How the University of Virginia Health System "Evolved" Into Enterprise Imaging

Healthcare systems today are battling rising costs and uneven quality. At the core of each challenge is the fundamental need to deliver value — the best possible patient care at the lowest possible price.

The University of Virginia (UVA) Health System is boosting value by sharing medical images of all types across a broad swath of medical specialists. The objective, said Christopher (Cree) Gaskin, M.D., is simple: "One patient, one imaging record." The end result has been to embrace enterprise imaging.

But the university did not set out to implement enterprise imaging. Instead, UVA Health gravitated, slowly and naturally, to the current system.

Natural Evolution

The journey has been complicated by the number and variety of medical images. The 600-bed university-affiliated hospital and outpatient centers that comprise the University of Virginia Health System offer virtually every specialty and subspecialty of medicine and surgery. Yet, today physicians throughout the enterprise are accessing both radiological and nonradiological images through the electronic health record (EHR) and enterprise picture archiving and communication systems (PACS).

Many are stored on the radiology department's PACS, according to Gaskin, professor, vice-chair of informatics and operations, and associate chief medical information officer at the UVA Health System. In his role providing oversight of technical solutions involving medical imaging, Gaskin helped lead the transformation of its PACS into what he describes as the equivalent of an "enterprise vendor neutral archive."

This transformation was made possible by upgrades to the Carestream PACS, as well as available PACS storage capacity, according to Gaskin. "We began using the PACS as an enterprise imaging archive, letting other areas (of the health system) store their images," he said.

Although storing all images at a single location would have been "ideal," Gaskin said, some "ologies" chose to store their images in separate archives. To allow easy access from the EHR to all archives, the UVA Health System created "access points" in the EHR that take providers to medical images no matter where those images are stored.

While the path to enterprise imaging was complex, the motivation underlying this expansion was basic.

"We wanted our referring providers to have easy access to imaging reports — and the images themselves," he explained.

Defining Requirements

While each "ology" has its own way of working, all must meet certain requirements in order for enterprise imaging to work as intended.

Regardless of their origin, all images must be captured, managed and archived. Only then can they be used to enhance collaboration by physicians in different specialties.

Although images may be spread over several archives, most doctors, according to Gaskin, don't want to manage multiple information systems and multiple access points. What they want is easy and convenient access to all their patients' images.

"If patient data access is easy, doctors can focus on care delivery, " he said.

To assure the system works efficiently and effectively, every group that might use the system must have a role in its definition — what it will deliver and how it will function. This must include those who will operate the system as well as those who will use it.

"To have a solution that works well for all parties, you must consider the needs of all relevant parties," Gaskin said. "Otherwise, something may be missed or parties may work independently leading to duplication of systems and unnecessary costs."

Information technology leaders and technical staff must be involved because they appreciate how possible solutions might be fitted to existing or planned future infrastructure. "Also, they have the best understanding of implementation efforts and system maintenance over the long-haul," he said.

The end goal is a smoothly running health care system, one whose efficiency and effectiveness benefits the patient, as well as the institution's bottom line.

Author's note: You can download the White Paper "Functional Requirements for Enterprise Clinical Data Management: Solving Technical Problems, Satisfying User Needs" here.