Originally published on InContext, a Lexmark website. 

silo-bustingMost patients don’t know anything about interoperability, but they expect their doctor to have all the information necessary to make the best treatment decision. No matter where or when they last received care.

One of the largest roadblocks to meeting this expectation of complete accessibility are imaging silos. To achieve interoperability that improves patient outcomes, healthcare organizations have to tear down the silos that waste money and render vital patient information inaccessible to those who need it most.

People throw around the term interoperability, so let’s define it before we continue. According to HIMSS, “interoperability is the ability of health information systems to work together within and across organizational boundaries in order to advance the effective delivery of healthcare for individuals and communities.”

Interoperability no longer optional

While interoperability has been a popular topic and a favorite buzzword of the industry for years, organizations looking to maximize their reimbursements can no longer look at it as a “nice to have.” According to data from Frost & Sullivan, 30% of fee-for-service Medicare payments will shift to value-based reimbursement models in 2016.

The shift to patient-centered care will only increase over time. In 2016, 10% of diagnostic imaging procedures are reimbursed as part of bundled payments, while by 2020 50% will be part of bundled payments.

With this new reimbursement model, organizations must know all the imaging procedures performed on a patient, no matter, where or when it occurred, because they will not be reimbursed twice for duplicate imaging of the same patient.

How can an organization adequately respond to these changes if each imaging department continues to manage their information and images within disparate departmental systems or not have a centralized management strategy at all?

Flashback to the 1990s

The siloed state of imaging today can be compared with the state of departmental systems in the 1990s, prior to the adoption of electronic health records (EHRs).

In the 90s, departments each bought their own departmental systems. The director of lab purchased a lab system. Director of pharmacy bought a pharmacy system and the director of radiology bought a radiology system. But as we moved into the early 2000s the industry and the government realized the power of bringing all discrete patient information into one system – the EHR was born.

While the EHR is broken into separate modules for registration, lab, pharmacy and so on, it is typically purchased under one enterprise strategy from one vendor. Department heads rarely purchase their own siloed solutions these days.

While the EHR is not perfect, it has done wonders for an organization’s ability to centralize discrete information around the patient and make that information accessible throughout the organization.

PACS and silos are holding you back

Now fast forward to 2016 and the same story can be told about imaging.

Imaging is one of the last holdouts around interoperability. Departments including cardiology, radiology, ophthalmology and gastroenterology, manage their images in siloed systems like the radiology PACS, the cardiology PACS or other “mini” PACS.

The problem with a PACS-focused strategy centers around the proprietary design and code sets of these systems. While DICOM has been widely adopted as the defacto standard, PACS vendors continue to use proprietary extensions to make interoperability within and outside the enterprise complicated and costly. The problem is compounded when organizations try to incorporate specialty images that fall outside traditional PACS parameters.

CIOs need to start challenging how their department heads think about PACS. Not only does relying on a PACS strategy hinder interoperability, but it also limits an organization’s agility. PACS systems were developed 20 years ago before surgical video, endoscopy digital output or mobile capture were even a thought.  As new modalities and image types are created, PACS systems are ill equipped to ingest their images.

A PACS-focused strategy also hampers your ability to innovate. With patient images and information locked in a PACS, are you prepared for the data usability requirements of population health and data analytics? Can your PACS handle the large data sets that come with digital pathology and genomics? If you can’t enable these tools with the best data you will never fully realize their benefits.

Simply stated, multiple silos mean multiple infrastructures and support models. This becomes a costly headache as you try to integrate these departmental silos with enterprise systems such as the EHR. To make imaging and specialty department information viewable from within the EHR, you have to build multiple connection points which are expensive, resource intensive and difficult to maintain.

And remember, we aren’t talking about an insignificant amount of patient information. As this infographic points out, by 2017, 75% of healthcare data will be in the form of non-DICOM medical imaging assets. This 75% includes video, photos, oncology treatment plans and other file types which the PACS cannot manage, therefore they wind up as islands of data scattered throughout the organization and inaccessible from the EHR.

If your clinicians cannot view imaging and specialty assets from the EHR they are not getting a full picture of their patients. Healthcare can no longer afford this lack of transparency and its associated costs.

Enterprise imaging is the “beyond”

It’s time to integrate the enterprise around one holistic imaging strategy. The theme of RSNA’s 2016 Annual Meeting was “Beyond Imaging” – enterprise imaging is a giant step to get you into the beyond.

Enterprise imaging is about more than just image-enabling the EHR; it’s about image-enabling the entire enterprise. It does this by capturing both DICOM and non-DICOM images as well as unstructured data and making this information accessible to all clinical stakeholders, even those who may not have EHR access. As such, it is a solution that supports not only the EHR but also a whole host of enterprise systems, including population health analytics, PACS and specialty departments.

Enterprise imaging enables more informed clinical decision-making and drives down costs by allowing healthcare organizations to capture, manage and view medical images at the clinical point of care and within the radiology and cardiology departments.

Enterprise imaging enables interoperability by consolidating imaging information throughout the enterprise into a federated, standards-based data repository that communicates seamlessly with all the IT systems involved. Through true standardized data formatting, enterprise imaging provides organizations with all-encompassing ownership of their imaging information, removing the vendor lock-and-block of proprietary systems. It leverages advanced technologies to support the management and sharing of imaging data across the enterprise and beyond, empowering clinicians with real-time collaboration.

By centralizing your image management with an enterprise imaging strategy, you will build a foundation for interoperability that will lead to fully informed clinical decision-making, reduce costs and add an important complement to the EHR.

You have to start somewhere

While the words “enterprise” and “strategy” can be overwhelming, it’s a journey that is made up of steps. The best enterprise imaging solution is one you can implement in a phased-approach. Some organizations begin with a vendor neutral archive (VNA), while others choose to link their PACS systems using an enterprise viewer.

No matter where or how you start, it’s important to keep your eye on the goal of an enterprise class vendor neutral strategy that busts down silos while giving you ownership over your data. Stick to that goal and you’ll be well on your way to interoperability that has a direct and measurable impact on patient care and outcomes.

Take the first step on your silo-busting journey with this ebook, Enterprise Imaging: See What You’ve Been Missing.

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