Advanced Visualization in the EMR

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Screen shot courtesy of TeraMedica.

The push to develop EMRs across healthcare enterprises really lies at the heart of  the Health Information Technology for Economic and Clinical Health Act (HITECH Act, part of the American Recovery and Reinvestment Act of 2009), and it is certain that all medical documents—including images and imaging reports—will eventually become part of the electronic health record. But those images are not just limited to diagnostic radiology. They include everything from endoscopy and cardiology images to  dermatology and dentistry. And they also include advanced visualization (AV) images.

What is the value of advanced visualization integration with EMRs? According to Janice Honeyman-Buck, PhD, associate professor and director of informatics, department of radiology, University of Florida, advanced visualization “has become a standard of care.” And while radiologists seem to own AV, she says, other specialists, particularly neurosurgeons and orthopedic surgeons, are increasingly relying on the technology.

“They want to be able to see the same thing the radiologists are seeing,” says Honeyman-Buck, who is also editor-in-chief of the Journal of Digital Imaging of the Society for Imaging Informatics in Medicine (SIIM), as well as an imaging informatics consultant. “So they needed to be provided with the tools they need to do their jobs.”

Gary Wendt, MD, professor of neuroradiology at the University of Wisconsin, Madison, says there are obvious benefits to being able to integrate advanced visualization into an EMR—but only after it has been extended throughout the enterprise. “Getting integrated advanced 3D imaging and perfusion processing into the EMR isn’t really worth the effort if your radiologists, neurologists and neurosurgeons can’t even get at the application at a regular workstation. If that’s the case, then why worry about it in an EMR?”

Consequently, before a healthcare enterprise even thinks about integrating advanced visualization into an EMR, it needs to see whether AV extends throughout its PACS, Wendt says. “And I don’t think most sites even have advanced visualization available everywhere within their PACS. We [the University of Wisconsin] have PACS integrated with EMRs at multiple sites and that’s really critical.”

One problem is the sheer difficulty of making sure that specific advanced visualization applications are available throughout an enterprise, says William Boonn, MD, chief of 3D and advanced Imaging and associate clinical director of imaging informatics, Hospital of the University of Pennsylvania in Philadelphia.

“The move to thin client helps considerably,” says Boonn, “But you still run into a problem that a particular application still needs to be installed everywhere you want to display the images. That’s typically not possible, or even reasonable, in a larger enterprise.”

According to Wendt, much depends on an enterprise’s PACS environment to successfully integrate AV into an EMR. Wisconsin uses McKesson PACS and Vital Images advanced visualization software, “so for us,” says Wendt, “once we had the integration of McKesson and Vital Images done, then it was pretty much of a no-brainer [to integrate the AV into the EMR] because if it’s available on the PACS then it’s available within the EMR.”

With other systems, it could be more problematic, says Wendt, because the process of integrating advanced 3D capabilities on a radiologist’s workstation “doesn’t necessarily mean that the advanced visualization will be available on the web interface or within the interface of the EMR.”

According to Wendt, much depends on the PACS architecture and how vendors handle their advanced integration. “With us—with the McKesson/Vital Images integration—it really doesn’t make a lot of difference whether you’re on a stand-alone [workstation], if you’re on a thin-client radiology workstation, on a web-based PACS workstation, or if you’re in the EMR integration, because it all behaves the same.”

Who will use it?

Joseph Marion, founder and principal of Healthcare Integration Strategies, a consulting firm located in Waukesha, Wis., says there are three levels of advanced visualization user. The most advanced is the diagnostician who interprets the information to create the report, while the most “casual” will likely be the referring physician who is strictly looking for results and whose need to access images may be fairly minimal. Then there’s the in-between user—the specialist