Applying content services to complete your EHR

If you were at HIMSS 2018, you might have been fortunate enough to sit in on a Hyland Healthcare-sponsored presentation by the University of North Carolina Health System titled, One Patient, One Record, One Imaging Record.

The presentation outlined the importance of creating an enterprise medical imaging (EMI) strategy that allows healthcare delivery organizations (HDOs) to create a complete healthcare patient record that is interoperable across the healthcare’s enterprise. It also focused on establishing methods to obtain all clinical content on a patient.

HDOs are increasingly acknowledging that their electronic health records (EHRs) do not contain all the data that exists on a patient within their organization, even after significant investments in EHR applications. Many HDOs are now applying what they have learned in EHR implementations to their medical imaging and content management development to advance the capabilities of their EHR and position their HDO to address more active patient consumerism.

But disparate components of patient records still exist within HDOs today and complicate how providers are informed or provided greater clinical insight into the care of their patients. Clinical data that exists but isn’t available might as well not exist at all.

The following formula recently established qualifies the lack of information access that exists in most EHRs today.

EMR + Content Services (EMI + ECM) = EHR 2.0

The enterpise content management (ECM) and EMI components in this formula represent the content services that exist primarily as unstructured content within the HDOs clinical data environment. However, when combined appropriately with the organization’s electronic medical records (EMR) component, a new level of EHR emerges: EHR 2.0.

Dr. John Halamka recently described how we’re transitioning into EHR 2.0. As CIO of Beth Israel Deaconess Medical Center, Chairman of the New England Healthcare Exchange Network (NEHEN), and Co-Chair of the HIT Standards Committee, he should know.

EHR requirements are changing to encompass the need for team-based care, value-based reimbursement, reduced government mandates, and a more usable and consumer-driven her, says Dr. Halamka. All of which supports a more patient-centered clinical care record that can more actively engage the patient as a more active consumer.

However, before an HDO can respond to the demands for the changing EHR, it must get control of all the digital content that exists within the healthcare delivery environment. Digital transformation is coming to healthcare. And content services are driving it. Components in the form of medical images (X-rays, CT scans, MRIs, GI Images and video, wound photos, GI components, and visual images) and other unstructured content (clinical documents, consents, insurance forms, etc.) make up a vast majority of patient information today.

However, most of that information lives outside of today’s typical EHR. To make the EHR more valuable to support an emerging EHR 2.0 environment, a content services strategy that completes the formula can provide more patient-centered care and positions the HDO for greater patient consumerism.

Defining content services

Gartner has defined content services as a set of services and microservices, embodied either as an integrated product suite or as separate applications that share common APIs and repositories, to exploit diverse content types and to serve multiple constituencies and numerous use cases across an organization.

Given Gartner’s definition of content services and the close relationship that EMI today has with ECM’s new content services role in the healthcare organization – including EMI components as part of the content services platform within an HDO – the emergence of EHR 2.0 starts to make sense.

EMI platforms provide a similar level of governance and processing components as does traditional ECM, and although EMI is not a primarily traditional document and record management, it does share many of the same characteristics. EMI can search, index, categorize and capture images which are not exclusively within the traditional ECM platform.

In the healthcare delivery space, the business of healthcare is embedded within the clinical care delivery process, and the need for common APIs and repositories that promote the interoperability of clinical data exist like never before. So including EMI as a content services platform given its vast similarities to the definition of content services makes a lot of sense.

Addressing EMI within the content services platform definition in healthcare allows HDOs to provide for a focused interoperable approach for both imaging and unstructured content that contributes in a much more meaningful way to the HDOs EHR strategy.

Principles of a healthcare content services strategy

Some important principles that need to be addressed within a healthcare content services component include:

  • Leverage your portfolio of existing best-of-breed components.

The advent of integrated EMR deployments has dominated the healthcare landscape over the last ten years. However, there remain important patient care systems that are still operating in best-of-breed environments.

Many of these components exist as traditional PACS or EMI solutions. However, increasingly there are imaging applications, both DICOM and non-DICOM, that exist across the HDO today. Included are areas that support gastroenterology, wound care, dermatology, and other areas that capture visual images, like the ED. Leveraging your portfolio in these areas provides a more focused enterprise approach to the capture, management, indexing, and visualization of these components and allows for much more valuable EHR processes to exist.

For instance, approaching the management of all of these components through one enterprise archive solution allows the HDO to follow a very familiar roadmap to begin to integrate this important data. Why have multiple imaging repositories supporting individual departments across the HDO when a common archive management solution can improve workflow, help to address security concerns, and better enable a true EHR delivery model that better enhances the delivery and quality of care?

  • Deliver an integrated ECM-EMI solution.

HDOs will come to realize that a content services strategy can help to improve overall care delivery and do that at a lower cost per unit of service, allowing the integration your ECM and EMI solutions so they can contribute important clinical care information. Having multiple methods upon which you can decide where clinical content needs to be housed, stored, and visualized is only a greater benefit for the HDOs EHR strategy.

That said, the EMR should be the controller of the patient index and then integrated within a healthcare content services strategy that allows both ECM and EMI content to be presented in a more meaningful way to important clinical care providers.

  • Vendor neutrality, interoperability, and data liquidity.

Besides being a vendor-neutral approach for all EMI related applications and repositories, the EMI solution should offer full conformance with the latest DICOM SOP classes and conform to DICOM syntax representation. EMI solutions should be able to ingest both DICOM and non-DICOM data and make it available in its native format to the originating system. EMI solutions should also support mobile capture capabilities that link content through DICOM or XDS services, allowing for visible light capture.

The ability to also link the mobile capture solution to the ECM solution is also a plus. The EMI solution should have a strong visualization solution that can deploy on an enterprise-wide basis and support the federation of clinical visualization across different platforms if required. Once an EMI strategy exists that supports vendor neutrality and improved interoperability data will become more liquid as it becomes more available in its native format within the EHR infrastructure of the organization.

  • Availability, performance, and stability.

Its only through the specific attention of evaluating an EMI content services strategy on an enterprise-wide basis can an HDO achieve a usable and distributed high-availability model that offers high-performance and stability. Any well developed EMI content services approach addresses the capabilities needed to address these issues.

Developing a healthcare content services strategy

Developing a healthcare content services (HCS) strategy allows the integration of DICOM and non-DICOM clinical content into a common visualization storage infrastructure that integrates with your EMR. For the EHR to truly become a single source for patient information, it must contain all the content exists on a patient. The problem is that today, upwards of 75 percent of patient information can live outside of the EMR component and doesn’t exist within a comprehensive and fully interoperable EHR solution.

Implementing the right formula, EMR + Content Services (EMI + ECM) = EHR 2.0, can move your organization to the next step in its digital patient care journey.

Phil Wasson

Phil Wasson

Phil Wasson, FACHE, is a healthcare industry manager and consultant at Hyland. His mission is to develop content and create alignment with healthcare organizations focusing on information management and imaging solutions so healthcare organizations can realize more efficient operations that improve patient care. Phil joined Hyland after a three-year stint at Lexmark Healthcare as a consultant, and later as a healthcare industry manager. Phil has more than 25 years leading healthcare IT functions as a CIO and holds a fellowship in Healthcare Management with the American College of Healthcare Administrators. He received his B.S. in Healthcare Management from Southern Illinois University at Carbondale, IL.

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