One of my readers recently asked me, “Where’s the imagery in EHR?”
It was a fascinating question. At the core of their question was the implication that there was real value in images that wasn’t being leveraged in EHR software. This is not to say that EHR software doesn’t do any imagery, but it could do so much more. Pretty much every EHR software I’ve seen has some sort of image documentation available. Sometimes it’s just uploading an image to the EHR, but in most cases you can incorporate an image into the documentation itself. Usually you can do some sort of Paint like editing of the image as well. Although, that’s about the extent of imagery in most EHR software.
Of course, when most people hear imagery and EHR, they likely think of DICOM images from radiology. This is definitely missing from most EHR software as well. The excuse is usually a mix of the DICOM images being too large and having the right software to view the DICOM images. With that said, I think this imagery will eventually be part of the images available in an EHR.
I’d love to see much more imagery available in the EHR. It should be as simple to add a photo into your EHR as it is to post it to instagram. We’re not there yet, but we should be. There are hundreds of situations in healthcare where an image provides incredible benefit to your documentation. Imagine having images or video from the Otoscope stored in the EMR. The technology is there to be able to store this type of imagery in an EHR. In fact, back in 2006 I predicted that one day an EMR would store a video recording of an entire patient visit.
Why don’t we see more imagery in EMR?
The simple reason we don’t see more imagery in EMR is that reimbursement doesn’t require it. In fact, you could make a case that reimbursement discourages the use of imagery in documentation. The same goes for physician liability. You can make a case that more imagery in an EHR can make for more physician liability. Unfortunately, healthcare is heavily influenced by both reimbursement and liability.
Meaningful use doesn’t do anything to encourage the use of imagery as well. In fact, the healthcare interoperability standards do almost nothing to consider the transfer of image based documentation. They basically didn’t take this into account, because so little documentation includes it.
There are a few EMR vendors that are taking imagery seriously. Modernizing Medicine’s EMA EMR is one example. They use images to document the whole visit. Although, ironically they take all this amazing image work and translate it into text because that’s what’s required for reimbursement. How twisted is that? Of course, the EMA EMR is designed for specialties that really benefit from images: dermatology, opthamology, optometry, plastic surgery, and orthopedics.
I’d love to see more imagery used in EMR. Unfortunately, I see nothing driving the use of images in EMR.
Does anyone besides me think that sooner or later imagery should be required for MU? Oh, and that MU should be for all medical practices, not just Medicare and Medicaid?
I think that imagery should be part of the standards and MU should push those interoperability standards.
I don’t think that MU should be expanded beyond its current purpose.
There are a couple ways to look at this. First, that MU is already beyond absurd, and / or way off base in many of its requirements. Or, that it’s missing far too many important features.
Someone I know just had an imaging study done, and was advised to go for a biopsy. The surgeon’s practice just got taken over by a large hospital group, but I’m guessing is either not yet up on their ambulatory EHR or that it doesn’t have imaging capability. This person was told – DON’T BRING A DISC. You’ve got to bring the physical xray! That from the affiliated hospital which doesn’t use film!
An orthopedist I know told me a couple years ago that he could see far more in electronically presented xrays than he could with film in a viewer – and went on to give me a very clear demonstration of that using my hand as his subject. To me it’s pure foolishness for appropriate practices to not have imaging. However – maybe that shouldn’t have anything to do with MU – but to me, it has everything to do with common sense!