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Key Radiology Takeaways from RSNA

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This is a guest post by Janakan Rajendran, CIO, GNAX Health.

RSNA began their integration journey in 1998 with the initial launch of Integrating the Healthcare Enterprise (IHE), a multi-vendor technology project designed to connect radiologists with other clinical departments.  The project has grown by leaps and bounds. Now partnered with HIMSS, IHE is a well-respected, annually-demonstrated, healthcare connect-a-thon. At this year’s RSNA, the association took connecting one step further.

RSNA 2012 was all about connecting with the patient. From the opening keynote to exhibit hall signage and educational sessions, radiologists were encouraged to charge forward into a new frontier—patient relationships. This new drive towards end user connectivity was reflected in three key trends:

  • Radiologists are Members of Core Care Team
  • Vendor Neutrality is Essential
  • Images are Embedded into Health Information Exchange

Shared Ownership of Patients – Dosage Tracking

For professionals typically sequestered in dark rooms and technology silos, the concept of patient interaction is novel, timely and suddenly important.  RSNA 2012 even included a day-long workshop on the art of difficult conversations. Focused on front-line conversations with patients, peers and payers, the workshop set a new bar for radiologists’ ability to effectively communicate outside of the reading room.

The conference theme, “Patients First”, was reiterated by Dr. George Bissett, 2012 RSNA President, in his president’s address.

“After a year of reflection on our profession, I believe more than ever that our future depends on our capacity to develop a new kind of shared ownership, along with our primary care and specialty colleagues, of our patients’ needs and expectations.”

Just as the IHE integrated radiology technically, we expect medical imaging to take a stronger position within the core patient care team. One component of “patients first” is the regulatory need for providers to track radiology dosage over patient lifetime—certainly a huge technology challenge and patient safety concern for all.

Vendor Neutral Archives Go Second Generation

Vendor-neutral archives (VNAs) were showcased notably during the 2011 RSNA. This years’ RSNA uncovered the real, extensible benefits of VNAs. Now VNAs are considered a platform that enable providers to do much more than simply avoid future PACS and storage migrations. Cloud-based hosted VNAallows for:

  • Long-term archival of images from all departmental PACS without any additional hardware or software purchase.
  • Image storage is no longer on-site at the provider location, reducing the VNA’s physical footprint within the IT department and staff time to maintain and update the system.
  • Multiple PACS can be easily integrated into the VNA. Savings are substantial for organizations planning ahead for mergers, acquisitions or participation in an ACO or HIE.
  • The cost to migrate images from one PACS to another is eliminated through a VNA. Once moved into the VNA, images are not held hostage by the PACS. Organizations achieve greater flexibility for future PACS purchases and negotiate from a stronger position.
  • Image enabling of the EMR with a Universal Viewer through one, single integration.

Several second generation VNAs were demonstrated at RSNA. These VNAs focus on image exchange within health systems.  Next up: third generation VNAs to support image sharing between health systems. Initial strides toward third generation VNA are already underway.

Images Part of HIE

For decades, the only way to share medical images between radiologists and physicians was manual. Patient sneaker-net (patients hand-carrying CDs from radiology departments or imaging centers to specialists and primary care physicians) is common practice even today. Vendors at RSNA 2012 aim to take patients out of the equation and eliminate CDs.

Several companies demonstrated the ability to control image access, move images along the HIE or ACO continuum, and consolidate image access reporting. Key technology partnerships to support end-to-end image sharing were introduced. As an example, GNAX Health announced an agreement with ACUO Technologies and Client Outlook to integrate medical images into the Colorado Telehealth Network (CTN).

Hospitals, imaging centers, clinics and other health care providers in Colorado will safely store and share medical images through a private cloud hosted and managed by GNAX Health and using GNAX’s SDEXTM (Secure DICOM Exchange) platform. CTN and GNAX Health are working with the Colorado Regional Health Information Organization (CORHIO) and Quality Health Network (QHN)—the two Colorado Health Information Exchanges—to image-enable their physician portals so that images and diagnostic reports will be available through the HIEs. GNAX Health will also allow CTN to offer disaster recovery and business continuity solutions. Nine CHA member hospitals worked with CTN over the past eight months to develop the imaging program with input from hospitals across the state. For Colorado, the future is already here.

RSNA Conversation Changes

RSNA 2012 reflected a new conversation between radiology and their key stakeholders: patients and peers. Technology is supporting this dialogue in ways never thought possible. There seemed to be many more technologists and internal provider system integrators at this show. For once, PACs was not the buzz at RSNA. Information technology was.

December 6, 2012 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 5000 articles with John having written over 2000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 9.3 million times. John also recently launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and Google Plus. Healthcare Scene can be found on Google+ as well.

Direct Model or HIE Model

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There’s a pretty fierce battle going on right now between all the various stakeholders interested in exchanging patient data. The stakeholders range from very large companies to government initiatives to startup companies. One of the major problems that I see is that it’s not completely clear which model of patient data exchange will win out. In fact, let’s not be surprised if a number of different options take hold.

With this said, I found it interesting that my favorite open source healthcare IT advocate, Fred Trotter, has chosen to get behind the Direct Project. In Fred’s post describing the challenges with the IHE-protocol HIE model approach is flawed and that the direct exchange of healthcare information is the way to go. In fact, he provides the following two illustrations in his post to show the difference:

HIE Model (click on the image to see it full size)

Direct Model (click on the image to see it full size)

Fred then offers this incredibly interesting conclusion:

At every level, organizations are deciding whether to invest in Direct or IHE-based exchange. At this point, I believe the only viable option is for a local exchange to either support Direct only, or both Direct and IHE. IHE is simply going to be too heavy weight for early adoption. Eventually, IHE may become dominate but for now Direct is much simpler, and puts the patient right in the center of everything. If you are a policy maker, you should be asking anyone involved with an HIE process to detail what their Direct-strategy is. If any effort is ignoring Direct and going with IHE-only I would lay odds that they will be broke and defunct before the decade is out.

Moreover, an IHE-only strategy is going to exclude direct participation from patients at this stage. If you care about patient empowerment, I recommend that you advocate for the Direct project at every level, including in your local HIE and REC.

Lots to consider with this complex challenge.

I guess you could say that the direct model is the patient centric model. Although, one could easily argue that the direct model doesn’t have the patient as the center of the model, but instead is a PHR centric model. So, the direct model will be a patient centered model only as much as the PHR software allows the patient to be involved.

Thus, it makes since why Microsoft HealthVault and Google Health are heavily involved in the Direct Project. Of course, they want to be involved in a project that puts them at the center of the communication.

The real question even with the direct model is what incentive do the various PHR vendors have to make this interaction happen? What will be the “cost” that PHR vendors pass on to consumers and/or doctors that use the PHR centric model? Basically, what’s the business model of the PHR vendors?

Unless we can find a PHR centric business model that works for the PHR vendor while still empowering the patient, even the direct model will fail or have adverse outcomes.

February 15, 2011 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 5000 articles with John having written over 2000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 9.3 million times. John also recently launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and Google Plus. Healthcare Scene can be found on Google+ as well.