enterprise imaging white paper aug 15 2011_web

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Adopting an Enterprise Imaging Strategy: Bene ts or Hospitals, Re erring Physicians, and Patients

A Merge Healthcare Whitepaper© 2011 Merge Healthcare



ADOPTING AN ENTERPRISE IMAGING STRATEGY: BENEFITS FOR HOSPITALS, REFERRING PHYSICIANS, AND PATIENTS• A MERGE HEALTHCARE WHITEPAPER

IntroductionAn auto accident victim with head injuries isrushed by ambulance to the nearest communityhospital, where he is given a CT scan o the head.A ter reviewing the scan, the ER doctor decidesthat the patient needs a higher level o care thanthe community hospital can provide. The patient istrans erred along with a CD o the scan to a Level1 trauma center. However, the trauma center’spicture archiving and communication system(PACS) cannot read the CD, so the patientundergoes another head CT scan.The manual process o sharing diagnostic imageson CD delayed treatment or an injured patient,exposed the patient to unnecessary irradiation,and required a duplicate test that the patient’sinsurance may not cover. I the community hospitalhad an enterprise imaging strategy in place, its ER

physicians would have been able to send the CTimage electronically in a standardized ormat inreal time to the trauma center. A radiologist at thetrauma center could have used their native systemto quickly determine that trauma-level treatmentwas not necessary. The patient would havereceived care without delay and would haveavoided additional, potentially harm ul radiationwithout incurring duplicate costs.

Although this example is ctitious, it illustrates anall too real scenario that plays out in hospitals,

emergency rooms, and specialists’ o ces acrossthe U.S. every day – and the statistics illustratethe seriousness o the situation:

> The National Council on Radiation Protectionand Measurements (NCRP) reported in 2009that U.S. patients’ exposure to ionizing radiation

– delivered through millions o CT scans andother radiation-generating proceduresper ormed annually – has almost doubled overthe last 20 years.

> According to a study published online inRadiology, rom 1995 to 2007, the number o visits in which a CT scan was per ormedincreased 6- old, rom 2.7 million to 16.2 million,representing a growth rate o 16% per year. Thepercentage o visits that were associated with aCT scan also increased substantially, rom 2.8%o all visits in 1995 to 13.9% o all visits in 2007.

> Just one CT scan exposes a patient to the sameamount o radiation as 100 chest x-rays,according to a 2010 study by the Center orDevices and Radiological Health and the U.S.Food and Drug Administration. The radiationlevel in one CT scan o the abdomen isapproximately the same as 400 chest x-rays.

> According to the American Society o Radiologic Technologists, healthcareorganizations generate close to 600 milliondiagnostic imaging procedures annually.

> A 2009 report on the CBS Evening Newsindicated that $100 billion o annual healthcarecosts are related to diagnostic imaging tests

– but an estimated 35 percent are unnecessary

scans. That translates to $35 billion inunnecessary costs or U.S. patients andinsurance providers.

Research and anecdotal evidence alike build astrong case or why diagnostic images should beeasily accessed and shared electronically acrosshealthcare enterprises, regional healthcarein ormation organizations (RHIOs), and statewidehealth in ormation exchanges (HIEs). Why?Diagnostic images make up a critical part o thediagnosis process. Yet today, the most commonway they’re exchanged among providers and

re erring physicians is by making a copy o theimage onto a CD and giving it to the patient totake to the next appointment at a specialist’spractice or a hospital – an ine cient process thatlends itsel to human error and the risk o the CDbeing unreadable on the acility’s PACS.

Although many healthcare systems already have

$100 billion of annual healthcarecosts are related to diagnosticimaging tests – but an estimated 35percent are unnecessary scans. Thattranslates to $35 billion in unnecessary costs

for U.S. patients and insurance providers.




PACS or electronic image managementcapabilities, these are proprietary, closed systemsthat do not allow providers to easily sharein ormation between departments, acilities, andentities. Plus, sharing images electronically withre erring physicians outside o the system isdi cult i the two acilities have di erent PACSvendors. To do so would require a priorimplementation o a solution to morph the studiesso that they could be viewed on the receivingsystem. Many o these approaches require theimplementation o specialized hardware andso tware at the sending site, which can create acost that is not sustainable by the receiving center.

