Seeking Interoperability: Images in the Right Hands

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A focus on improving patient care and decreasing healthcare costs has created a need to centralize image and data access, enabling highly mobile caregivers to make decisions nearly anywhere. Data access must be instant, while safe and secure. Web- or cloud-based technologies, equipped with open DICOM standards, are presenting unique adoption avenues for innovative healthcare providers to begin the process toward true interoperability.

Breaking down access barriers

Through the HITECH Act, the U.S. federal government is providing financial incentives for healthcare organizations to adopt EMRs and electronic order entry systems, mandating the proliferation of electronic information exchange and patient communication. Additionally, some meaningful use criteria are built around quality measures that require enhanced sharing of information and images, as well as the consolidation of those data.

“Meaningful use criteria present requirements for data to be accessible across multiple settings. It’s a driving need for providers to access data across multiple areas within a hospital network and share information with other providers,” explains Judy Hanover, research director at IDC Health Insights.  

Simultaneously, clinicians need to be able to use the EMR for clinical documentation and to view other relevant information about patients, from both the ambulatory and inpatient setting. “There is a need to make all data accessible in the EMR, which may include the need to access images,” Hanover says.

Traditionally, images have been siloed in radiology and cardiology departments, where they were created and stored in separate PACS. Recently, there has been a call to integrate and centralize image and medical record storage, according to Hanover, and web-hosted or cloud-based technologies are presenting new options to provide services beyond simple storage.

To achieve interoperability, providers are beginning to adopt middleware technologies such as web services and service-oriented architectures (SOA) that are DICOM aware, allowing disparate PACS, for example, to communicate through open standards. This allows providers to lower costs while achieving greater efficiency. On the near horizon are services that will unlock proprietary vendor formats, opening up data access, allowing better patient care and reducing the cost of business because legacy systems will speak freely with one another.

Getting interoperable from the inside out

“Due to the high costs associated with utilizing a traditional PACS-based, client-server environment, web-based solutions present an inexpensive means of dispersing images and reports throughout the hospital network, even outside the firewall,” explains David S. Mendelson, MD, chief of clinical informatics at Mount Sinai Medical Center in New York City. “They typically employ a local VPN service, which the institutions use to connect their staff to a variety of data and images, from outside of the enterprise.”  

First, healthcare facilities must ensure their disparate technologies can communicate through enterprise-wide standards. “Having a DICOM umbrella across a network allows varied PACS and storage technologies to speak the same language,” says Philip Politowicz, PhD, associate director of information systems at University of Wisconsin (UW) in Madison.

Through an internet browser or VPN, healthcare professionals can access EMRs, as well as clinical data and images, allowing secure, authenticated access from outside the hospital setting.

“The trend is moving to web-based technology for image and information exchange,” says Tom Coppa, infrastructure architect at Iowa Health System (IHS), based in Des Moines. “In choosing a new platform, we sought to make access easy through the web, especially for referring physicians and appropriate caregivers.” Earlier this year, IHS, which incorporates 13 hospitals and 30-plus additional outreach facilities, went live with a McKesson platform in a four-month period, embracing 3.5 million studies of nearly 200 million images and 60 terabytes of data.

Iowa Health System physicians now can access PACS images via a context sensitive or context aware link in the EMR, from which they are brought into the PACS viewer.

Because they adhere to DICOM standards, images can be accessed throughout the network. For transferring additional data, the health system is seeking to use HL7 and other standard protocols, as well as to employ non-proprietary database systems, such as Oracle.