HIEs Revamp Radiology: Image Access Anytime, Anywhere Breaks the Boundaries

Healthcare systems and radiology practices are beginning to tap into health information exchanges (HIEs), with some exchanging HIE’s prized peacock: images. Early adopters are fueling growth, boosting efficiency and cutting costs as well as discovering the value of collaboration by embracing data sharing among competitors. Consider:

• One of the large referral sites linked to the OhioHealth (Columbus) Results Browser HIE has cut exam duplication by 85 percent since plugging into the HIE.
• HIE-enabled processes helped Spokane, Wash.-based Inland Imaging cut imaging exam turn-around time in half.
• By offering HIE image access, which eliminated the majority of film and storage costs, Michigan Regional Health System in Petoskey, Mich., saved more than $100,000 since going live with PACS at Northern Michigan Regional Hospital.

Driving efficiency and growth

Inland Imaging Business Associates has benefitted in several ways from its web-based HIE. From 2007, when the practice first implemented the HIE, to 2010, the practice cut exam turn-around times by 50 percent, reports CEO Jon Copeland.

Using a single enterprise worklist, the system stores 1.3 million radiology image exams per year and more than 1,000 users access the system every day. An internal algorithm lays on top of multiple radiology and hospital systems, which enables a single workflow for radiologists and radiologist assistants and creates a continuous workflow for tracking critical and urgent findings in reports, says Copeland.

The system augments and tracks statuses such as when the orders are entered, when an exam is completed and when the technologist marks an exam as ready as well when an exam is finalized. Additionally, the system tracks quality check statuses including transportation time and presentation of preliminary exams. “We’ve added extra statuses to track at a more granular level of the workflow throughout the hospital department,” says Copeland, who attributes radiologists’ 15 percent efficiency gain in the last three years to the HIE.

The HIE has stretched Inland’s growth into the Phoenix and Seattle markets. “Clinicians should be willing to share and agree to collaborate with patient exam data in an HIE model across competing entities in order to enable a seamless flow of patient data,” says Copeland. The combination of sophisticated tracking and routing 1,300 imaging devices to a single PACS database fuels the HIE’s growth. Driven by HIE participation, Inland brought four new customers onto its PACS in 2010.

Anatomy of an HIE

Web-based HIE systems are hitting the market at breakneck speeds. Take for example OhioHealth Results Browser (ORB). Some 3,000 users plug into the internal single sign-on-based application to provide image sharing and clinical decision support, says Scott Starkey, director of digital imaging at the nonprofit OhioHealth Information Services.

The HIE integrates PACS data with other clinical data from OhioHealth’s family of hospitals and 20 health and surgery centers throughout a 46-county area and pushes that data via a virtual private network to a web browser (or via cloud DICOM routing if the referring site’s bandwidth volume is insufficient for a particular exchange). The system stores one million studies—150 terabytes—annually. The application has been so widely adopted that Starkey reports that OhioHealth recently rolled a version of ORB onto the iPhone.

Smaller HIEs report similar success. Michiana Health Information Network (MHIN) in South Bend, Ind., formed in the mid-1990s with an original goal to deliver clinical results to providers. Currently, MHIN encompasses about 1,000 clinical providers sharing clinical data including surgical notes, radiology reports and clinical summaries during visits to provide a community regional record. An average of 500 to 600 providers access MHIN daily, with two million transactions occurring monthly, according to Tom Liddell, executive director for MHIN.

Medical information, including radiology reports, is fed into a single pipeline database which is bifurcated and routed naturally into a clinician’s inbox so users have up-to-date information depending on the type of practice. According to Liddell, a radiology exam and associated results can be routed to the radiologist’s inbox. “In many cases, though not all, we present the diagnostic image, and in other cases, if a radiologist’s security parameters are not strictly set, it will drop them to log on to PACS to view that image,” says Liddell.

MHIN has grown 15 percent in the last year. South Bend, Ind.-based Memorial Health System has linked into MHIN for seven years. “We have seen a reduction in the transmission of paper results throughout the community, and our clinicians tell us the timeliness of the results reporting and accuracy has reduced the need for duplicate tests, which reduces cost where appropriate,” says Steve Huffman, vice president and CIO at Memorial Health System.

Quality, safety and cost impacts

OhioHealth is reaping benefits from improved access to images and data. If a clinician sees an incoming patient just had an MRI or CT exam and can thus view the results, it cuts down on a patient’s radiation exposure and costs, says Starkey. One of the larger referral sites cut exam duplication 85 percent since plugging into the ORB, according to Starkey.

Is Your Local HIE Ready for Image Exchange?

Some questions to ask: Does this HIE have the infrastructure and resources to support imaging? A single image can take two to three times as much space as other types of data to store, quickly sopping up terabytes of storage and prolonging exchange times.  Is there a PACS-independent viewing capability or does it require single sign-on to multiple PACS and downloading of multiple viewers? How is image exchange built into HIE workflow? How is storage handled? Is there a cost to radiology providers, or possibly opportunities for providers to leverage that storage?

Similarly, Huffman notes that the 526-bed Memorial Hospital, a regional referral center for cardiac, childbirth and emergency medicine services, has seen a drop in duplicate imaging exams while experiencing a growth in patient population since beginning to exchange radiology reports through MHIN.

When dealing with a large patient catchment, transport turn-around times for images and patients can be critical. Mark S. Gray, CIO of the Northern Michigan Regional Health System (NMHRS), notes that using a web-based HIE has helped rural providers in the 22 Michigan counties it serves access radiology images. The exchange archives 125,000 images annually. NMRHS’ flagship 214-bed Northern Michigan Regional Hospital saved more than $100,000 going live with PACS, according to Gray. Using interfaces through a Citrix portal to pull EMR and PACS images, the web-based HIE delivers 30 second turn-around time.

Prior to the HIE, reviewing a typical CT exam entailed two minutes to print each of 10 sheets of film. “Now, a technologist hits a button [to send the image to the consulting physician] and within five minutes, the radiologist and consulting physician are discussing the case.” Two rural hospitals that would have had a hard time getting radiology images were able to slash costs and accelerate care by eliminating film, adds Chuck Beat, NMRHS’ IT interface analyst.

The future of HIE is now

Radiology data and image exchange are gaining traction and utility with HIEs. Through web-based products, interfacing algorithms and re-routing of reports and clinical images, healthcare providers across the country are beginning to realize the multi-faceted benefits of exchanging radiology data and images.