Live from HIMSS18: One patient, one chart demands enterprise imaging

healthcare enterprise imaging

During a “Lunch-and-Learn” session at HIMSS18, members of UNC Health Care’s clinical and IT staff outlined the provider’s ongoing “one patient, one chart” vision. The presentation, titled One Patient, One Chart, One Imaging Record: A Journey To Simplification, emphasized the significant role enterprise imaging plays in the execution of this initiative.

Like many healthcare providers, UNC Health Care initially focused on consolidating the multiple EMRs in use throughout the health system into a single enterprise EHR as a means to this end. However, the institution quickly realized that developing a truly comprehensive patient chart required much more than EHR aggregation.

“Medical images are an essential extension to the patient chart,” says Vineeta Khemani, Director of ISD Architecture and Clinical Systems at UNC Health Care. “However, these vital assets aren’t effectively addressed as part of an EHR-only strategy. We knew we needed to establish a single clinical image repository and integrate it with our enterprise EHR via one common viewer to make our ‘one patient, one chart’ vision a reality.”

At the time of this realization, UNC Health Care maintained multiple PACS and specialty imaging systems. Integrating each of these individual systems with the EHR was an overly complex proposition. Moreover, PACS weren’t viable repositories for the visible light images that were becoming more in demand for clinical reference. As a result, UNC Health Care initially attempted to leverage the EHR itself as a repository for visible light images, but image quality and organization suffered.

“As a physician, my biggest problem was finding images, media and other non-discrete data in the EHR,” says Dr. Don Spencer, CMIO of UNC Health Care. “I would also regularly receive complaints from other physicians regarding the ineffectiveness of the EHR’s Media Manager functionality.”

VNA, enterprise viewer provide longitudinal image history

To address this issue, UNC Health Care invested in the Acuo by Hyland Vendor Neutral Archive (VNA) in September of 2015 and launched the solution eight months later. The VNA serves as a single, non-proprietary repository for all clinical images — including all DICOM-based radiology and cardiology studies, visible light images/video and other native image assets. To date, more than six million imaging studies are stored in the VNA, which has allowed for the elimination of nine PACS and three reporting/dictation systems.

The VNA feeds the NilRead enterprise viewer that is integrated with the EHR, providing a longitudinal image history that’s tied directly to the patient record. The solution has provided UNC Health Care with several benefits, including:

  • Tighter clinical integration and better continuity of care

The enterprise imaging platform provides timely access to images across all enterprise facilities, which facilitates time-sensitive consultations and collaboration. The fact that historical patient images are readily available has also led to a significant reduction in unnecessary repeat imaging tests.

  • Operational efficiencies and compliance

The aggregation and elimination of systems has resulted in a reduction in annual support and enhancement costs, fewer upgrades and more efficient support models.

  • Architecture simplification

Fewer systems means a smaller server and application footprint, which makes it easier for UNC Health Care to focus on and address business continuity planning.

Cloud-based image exchange, AI and ECM convergence up next

Despite these gains, UNC Health Care stresses that its enterprise imaging initiative is an ongoing journey. The provider continues to expand and evolve the system to ensure it delivers optimal value to the enterprise and its patients.

Some current and future enterprise imaging initiatives include the development of a cloud-based image sharing architecture that will further support collaboration and continuity of care by replacing CDs and DVDs as the primary means of transporting patient images from one facility to another. UNC Health Care is also investigating ways its enterprise imaging infrastructure can support AI and machine learning algorithms for image reconstruction. Finally, the provider plans to integrate its enterprise clinical image repository with a unified enterprise content management (ECM) system that will centralize and consolidate clinical documents and other unstructured content and connect it with the EHR.

“Studies show that more than 70 percent of the information related to patient health lives outside the EHR, so it’s imperative that you can locate this information, aggregate it and tie it to the patient record to ensure a comprehensive single source for patient data,” says Jeff Agricola, IT Manager at UNC Health Care. “Aggregating multiple EMRs into a single enterprise EHR was the first step in this process. We believe the convergence of a single ECM system, a single clinical image repository and a single EHR is the next phase of EHR enhancement — we call it EHR 2.0.”

Learn more here.

Ken Congdon has expertise in the healthcare technology industry and has been a contributor to the Hyland blog.
Ken Congdon

Ken Congdon

Ken Congdon has expertise in the healthcare technology industry and has been a contributor to the Hyland blog.

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