NATIONAL HARBOR, MD - In a turbulent healthcare environment rife with consolidation, standardization, and integration, imaging informatics professionals have much to offer, consultant Donald Dennison told attendees on Thursday during the opening session of the Society for Imaging Informatics in Medicine (SIIM) meeting.
In particular, imaging informatics professionals should have a written plan and share it. They should also look for measurable value in every IT investment, said Dennison, who is a member of SIIM's board of directors and chair of the American College of Radiology's (ACR) Connect Committee. Furthermore, they should develop a policy for monitoring imaging record quality.
Finally, imaging informatics professionals should be ready to prove their value, he said.
"We better start tracking things and getting good not only at operational analytics but fiscal analytics," Dennison said. "You also need to invest in yourself."
Key market trends
The world of imaging informatics is currently being shaped by three significant market forces: healthcare payment reform, the adoption of electronic medical records (EMRs), and provider consolidation, Dennison said.
The shift from volume- to value-based reimbursement models leads to a focus on cost avoidance through the use of appropriateness criteria, and a shifting of risk from payors to providers and patients, he said. Meanwhile, the surging rate of EMR adoption means that fewer interfaces are needed to link many information systems. It also provides an opportunity to improve integration of imaging data via integration of technology such as enterprise viewers within the EMR.
"These are new opportunities for us that require, in many cases, new systems or upgrades to systems to take advantage of," Dennison said.
There's also been a shift from a departmental RIS to having that functionality incorporated as an EMR module.
"Now that we have this opportunity of all of this aggregated digital content from patients in the EMR, there's another shift, which is taking all of that rich information and making it available at the point of diagnosis," he said.
Consolidation is also having a big effect, with large healthcare providers buying or affiliating with smaller hospitals, care facilities, and imaging centers, Dennison said. Consequently, EMRs and imaging records are being consolidated at these facilities. In imaging, this involves either pursuing a large centralized PACS or a vendor-neutral archive (VNA), with the value proposition of being able to remove the cost of managing separate archives.
"In reality, I believe the greater value proposition will turn out to be that we have a system -- that is basically paired with our EMR -- that is our electronic medical record imaging repository, so that we now have a single system that we can touch and can put viewers on that contains all of the consolidated imaging records from all of our facilities from all of our image-generating departments," he said.
Patient identity domains will also need to be integrated in a consolidated enterprise, he said.
"Yes, we have technologies such as a master patient index that indexes all of those things, but as you bring in new facilities, know that they have to have technology, policies, and programs, but you also have to have staff that understand it," he said. "And the more efficient we want to make imaging, the more we need to understand how those work in principle, and also within my organization, exactly how those identities are being managed, so that I can ensure that my medical imaging records are matching the same type of identification."
Data will need to be migrated from a variety of different institutions that may have been managed with different informatics and quality control policies. Informatics staff members will also need to be integrated, each with their own skill sets, Dennison said.
Enterprise imaging
Beyond the consolidation and aggregation of diagnostic imaging records across the enterprise, the collection and integration of so-called enterprise images is starting in earnest, he said. An enterprise plan requires governance to determine how best to present images and related information in a user interface and where to store images and related information, delineating common patient and record identifiers across systems, connecting and managing devices and interfaces, and defining acquisition protocols and standards, according to Dennison.
The goal is to have the best methods and systems for capture, integration, discovery, and presentation of enterprise images within the patient records, he said.
Dennison noted that the SIIM-HIMSS Workgroup is collaborating on defining best practices in enterprise imaging. Three subcommittees are working, respectively, on the definition of enterprise imaging, identification of acquisition workflow and acquisition-related data governance and standards, and image exchange and sharing, he said.
PACS vendors can either fight or adapt to the enterprise imaging era. They could defend their position by making a better PACS, with engineered integration of worklist, image display, report creation, and advanced visualization. It's also easier to deliver multimedia-enhanced reports with this model, which in another advantage results in only one desktop to manage.
PACS vendors could add VNA-like features to their PACS servers, which could then be deployed as either a PACS or VNA server. They could also offer discounted service maintenance agreements to compete on operational cost avoidance, he said. It also may be beneficial for customers to have one vendor to contact for service, rather than having to deal with contracts with a number of different vendors
"For many environments, the death of the PACS vendor may be greatly exaggerated," he said.
To be ready for the new era, imaging informatics programs need to focus on consolidation, EMR integration, accessibility, quality and safety, and data governance tasks, Dennison said.
Consolidation tasks include VNAs, PACS consolidation, image sharing, shared workflow, and enterprise image capture. EMR integration areas include adding an enterprise viewer in the EMR, clinical decision support in the EMR, and a radiologist reading portal.
Accessibility issues include referring physician portals, mobile access, and patient portals, while quality and safety tasks encompass radiation dose monitoring, data analytics, communication, teaching files, and peer review. Data governance covers image record quality, privacy and security policies, and data normalization, Dennison said.