It’s time to adopt a new vision or an enterpriseimaging strategy that ocuses on providingelectronic access to any medical image, anywhere,anytime. Current trends in patient sa ety andhealthcare re orm as well as competition orre erring physicians are driving the need or thisnew paradigm o image sharing. The right strategy

aligns with business needs, integrates with existingEHR and PACS, and incorporates three criticalcomponents.

What is an enterprise imaging strategy?An enterprise imaging strategy must ocus onproviding access to any type o medical image,anywhere, anytime by anyone – provider, re erringphysician, radiologist, patient, etc. – across thecontinuum o care in healthcare systems, RHIOs,and statewide HIEs. This new vision goes beyondPACS to make image sharing truly interoperable

and accessible in real time on any approvedbrowser-based electronic device – without havingto load and support additional so tware andwithout complicated and unnecessary movemento data.

Three components are critical to the success o an

enterprise imaging strategy which can beimplemented individually or as a comprehensivesolution: a standardized vendor neutral archive(VNA), an intelligent digital image communicationin medicine (DICOM) gateway, and a universalviewer that can be accessed via an embedded linkor a stand-alone portal that enables viewing o images on any browser-based electronic device.

VNA – High availability or imagesA VNA goes beyond the traditional process o archiving in PACS to create a centralized,standardized, consolidated system that holds andmanages the li ecycle o all images rom eachindividual silo across multiple PACS, sites andspecialties. This system morphs all DICOMheaders into a standard ormat so that any o theDICOM viewers within the healthcare network can

display the images, regardless o which PACSoriginally held the image. Consequently, theimages are much more accessible to thehealthcare network’s physician community at large.

Although VNA is called an archive, it is so muchmore than image storage because the systemkeeps track o all types o diagnostic images or allpatients. For example, a physician can quicklyaccess all patient images rom cardiology,neurology, orthopedics, and other medicaldepartments in a single system, at one time. This

patient-centric approach saves time or thephysician, supports the aster delivery o care orthe patient, and guards against duplicate imaging.

A VNA also manages the li ecycle o images– making it easier and more cost e cient to complywith regulations regarding patient in ormationarchiving, such as the security policies issuedthrough HIPAA in 2005, which require a disasterbackup and recovery plan or all stores o patientdata.

Intelligent DICOM gateway – Eliminatingthe need or CDsWhile the VNA simpli es the sharing and archivingo images within a healthcare network, integratingan intelligent DICOM gateway to read studiescoming in rom outside o the enterprise is the nextstep in an enterprise imaging strategy.

It’s time to adopt a new vision for an enterprise imaging strategy that

focuses on providing electronic access toany medical image, anywhere, any time.




Because the intelligent DICOM gateway canreceive images in real time, it eliminates the needor providers to create image CDs and or patientsto hand-deliver them to specialists. To send animage, the re erring physician simply drags anddrops the le onto the intelligent DICOM gateway’sWeb address. Once received by the gatewayserver, the image is morphed into the receivinglocation’s native PACS ormat, and a noti cation issent to the physician that the study is available orreview in their native system. Doing so candecrease the time to treatment and can lower theincidents o duplicate testing. Images that come tothe acility on CD can also be uploaded using thesame intelligent DICOM gateway. Once viewed,the physician will have the opportunity to deletethe study or to store it or uture re erence.Regardless o the way the images are accessed,

this acet o an enterprise imaging strategy makesit easier or specialists and re erring physicians todo their jobs without changing their normalworkfow. Patients bene t by receiving aster, morein ormed care that leads to ewer duplicate testsand reduced radiation exposure.

Zero-download DICOM viewer – Fast, easyaccess to images anywhereThe third critical piece is a zero-download DICOMviewer to support the viewing o images in theVNA or other DICOM archives. Because it is a

zero-download viewer, users do not have to spendvaluable time downloading so tware, applets, orscripts in order to access the DICOM viewer ontheir personal computers and other approveddevices. Importantly, a zero-download solutioneliminates the need to constantly upgrade orrecon gure the viewer when new versions o

assisting so tware applications, such as Flash orActiveX, are released, resulting in lower IT andsupport costs.

