Q&A: Chris Tomlinson on Building the Network of the Future with Image Exchange

Chris Tomlinson, MBA, CRA, FAHRA, senior director of radiology at the Children’s Hospital of Philadelphia (CHOP) and executive director, RACH in Philadelphia, Pennsylvania, has big plans for the future. He envisions a large pediatric radiology network where everyone is connected and imaging results can easily be shared in seconds.

For more than six years now, Tomlinson and his colleagues at CHOP have been relying on the lifeIMAGE image exchange platform to make those big plans a reality. He says the lifeIMAGE software has had an immediate impact on patient care while also helping the hospital look ahead to the future.

Tomlinson spoke with Health Imaging about the significant impact the lifeIMAGE platform has had on CHOP.

Can you detail the importance of lifeIMAGE to CHOP and its affiliated hospitals?

Chris Tomlinson: Image exchange is entering a more mature phase. The early use cases were about setting up the system; uploading images from CDs and formally integrating the exchange into the distinct locations within a healthcare organization. Next came relatively simple use cases, such as retrieving images from a different institution when a patient ends up in the emergency department (ED) or for trauma care. I think everybody got on board with that—it’s more efficient and we don’t have to rely on patients carrying CDs.

Now, I think we’re moving into a different phase, using image exchange for an expanded range of applications. Our International Medicine division is a great example of that. When someone is considering traveling to Philadelphia for care from other countries for one of our frontier programs, they can send images ahead of time. We can’t do a full assessment, but we can parse out if they should travel to us or the condition can be treated locally. We don’t have to wait for a FedEx from across the world anymore.

The next step is creating an entire pediatric imaging network. We already do subspecialty pediatric reads for many institutions outside of our large integrated network, so we have image exchange with non-CHOP facilities from across town to New Jersey and soon in New York. If their networks go down and the local hospital loses its PACS, let’s say, we use lifeIMAGE as a continuity plan. They can upload images to us and they can at least get reads that way if their PACS is totally down.  This is just one use case where lifeIMAGE can be used as a Swiss army knife of sorts; meeting many challenges of image exchange.

The other thing I’m really excited about is efforts to create large networks utilizing an image exchange for pediatric reads. Many healthcare organizations do not have pediatric radiologists. You sometimes get a nuanced case that a general radiologist doesn’t feel comfortable reading, or wants a second opinion on, and we are looking at how to create large networks of subspecialists using image exchange. We want to be able to find the most competent and capable person to read that study wherever the patient and the radiologist might be.

As a radiology leader, why did you bring image exchange to CHOP? What was the decision based on?

Well, we’ve got over 50 sites throughout the region that are all bringing in images from different places. In the old days, we would upload images centrally into from our PACS location, but with lifeIMAGE, we can do it anywhere. You don’t want doctors carrying CDs in the trunks of their cars; that’s how CDs get lost. Losing images can create major problems down the line if someone questions the care and the doctor doesn’t have the images to back up their care decisions.

I laid out the initial value proposition and now we’re in the maturity phase with our trauma workflow—but we’re still pushing it further. Everyone speaks in terms like, “we did a study at one ED and the other EDs have access to it,” but I’m talking about the next step: networks between specialists and hospitals. Pediatric subspecialized interpretations could be available to the most rural place in the U.S. that’s hours away from a hospital, and maybe further still from a pediatric radiologist.

How are other departments involved in the image exchange workflows?

I actually can’t think of a department that involves imaging that wouldn’t use the image exchange—any department that has incoming patients utilizes the lifeIMAGE workflow. International medicine gets those requests for assessment mentioned earlier, and the ED and trauma folks use the image exchange when patients are transferred. Sub-specialists are using lifeIMAGE when patients are showing up with CDs or if the doctor just wants to use old imaging as a reference.

What are some specific ways lifeIMAGE has impacted patient care at your organization?

Image exchange has been a boon for trauma care, partly because we’re a tertiary care facility—we’re at the end of the line. Folks in our community and region come to us when they have a really difficult pediatric case that needs intervention, and having automated processes can really expedite patient care. Our trauma team can look at images and the information ahead of the patient’s arrival, perform the initial triage and know if the patient is going directly to the OR or spending time in the ED for observation.

In addition, it’s important to minimize the amount of studies that are being done—especially in the pediatric frame. Any radiation given to a child has to have a specific trade off. It has to be worth it so the last thing we want to do is repeat a study because the prior study is not available to us.

How important is it that the image exchange integrates with the electronic medical record (EMR)?

It’s very important, for two main reasons. First, it’s a workflow issue. It creates inefficiencies when a non-radiologist physician is asked to go outside of their workflow to view imaging. Second, they have to place orders for images in the EMR. When the image exchange is integrated with EMR, they can make decisions about ordering additional studies while looking at the current imaging studies already completed.

Interoperability is key for the future of image exchange. Why is this so important in modern healthcare?

In a value- and risk-based world, you want to efficiently provide the best care across networks. Not being able to share information across hospital networks will result in duplicated scans. That’s going to hurt you from a cost perspective in a value based payment world.

How would you describe the support you’ve received from lifeIMAGE?

We’ve been very pleased with the support. They’re keeping the system running efficiently and as we come up with new ways to utilize the software, they’ve been thoughtful and responsive. We need to move images and information across states, countries, and continents, and they are helping us figure out how to best use their system to accomplish this.