Images in the EMR: One Size Does Not Fit All

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Image source: Children’s Medical Center of Dallas

As more and more healthcare enterprises deploy and expand EMRs, the issue of clinical image access within the EMR presents itself. For radiologists and referring physicians alike, image access in the EMR can be a game-changer—boosting clinical collaboration, enhancing patient education and care and shaving minutes from patient encounters throughout the day. Although the benefits of image access in the EMR are clear and multifaceted, there is no straightforward formula for a successful integration.

That’s because the roadmap to and model for image access varies among and, oftentimes, within institutions. Some cutting-edge facilities shun customization and employ an EMR-centric model for all image access. Others adopt a more flexible model that allows users to determine their image access method and offer a progression of options to support diverse workflows across the enterprise. This month, Health Imaging & IT visits a variety of enterprises to learn more about their strategies for image access in the EMR and the clinical, workflow and patient care benefits derived.  

HIMSS Stage 7 Sites: A tale of two models

The 52 facilities that have earned Healthcare Information Management Systems and Society (HIMSS) Stage 7 EMR status epitomize paperless healthcare and readily share clinical information via standard electronic transactions with all entities within health information exchange networks. Most also emphasize rich image access mechanisms. However, while one pioneer stresses user-centered flexibility, another focuses on patient-centric standardization across the enterprise.

HIMSS Stage 7 site University of Wisconsin Hospital and Clinics (UW Health) of Madison, is comprised of a 493-bed facility and 85 outpatient clinics. More than 1,200 physicians are affiliated with UW Health and expect image access in the EMR as the health system integrated PACS and the EMR nearly a decade ago.

“We see a wide variety of image access needs across the enterprise,” offers Gary J. Wendt, MD, MBA, vice chair of informatics and enterprise director of medical imaging. The academic medical center strives to support a variety of imaging workflow models among clinical end users. “A lot of image-intense people don’t live in the EMR. A neurosurgeon or orthopedic surgeon may sit in front of a dedicated workstation and work more like a radiologist than a primary care physician,” explains Wendt.  

Children’s Medical Center of Dallas, another Stage 7 institution, a two-hospital system with five specialty centers and 11,000 EMR users, employs a very different tactic. “Customization is a bad word,” offers CMIO Christopher Menzies, MD. That’s because customizations tend to break down with upgrades. Instead, Children’s emphasizes platform-enabled nimbleness and encourages all providers to use the EMR as the single patient chart and access point for all radiology and non-radiology images.

The clinical rationale for maintaining the EMR as the central enterprise hub is simple. “Images don’t make up the patient. They don’t have all of the essential clinical information attached to them. Patient data stored in the EMR, coupled with images, make up the patient,” explains Menzies.

The IT infrastructure for different types of image sets varies slightly; however, Children’s strives for a seamless, standardized viewing experience for the end user. The enterprise established a completely integrated environment; a context-enabled link in the EMR takes users directly to radiology images stored in PACS.  Secure data are delivered through a hosted environment and are available for all users across the enterprise. Other images such as photographs of lesions are stored directly in the EMR, and some are housed in niche image management systems. Although images are stored in multiple systems and users can view images via a variety of systems, Children’s stresses the EMR as the access point.

Menzies recalls an encounter with providers accessing echocardiograms via the cardiology PACS. He asked why they preferred that method over the EMR. When they responded that it was faster to access the studies via the cardiology PACS, Menzies suggested an EMR interface to streamline access via the EMR. The fix worked and edged the medical center closer toward its universal EMR hub model.

The ultimate beneficiaries are patients because the central hub model improves multidisciplinary collaboration among caregivers. When