Why healthcare systems need anenterprise imaging strategyThe question is not i , but when a healthcaresystem should implement an enterprise imagingstrategy that provides access to any image,anywhere, anytime. There are many drivers thathospital CEOs, CIOs, and physicians can no longerignore: patient sa ety issues around radiationexposure; new Medicare policies to reducereimbursement and oster in ormation sharing;competition to retain the best physicians; the pushor an interoperable system o EHRs acrosshealthcare systems, HIEs, and RHIOs. Let’sexamine these in more detail.

Compliance with patient sa ety initiativesToday, individual states are starting to takeunilateral action to create legislation and ITstrategies to help eliminate the increased radiationassociated with duplicate imaging tests. The stateso Maine and Alabama are the rst to include thesharing o diagnostic images, in addition to thePDF les o radiologist reports, in their statewidehealth in ormation exchanges (HIEs). Cali orniapassed its Patient Sa ety Radiation Act inSeptember 2010, which calls or strict

documentation o every imaging exam per ormedin the state’s hospitals and physician practices. Forexample, the in ormation must include the type o imaging study, the date it was per ormed, the typeo equipment used, the equipment settings, thepatient’s body mass index (BMI), and the names o the patient, doctor, and the imaging personnelwho per ormed the test. I the ederal governmentenacts a similar law, then hospitals and practiceswith a VNA as part o an enterprise imagingstrategy will be one step ahead in the race orcompliance.

Trend toward reduced reimbursementImaging is moving rom being a pro t center to acost center as Medicare, Medicaid and someprivate insurers begin to decrease reimbursementor duplicate tests. Another case in point isMedicare’s proposed launch in 2012 o its Gain-

Three components are criticalto the success of an enterprise imagingstrategy: a standardized vendor neutral

archive (VNA), an intelligent digital imagecommunication in medicine (DICOM)

gateway and a universal viewer.




Sharing Program, which gives physicians, grouppractices, networks, health centers, and otherproviders the option to create an accountable careorganization (ACO) model. Patient-centered caredelivery, advanced care coordination, andin ormation sharing are three key areas o ocus orACOs, with the goal o improving the quality o patient care and eliminating unnecessary costs. Anenterprise imaging strategy as described in thiswhite paper, with its ocus on reducing theradiation risks and unnecessary costs o duplicatetesting, would t well within an ACO model.

Competitive advantage to attract andretain physiciansA physician with a strong patient ollowing cangenerate approximately $1.5 million in annualrevenue or a hospital. There ore, making image

accessibility easy and physician- riendly is acompetitive advantage because it makes it easieroverall or the physicians to do their jobs, leadingto greater job satis action and loyalty. Using asystem based on the enterprise imaging strategydescribed in this paper, re erring physicians wouldhave access to the ull diagnostic image and thetools to study it, not just the PDF o theradiologist’s report. In addition, diagnostic imagingreview ts seamlessly into their workfow sincethey can access and study all o the patient’simages within their current EHR.

Stop fow o outside CDs to reduce IToperational costsHospital IT departments o ten need to maintain aseparate system and sta just to manage thedeluge o outside image CDs that pour in romre erral patients and providers. Yet only about 80percent o the CDs are able to be uploaded andread without additional IT involvement. The timespent troubleshooting the other 20 percent o CDsthat are di cult to load can translate to lostproductivity and higher IT costs – and that can

lead to delays in patient treatment. Because anintelligent DICOM gateway as part o an enterpriseimaging strategy would eliminate the need or ITinvolvement, costs would be reduced andresources could be reed or more value-addedcore IT projects.

Trend toward greater patient accessibilityto personal health in ormationAs patients demand more accessibility to theirhealth in ormation, hospitals may one day providepatient access to images through personal web-based devices that can inter ace with the hospital’senterprise imaging system. Patients could controlaccess to their records and provide physicians withpermission to view their images. While this trend islikely to occur urther in the uture, hospitals andphysician practices should be aware o thisemerging new paradigm and be prepared torespond to their patients’ increasing desire orpermission-based access with a fexible, easy-to-use enterprise imaging system.

