There is often a large gap between implementing technology and actually using it. Ensuring that healthcare providers not only have access to important patient information, but also that they are using it in a meaningful way is the purpose of the recent meaningful use (MU) definition. We applaud the focus on patient care as a requirement for receiving funding from the government’s healthcare IT stimulus portion of the American Recovery and Reinvestment Act.
Thousands of clinicians worldwide can speak to the importance of electronic access to patient data. Systems like radiology information systems (RIS) and picture archiving and communications systems (PACS) that deliver imaging studies along with vital patient information to reading radiologists improve staff productivity and enhance the speed of reporting to referring physicians. Providing enterprise-wide access to radiology reports by authorized clinicians in remote locations is a technological hurdle that is just now being solved. Implementing an electronic medical record (EMR) that collects and delivers information from dozens of disparate systems is a much larger challenge, but a worthy one. Reviewing pertinent patient information, such as age, existing conditions, allergies, prescriptions, smoking status and other data as part of a diagnosis makes perfect sense. While many data systems are part of the continuum of care, our purpose with this article is to discuss the role of the radiology solutions, RIS and PACS.
Stages of Meaningful Use Certification
MU criteria are being identified and certified in stages. Healthcare suppliers can now submit an application for certification of RIS as an electronic health record (EHR) module. Some companies can already demonstrate the collection and/or receipt of the following data, which meets the first stage of meaningful use requirements: patient demographics, vital signs, smoking status, immunization records, diseases, allergies and advanced directives for patients over 65, plus validation that patient medications were tracked by referring physicians. A preliminary set of recommendations for stage 2 MU criteria is currently being discussed through public hearings and comments to a blog hosted by the Health Information Technology Policy Committee.
According to the committee, final stage 2 recommendations are expected to be issued this summer. While medical imaging isn’t specifically included in stage 1 of the meaningful use program, many believe RIS and PACS technology can be shown to meet the measures and objectives of meaningful use. Leading healthcare facilities and suppliers are working to gain recognition for medical images, with the potential for inclusion of images as part of stage 2 requirements. An early leader in the campaign to recognize the importance of medical images to a patient’s EMR is Brigham and Women’s Hospital in Boston. A hospital research team presented a study at the 2010 Radiological Society of North America meeting that provided data to encourage recognition of imaging systems as part of meaningful use criteria. (See sidebar on page 20 for details.)
Key Images Essential to Complete Patient Record
We encourage hospitals and other providers and industry groups to establish the need for key images as part of the patient medical record. Medical imaging studies do not need to be included in their entirety. But key images that illustrate the illness or condition and support the diagnosis are vitally important to referring physicians or specialists who are involved in patient treatment and care.
These key images can be supplied in several ways: 1. The most convenient access is delivered by a PACS that embeds key images into an EMR. With a zero-footprint viewer from PACS, these images are readily accessible without the need to launch another application or log into another system. 2. Less convenient is a PACS that can link images into the EMR, but requires users to launch another system with a different interface and log in. 3. Key images can be embedded in the RIS report, which is available from the EMR.
While the need for MU certification for PACS is up for debate, the emphasis should be on ensuring seamless image access from the EMR. How can a patient record be complete without the images that play a vital role in diagnosis and treatment?
Considerations for RIS/PACS Implementation
MU requirements are a moving target, so facilities that are considering installing or replacing RIS or PACS should be careful. We recommend that healthcare providers evaluate only RIS platforms that have been submitted for MU certification and select among those that offer the greatest level of information exchange. A few RIS platforms are already delivering numerous MU criteria, a seamless interface with EMRs, critical results notification and other highly valued features. Facilities can evaluate PACS platforms based upon their current ability to exchange image information easily with RIS, EMRs, health information systems (HIS) and other information systems. Ideally, suppliers should be focused on image-enabling the enterprise and offer the ability to rapidly share images with authorized users at remote locations over a standard Internet connection.
Also important are support for standards and the ability to share images and information with other vendors’ RIS and PACS systems. Each diagnostic imaging professional in the United States who can demonstrate he or she has met the criteria for meaningful use is eligible for as much as $44,000 in reimbursement, which extends to 2015. That gives imaging professionals time to evaluate, install and implement systems that not only satisfy the MU requirements, but also deliver enhanced information sharing that will boost productivity and efficiency and can enhance patient care.
Elad Benjamin is general manager, healthcare information solutions at Carestream Health.