The impact of COVID-19 on healthcare systems from an imaging point-of-view

In the early days of the COVID-19 situation, before several states issued stay-at-home orders, healthcare systems were already considering how to quickly stand up work-from-home capabilities for large segments of their employee bases. That included radiologists and other imaging specialists – disciplines healthcare systems were traditionally reluctant to turn into home-based practices.

“Sometimes you need a wake-up call to get you going, and the coronavirus is doing just that,” Barry Julius, M.D., a physician in nuclear medicine with Saint Barnabas Medical Center in New Jersey told Radiology Business in March.

“It’s absolutely time for the wake-up call,” echoed Joseph Marion, principal at Healthcare Integration Strategies, during a panel focused on healthcare imaging in this new environment, titled Optimizing your imaging approach for the COVID-19 fight, moderated by healthsystemCIO.com.

“Some organizations get it,” he said. “They have a defined enterprise imaging strategy, they’re executing on it, they’ve defined governance, they have a budgeting model. Others are kicking that can down the road, milking out their existing imaging solutions, continuing to invest in point and specialty solutions and just thinking the whole thing is going to go away. Which it is not.”

Marion, along with Brandon Taggart, founder and principal consultant at Konfidi Healthcare IT Consulting, and Chris Magyar, senior product manager, Enterprise Medical Imaging at Hyland, expanded on the topic during the Hyland-sponsored event.

Accessibility is key – and a couple caveats

There is some good news, at least for organizations prepared for the sudden shift. For those that have enabled radiologists to read from home, it is business as usual, save for a few caveats, like mammography.

“Most organizations have not set up appropriate parameters to read mammography,” said Taggart. “That complicates things, putting some radiologists at risk, since they need to go in and be physically present [to conduct those procedures].”

Patients and physicians have postponed many of those procedures, however, leading to revenue declines for some healthcare systems, in turn affecting the ability to properly staff. Taggart called it the calm before the storm, especially for communities outside hot zones that haven’t felt a significant impact yet. They’re wondering whether they should lower staff levels or ride it out until an expected patient surge arrives.

“The key is widespread accessibility,” said Marion. “Having the resources and capability to tie people in from remote locations and share information will be a challenge. It will tax hospital systems, particularly in terms of interoperability.”

Healthcare systems must make sure the information they acquire on any COVID-19 patient is available to the clinical staff, whether they are on or off site.

Hyland is helping customers work through those challenges, Magyar said.

“We’re asking ourselves how we develop solutions that will help healthcare customers deal with this more quickly and effectively,” he explained. “We’re really trying to figure out how we can help customers from a clinical review, enterprise-yield perspective, particularly those that may not have leveraged all of the diagnostics or remote reading diagnostic capabilities. How do we help make that transition?”

Read-from-home challenges

Most of the challenges radiologists are facing while reading from home come down to display quality, resolution and bandwidth, said Marion. But there is a bigger issue. Security.

“If organizations are using systems that require transmission of patient data, that opens up a can of worms,” Marion said. “Those issues need to be addressed or, at least in the context of remote reading, we need to make sure people are handling that information correctly.”

Questions healthcare systems need to consider include whether the remote reader’s technology is hospital issued or personally owned. Either way, how does IT support remote staff? Completely remote, or do they visit radiologists’ homes? And how does that decision effect security concerns?

“Did you set up a true strategy and standards from the get-go?” Taggart asked. “One in which the organization provides all of its own imaging devices? That can be expensive and isn’t always an option.”

Many information security officers do not want to provide VPN access directly from an unknown device, either, he explained. Access to the network creates potential vulnerabilities.

“You really want to make sure they’re locked down and they’re not open to the entire network,” Taggart said, “because that could introduce other vulnerabilities. That’s probably the most important thing to be concerned with right now. We want to make sure we’re protecting our secure information.”

For some organizations, it may seem daunting to make the kind of shift our current climate demands, but there are other approaches, and healthcare systems should investigate them.

“Cloud models, server-side rendering models, things that move away from the traditional, heavy radiology workstation client,” said Magyar. “You’ve got to change the rules in some way.”

Are healthcare organizations better equipped if they have moved toward enterprise imaging?

 

Panelists agreed that the COVID-19 situation compelled organizations to deliver workflow solutions many may not have anticipated, and those organizations that invested in a more flexible imaging infrastructure were better positioned to address those demands quickly. They also took a deep dive into whether the industry needs a thoughtful definition of enterprise imaging.

“It’s not always well-defined,” Taggart said, then offered one definition as it relates to COVID-19. “We should look at enterprise imaging as a consolidation of imaging data, ensuring information and image availability across the enterprise for diagnosis and clinical reference.”

Healthcare systems that have moved toward enterprise imaging – either having migrated, consolidated or federated data – are providing the information necessary for appropriate diagnosis.

“Organizations that have not prepared, it’s very hard for them right now,” Taggart said. “Mobility, the amount of staff they have, moving things around … Even if we’re talking about antiquated workflows, that becomes very problematic.”

In other words, they have very FTE-intensive, manual workflows with fewer FTEs.

Enterprise solution benefits outside radiology

“We also have to keep in mind that one of greatest benefits of going to an enterprise solution may occur outside of the classical imaging areas of radiology and cardiology,” Marion added. “It may not be in the context of COVID, but certainly areas such as wound care management and pathology, they are going to become much more intensive and probably benefit much more in terms of an enterprise solution.”

Magyar expanded on the subject.

“In more established imaging specialties, like radiology, we have order-based workflows, modality work lists, storage and manage capabilities – and they can all integrate with the EMR,” he said. “But they’re all specialty focused. They don’t necessarily scale well outside of radiology.”

Some departments lack infrastructure and are using any bit of technology they can to collect images, Magyar said. But are they associating those images with patient data? And how are they storing or managing that data?

“Situations like we’re facing now shine a light on things, and you can’t just sweep those under the covers and pretend it’s not going on,” said Magyar.

Taggart agreed, noting that if clinicians need something to treat their patients, they will find a creative solution.

“If an organization is not adapting with them and providing clinicians with viable solutions, they will find a way to work around that,” he said. “And chances are they’re not thinking about things like security protocols. So it’s very important to have an [enterprise] strategy. And if organizations haven’t already, this is the time to have that conversation.”

“Organizations that have invested in enterprise imaging … may have viewing capabilities that span all the above and are integrated nicely with their EMRs, giving them a single view of the comprehensive patient imaging record,” Magyar said. “Organizations that have made those investments can look at those demands and move much more quickly to deliver solutions.”

And those solutions help them deliver on the ultimate goal: Improved patient care, driven by data.

To hear what else the panelists discussed, watch Optimizing your imaging approach for the COVID-19 fight, sponsored by Hyland Healthcare.

Tom Tennant

Tom Tennant

Tom Tennant is the content marketing manager for Hyland Healthcare. He joined Hyland in 2010 as its first brand journalist after far too many years in daily news and trade... read more about: Tom Tennant

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