Getting startedNot surprisingly, many healthcare managementleaders believe that a password-protected PACSsystem is enough to ul ll the requirements orstreamlined sharing and storage o diagnosticimages. But physicians are tied to an o ce

computer to use it – there is no remote access onrounds, at home, or via other approved devices.What’s more, a single PACS cannot give physiciansa patient-centric view o all o the patient’s imagesacross the continuum o care, nor is there aguarantee that the system will read images romother PACS.

The idea, o course, is not to lessen the value o PACS, which have quietly revolutionized thediagnostic process. But hospitals and physicianpractices must be prepared to do more with their

existing or proposed PACS systems through anenterprise imaging strategy. However,implementation should not be a one-size- ts-allproposition. Here are a ew importantconsiderations to help organizations get ready oradopting an enterprise imaging strategy or an

“any image, anywhere, anytime” approach:

Although VNA is called anarchive, it is so much more than image storage because the systemkeeps track of all types of diagnostic imagesfor all patients.




> Establish the business requirements that aremost important to the enterprise. These mightocus on attracting and retaining physicians,improving patient sa ety through reduction o radiation exposure, reducing IT costs, orattracting new patients. Prioritize therequirements and let that be the roadmap orthe enterprise imaging project.

> Keep it simple. Determine which component(s)– VNA, intelligent DICOM gateway, or zero-download DICOM viewer – you need toimplement rst to meet your most pressingbusiness requirement.

> For example, a hospital competing or topphysicians would want to o er imageaccessibility that is fexible, easy to use, secure,

and available on approved devices. A goodplace to start an enterprise imaging strategy tosupport this goal is with a true zero-downloadDICOM viewer solution that can retrieve imagesrom all archives, even without a VNA.

> In another scenario, trauma centers or specialtyacilities that want to stem the fow o outside

CDs with patient images could launch theirstrategy with an intelligent DICOM gateway thatcan morph any image into any ormat or instantnative PACS viewing. On the other hand,

acilities that want to upgrade older, proprietaryDICOM systems could start by movingeverything to a VNA that provides standardized,patient-centric, enterprise-wide accessibility,and high availability along with “plug and play”support or new PACS systems.

The key point to remember is that there really is nowrong way to proceed with an enterprise imagingstrategy as long as decision makers ullyunderstand the capabilities o each technologycomponent, relate the capabilities to solving their

top business challenges, and look at the enterpriseimaging strategy as a solution that can grow andevolve over time.

ConclusionAdopting an enterprise imaging strategy with “anyimage, anywhere, anytime” accessibility is not atechnology issue. The in rastructure to do it is heretoday. Our children are using their Wii consoles togo out on the Internet and download a eature-length movie in just minutes – the video le size o

“Titanic” is 3GB, which is the same le size as anaverage diagnostic image o the heart. So why notgive physicians the ability to do the same withdiagnostic images that are critical to making ast,in ormed patient treatment decisions?

Hospitals are increasingly leading the way inadopting this new vision o an enterprise imagingstrategy. As such, they will make the industry evenmore competitive as they use this strategy toattract and retain physicians, protect their patients

rom unnecessary radiation and reduce the impacto duplicate tests, and prepare themselves or theinevitable urther declining reimbursement ratesor duplicate tests. What’s more, hospitals or anyhealthcare entity that embraces this “any image,anywhere, anytime” strategy will have a distinctadvantage as they can react much aster whenuture advances in diagnostic imaging emerge andnew patient radiation dosage regulations areintroduced.




About Merge HealthcareMerge Healthcare is the leading provider o enterprise imaging and interoperability solutions. Mergesolutions acilitate the sharing o images to create a more e ective and e cient electronic healthcareexperience or patients and physicians. Merge provides enterprise imaging solutions or radiology,cardiology and orthopedics; a suite o products or clinical trials; so tware or nancial and pre-surgicalmanagement, and applications that uel the largest modality vendors in the world. Merge’s products havebeen used by healthcare providers, vendors and researchers worldwide to improve patient care or morethan 20 years. Additional in ormation can be ound at www.merge.com.

200 E. Randolph St.

Chicago, IL 60602877.446.3743

www.merge.com

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