In today’s healthcare environment, longstanding, volume-based models of healthcare delivery are giving way to models where payers are tightening their purse strings and putting a greater emphasis on treatment value. Medical imaging providers are increasingly looking for a strategy to streamline workflows, enhance referral networks, increase referrals and better manage imaging appropriateness. Advanced interoperability is that strategy.
What is Advanced Interoperability?
Like an enterprise imaging strategy, an advanced interoperability strategy consists of three major components — a vendor neutral archive (VNA), universal viewing access, and cloud-based image storage and sharing capabilities — but also includes one more key component to complete the process.
The VNA serves as a centralized “storage bin” to save and manage images across multiple specialties within a health system regardless of which department they originate. This gives providers within the system fast access to images — especially images from prior visits — and enables them to provide treatment plans more efficiently for improved patient care. The second component, a universal zero-download image viewer, enables providers to access images and reports for every patient within a facility in real time. Thirdly, storage and sharing capabilities built into the universal viewer offer the secure convenience of viewing new and archived files in a single-user interface.
Advanced interoperability takes it one step further beyond enterprise imaging with the presence of a fourth component: an underlying imaging infrastructure and a narrow network for imaging that enables providers belonging to various healthcare systems to integrate and share information with different electronic health records (EHRs). To some degree, many imaging centers already have some level of integration with their most important referring physicians. For example, imaging centers that receive a majority of their referrals from certain oncology or cardiology practices have already invested and built interfaces to exchange information.
However, what most haven’t built yet is integration with everyone else — the entire community of physicians outside their own four walls. Today’s healthcare ecosystem for information exchange really is much like banks in the early days of ATMs, which at that time could only share information with ATMs belonging to the same bank. It wasn’t until later that an infrastructure was put into place allowing ATMs of different banks to transfer funds and exchange information with each other.
For true interoperability to take shape, the next phase of exchange must enter a new era where technologies and networks enable healthcare providers of any health system to safely and securely exchange patient data, without requiring them to completely replace their existing EHRs. This can be done by layering new solutions around existing investments to complement the technologies that providers already have in place. Automated report delivery to distribute images and reports directly into a referring physician’s EHR outside their four walls is possible through an advanced interoperability strategy.
Benefits of Leveraging Advanced Interoperability
Multiple reasons exist for hospital-based and freestanding imaging centers to implement an advanced interoperability strategy for appropriate imaging and clinical decision support. Opportunities include reduction in unnecessary imaging studies, streamlined workflows, growth of referral networks and improvements to the bottom line.
Reduction in Unnecessary Imaging, Streamlined Workflows
According to The Advisory Board Co., some 800 million medical imaging exams are performed each year in the United States, with hospitals and freestanding imaging facilities each handling about half of those examinations. Yet, statistics show that about a third of all medical imaging scans are unnecessary, and that some $26 billion is spent annually on redundant imaging alone in an overall $100 billion diagnostic imaging market.
As value-based care reform continues, it is expected that payers will continue to focus on appropriateness of imaging. Most recently, President Obama signed legislation that introduces a new clinical decision support mandate for Medicare starting in 2017. The Protecting Access to Medicare Act of 2014 introduced a one-year delay for ICD-10 implementation as well as a new mandate that will impact high-cost diagnostic imaging utilization. Under the law, physicians will become required to use clinical decision support tools as part of the order-entry process to help validate the clinical need for the requested test. Now, once a test is ordered, it will be critical that the clinical decision support information not only be transmitted to the imaging provider but also be included in the final report back to the ordering physician. This “closed loop” imaging process is essential to meeting both the letter of the mandate and improving referral coordination.
By streamlining the workflows and eliminating many of the time-consuming calls associated with obtaining pre-authorization, advanced interoperability promises to dramatically reduce the cost of unnecessary and inappropriate imaging. More importantly, this makes it easier to follow clinical decision support requirements and imaging appropriateness for improved patient care.
Growth of Referral Networks
Developing strong, close relationships with referring physicians will be a key factor in ensuring the survival of imaging providers in the new healthcare environment, especially as physician expectations rise with the use of EHRs and computerized physician order entry requirements. The Centers for Disease Control and Prevention reports more than 78 percent of physicians are now employing EHRs, and more than half of these physicians have signed on to Meaningful Use (MU) for the stimulus funds provided by the program.
Leveraging an advanced interoperability strategy is a key way for medical imaging providers to reach and engage these providers. It enables the imaging providers to promote themselves as the easiest hospital or imaging center to do business with when it comes to accepting electronic orders, returning reports and results directly to the referring physician’s EHR, as well as meeting other key aspects of Meaningful Use Stage 2 (MU2).
Minimized Referral Leakage for Bottom Line Improvement
On any given day, hundreds of thousands of physicians are referring patients to some 5,000 hospitals and 6,000 imaging centers across the United States, yet not all of those patients will actually undergo their prescribed tests. While there are more occurrences of patients failing to fill prescribed medications, patients don’t always get their images performed for a variety of reasons, such as they can’t afford to pay for the tests, they don’t understand why they need them or they are simply scared.
In addition, hospitals are constantly managing the high numbers associated with affiliated or employed physicians commonly referring patients to non-affiliated imaging providers. The Advisory Board Company indicates that the average 200-bed hospital loses about $20 million in such referral leakage each year. A solid advanced interoperability strategy can help to alleviate the impact of both patient non-compliance and referral leakage by alerting providers to the failure of a patient to obtain the exam or of a non-affiliated imaging provider earlier in the process. In fact, one health system turned such referral leakage into profit, resulting in $1 million of referral revenue.
Healthcare is clearly in the midst of transitioning from a time when test volume reigned supreme to a time when quality of patient care and the value of any given test or procedure will rank as key indicators of a provider’s quality of care.
Leveraging an advanced interoperability strategy that promotes the easy and efficient exchange of clinical data among providers from varying systems and enables healthcare organizations to reduce costs, increase referrals and meet MU2 requirements is critical to ensuring imaging provider success in this new era of healthcare.
Steve Tolle is chief strategy officer at Merge Healthcare.
April 11, 2024 
