Hospitals face a multitude of digital challenges. One of the most pressing involves the management of images generated by Radiology, Cardiology, Neurology and other departments. Problem is these images come from devices purchased from a wide variety of vendors. Their unique imaging technologies generate proprietary file formats, each requiring a custom viewer. This creates a situation in which many medical images and study types are stored in a hospital’s PACS and Mini-PACS in proprietary formats, making it cumbersome to migrate a patient’s medical images through the system. The only viable option, until recently, was to burn a CD. To improve this process, hospitals must leverage the expertise of health information managers (HIMs).
MIE + ROI = HIM
Hospitals must remain cognizant of the role their image exchange solution plays in release of information (ROI). Access, controls and reporting functions are often detached and not integrated components, and few of these systems provide work queues to support release processes. However, it is intrinsic to an MIE to enhance an organization’s ability to share patient information within the health system, as well as outside the network. That makes this component one of the most important applications HIM professionals might encounter. HIPAA privacy and security, patient consent and opt-in/opt-out procedures for medical image sharing are all dependent on HIM expertise to re-engineer traditional imaging release workflows.
So what can HIM professionals do to gain control of the release process of medical images? How can HIM expertise limit liability and improve the expediency of the sharing of medical images?
Six Steps HIM Can Take to Improve the Sharing of Medical Images
1) Build an infrastructure that utilizes a vendor neutral archive (VNA).
2) Add the MIE on top of the VNA.
3) Add a uni-viewer—a single, non-proprietary device for viewing a variety of study types.
4) Take appropriate security measures to safeguard your MIE.
5) Add integration to the EHR, to provide enterprise access.
6) Add web services, including physician and patient portals.
Step 1: Use VNA to Reel-In Your Medical Images
The first step in improving your imaging capabilities is to centralize all medical images, collecting them from all the PACS and Mini-PACS. This important step creates a centralized infrastructure, which serves as the foundation for the next four steps. Use a VNA as the central archive across all study types, since the VNA combines the medical image formats found in DICOM and non-DICOM data. This allows the images to move to a single system that can leverage several key enterprise benefits. Not only does the VNA translate the proprietary formats used by all vendors, storing divergent types of information in a single, convenient system, it also consolidates disparate study types. It provides tangible financial cost savings as hospitals create one infrastructure for archiving, a boon in the event of disaster recovery.
Step 2: Implement an MIE Solution
The second step is to install and deploy a Medical Image Exchange solution on top of the VNA. Many exchanges interface with a few PACS systems and retain information for a limited time, based on the estimated life cycles of how that information is used. This sort of solution can be effective, yet more and more solutions are basing their MIE systems on centralized archives. This is the preferred approach. Access to all studies, both current and historical, creates tremendous value and is beneficial in supporting the ROI process.
Step 3: A Room with a (Single) View
The third step along the path to enhanced medical image sharing is to add a uni-viewer—a single, diagnostic-quality viewer to the infrastructure you are creating. This is the exciting part of this process—the ability to view medical images from any desktop or any device, stationary or mobile. Many common viewers are not considered to be diagnostic quality. Some other viewers, while deemed diagnostic quality, are not paired with devices that have diagnostic quality monitors. In any event, these viewers can’t be trusted to produce the quality of images required for competent diagnosis. A diagnostic-quality uni-viewer will maximize your imaging capabilities.
Step 4: Keep It Safe
Hospitals must remember to protect the confidentiality, privacy and security of the medical images being shared—just as they protect the data contained in EHRs. The release process for medical images is more complicated than ever–and riskier than ever–as images course across departments and are accessed by multiple users. When observing medical images through a remote viewer–an integral part of the optimal infrastructure we’re describing–users leave no trace of having visited the data. This is because the viewer features a Zero Footprint download, an important security feature. No software is loaded onto the device, and no patient data is downloaded to local drives. When the user is done viewing the image, all traces of the user, the image viewed and accompanying patient data are gone. Think of it this way: The images don’t move to the device; they are simply displayed.
Step 5: Integrate Medical Images into the EHR
The fifth step in this optimal solution is to promote medical images to full-fledged members of your electronic health record. What started as simply providing patients a copy of their films has evolved into a complex process for integrating medical images from several study types into the EHR, allowing access for physicians and caregivers. As an added benefit, these new workflows let radiologists and physicians collaborate while viewing medical image studies from separate locations. Patient care improves because of the improved accessibility to the studies, which are now conveniently housed within the EHR.
Step 6: Making Sense of the Tangled Web
The sixth step in our solution involves adding all of the web services that can pave your road to image exchange success. Consider this: In this day and age, many of us are constantly working. When we’re not working, we’re still connected, with the ability to react to critical issues. Good web services—especially ubiquitous Wi-Fi and cellular signals—make this possible, for better or worse. So since the technology exists, the ability to connect to our image exchanges through several methods should be cultivated. Physician portals, patient portals, health information exchanges, URL or smart links to key web pages and hospital websites are all part of an optimal solution. Don’t settle for less than what you need.
There you have it—a simple six-step process. What’s next? Now you must determine how best to implement medical image sharing technology within your own organization. Take the time to carefully produce an organizational impact report, and you’ll be astounded at how strong your argument will be. The road to implementation may seem very long and circuitous. Just remember that a journey of a thousand miles begins with a single step.
See also: A Complicated Matter: Six Steps to Understanding HIM’s Role in Medical Image Exchange (For The Record, March 2014-HIMSS Conference Supplement)