemens Medical Solutions, and the practice replaced its first generation PACS with syngo Suite including syngo Imaging PACS, syngo Workflow RIS, syngo Voice speech recognition and transcription and NextGen Healthcare Information Systems electronic practice management system. DRC also deployed syngo Suite at facility where it interprets studies. The central syngo architecture segregates images by location and uses a different master index for each site, thus meeting HIPPA and providing legal and appropriate access to each user.
The solution serves as the foundation for an imaging health record, says Busch, and it has delivered critical patient care and practice benefits. For example, the 10 radiologists in the practice offer multiple sub-specialty expertise. “The area ENT surgeons strongly prefer that our ENT specialist interpret their studies. Before syngo, the radiologist had to be at the site where images were acquired to read the images even though they were on PACS because our system did not meet HIPPA patient confidentiality rules. Now, he can read images from anywhere. Surgeons have an immediate response to the most skilled interpretation. Before syngo, they might have to wait up to five days or settle for another reader. The technology truly improves patient care and referring physician satisfaction.” Average report turnaround has dropped from 24 hours to less than an hour, and Busch calculates that the practice has saved the equivalent of one radiologist FTE.
What’s more, as the practice evolves Busch foresees drastic improvements in