The impact of siloed medical imaging on interoperability

Most patients don’t know anything about interoperability. They expect their doctors to have all the information necessary to make the best treatment decisions, no matter where or when they last received care.

One of the largest roadblocks to meeting this expectation of complete accessibility are imaging silos. To achieve interoperability that improves patient outcomes, healthcare organizations have to tear down the silos that waste money and render vital patient information inaccessible to those who need it most.

People throw around the term interoperability, so let’s define it before we continue. “Interoperability is the ability of health information systems to work together within and across organizational boundaries in order to advance the effective delivery of healthcare for individuals and communities,” according to HIMSS.

Interoperability is no longer optional

While interoperability has been a popular topic and a favorite buzzword of the industry for years, organizations looking to maximize their reimbursements can no longer look at it as a “nice to have.” In fact, 30 percent of fee-for-service Medicare payments will shift to value-based reimbursement models, according to data from Frost & Sullivan Research. The shift to patient-centered care will only increase over time. The data also shows that in 2016, 10 percent of diagnostic imaging procedures were reimbursed as part of bundled payments, while in 2020, 50 percent will be part of bundled payments.

We have seen all the confusion around what forms of payments will continue into 2018 and beyond, but one thing is clear: Access to information must span organizations and information silos in order to cost-effectively plan and deliver care.

With new reimbursement models, organizations must know all the medical imaging procedures performed on a patient, no matter where or when they occurred, because they will not be reimbursed twice for duplicate imaging of the same patient.

How can an organization adequately respond to these changes if each imaging department continues to manage their information and images within disparate departmental systems? Worse yet, what if they don’t have a centralized information management strategy at all?

Flashback to the 1990s

The siloed state of imaging today can be compared with the state of departmental systems in the 1990s, prior to the adoption of electronic health records (EHRs).

In the 90s, departments each bought their own departmental systems. The director of lab purchased a lab system. The director of pharmacy bought a pharmacy system. The director of radiology bought a radiology system. But as we moved into the early 2000s, the industry and the government realized the power of bringing all discrete patient information into one system – thus, the EHR was born.

While the EHR is broken into separate modules for registration – lab, pharmacy and so on – it is typically purchased under one enterprise strategy from one vendor. Department heads rarely purchase their own siloed solutions these days.

While the EHR is not perfect, it has done wonders for an organization’s ability to centralize discrete information around the patient and make that information accessible throughout the organization.

PACS and silos are holding you back

Now fast forward to today and the same story can be told about imaging.

Imaging is one of the last holdouts around interoperability. Departments including cardiology, radiology, ophthalmology and gastroenterology manage their images in siloed systems like radiology picture archiving and communication systems (PACS), the cardiology PACS or other “mini” PACS.

The problem with a PACS-focused strategy centers around the proprietary design and code sets of these systems. While DICOM has been widely adopted as the defacto standard, PACS vendors continue to use proprietary extensions to make interoperability within and outside the enterprise complicated and costly. The problem is compounded when organizations try to incorporate specialty images that fall outside traditional PACS parameters.

CIOs need to start challenging how their department heads think about PACS. Not only does relying on a PACS strategy hinder interoperability, but it also limits an organization’s agility. PACS systems were developed 20 years ago before surgical video, endoscopy digital output or mobile capture were even a thought. As new modalities and image types are created, PACS systems are ill-equipped to ingest their images.

A PACS-focused strategy also hampers your ability to innovate. With patient images and information locked in a PACS, are you prepared for the data usability requirements of population health and data analytics? Can your PACS handle the large data sets that come   with digital pathology and genomics?

If you can’t enable these tools with the best data, you will never fully realize their benefits.

Simply stated, multiple silos mean multiple infrastructures and support models. This becomes a costly headache as you try to integrate these departmental silos with enterprise systems such as the EHR. To make imaging and specialty department information viewable from within the EHR, you have to build multiple connection points that are expensive, resource intensive and difficult to maintain.

And remember, we aren’t talking about an insignificant amount of patient information. Today, 75 percent of healthcare data is in the form of non-DICOM medical imaging assets, according to Frost & Sullivan. This 75 percent includes video, photos, oncology treatment plans and other file types which the PACS cannot manage, therefore they wind up as silos of data scattered throughout the organization and inaccessible from the EHR.

If your clinicians cannot view imaging and specialty assets from the EHR, they are not getting a complete picture of their patients. Healthcare can no longer afford this lack of transparency and its associated costs.

Enterprise medical imaging is the “beyond”

It’s time to integrate the enterprise around one holistic imaging strategy.

Enterprise imaging is about more than just image-enabling the EHR; it’s about image- enabling the entire enterprise. It does this by capturing both DICOM and non-DICOM images as well as unstructured data and making this information accessible to all clinical stakeholders, even those who may not have EHR access. As such, it is a solution that supports not only the EHR, but a whole host of enterprise systems, including population health analytics, PACS and specialty departments.

Enterprise imaging enables more informed clinical decision-making and drives down costs by allowing healthcare organizations to capture, manage and view medical images at the clinical point of care and within the radiology and cardiology departments.

Enterprise imaging enables interoperability by consolidating imaging information throughout the enterprise into a federated, standards-based data repository that communicates seamlessly with all the IT systems involved. Through standardized data formatting, enterprise imaging provides organizations with all-encompassing ownership of their imaging information, removing the vendor lock-and-block of proprietary systems. It leverages advanced technologies to support the management and sharing of imaging data across the enterprise and beyond, empowering clinicians with real-time collaboration.

By centralizing your image management with an enterprise imaging strategy, you will build a foundation for interoperability that will lead to fully informed clinical decision-making, reduce costs and add an important complement to the EHR.

You have to start somewhere

While the words “enterprise” and “strategy” can be overwhelming, it’s a journey that is made of steps. The best enterprise imaging solution is one you can implement in a phased-approach. Some organizations begin with a vendor neutral archive (VNA), while others choose to link their PACS systems using an enterprise viewer.

No matter where or how you start, it’s important to keep your eye on the goal of an enterprise class vendor neutral strategy that busts down silos while giving you ownership over your data. Stick to that goal and you’ll be well on your way to interoperability that has a direct and measurable impact on patient care and outcomes.

Sandra Lillie is the Director, Global Healthcare Industry and Product Marketing at Hyland Healthcare. She leads a team providing advanced market strategy and messaging expertise to Hyland Healthcare on market alignment, collaboration and client experience in support of Hyland’s extensive healthcare portfolio, including OnBase, Acuo VNA, NilRead Enterprise Viewer, and the PACSGear Enterprise Image Connectivity Suite. Sandra brings more than 20 years’ experience in hiring and developing high performance teams productive in business development and consultative selling of information technology solutions for the healthcare community. She has extensive leadership experience prior to joining Hyland through roles of increasing responsibility at Lexmark Healthcare, Informatics Corporation of America, Teramedica, Dell Healthcare, EMC delivering solutions supporting health information exchange, vendor neutral archive, enterprise content management, and technology infrastructure in support of healthcare information systems.
Sandra Lillie

Sandra Lillie

Sandra Lillie is the Director, Global Healthcare Industry and Product Marketing at Hyland Healthcare. She leads a team providing advanced market strategy and messaging expertise to Hyland Healthcare on market... read more about: Sandra Lillie