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KLAS Keystone Summit and Enterprise Imaging

Posted on July 21, 2017 I Written By

Healthcare as a Human Right. Physician Suicide Loss Survivor. Janae writes about Artificial Intelligence, Virtual Reality, Data Analytics, Engagement and Investing in Healthcare. twitter: @coherencemed


Recently, KLAS Research hosted their annual invite only Keystone Summit surrounding Enterprise Medical Imaging solutions.. The goal? To improve the success with which enterprise imaging solutions are deployed and adopted. A group of 24 executives from healthcare provider organizations and 10 enterprise imaging vendors met for the exclusive work day at Snowbird, Utah. In the sea of noise about healthcare technology Utah has been quietly innovating and improving outcomes. I was honored to be able to attend and see the results of their hard work.

Healthcare innovation needs voices that move out of the echo chamber and collaborate. We need more makers and quality information across measurement. Consistent messaging between large healthcare organizations as well as between vendors and providers improves outcomes for enterprise imaging.  

Adam Gale of KLAS shared his personal experiences leading youth in a pioneer trek during his remarks to the group and likened it to leading this market. Prior to the conference, Adam went as a leader for youth to travel some of the trails that early settlers of Utah followed. These settlers are called “The Pioneers” and the experience of a short pilgrimage can help today’s over connected and digital youth understand to a small degree, what past generations experienced in walking through Wyoming.

Adam Gale told of his experience:  “I spent several unique days last week on the plains of Wyoming with about 400 young people. The goal was to instill in them an appreciation for the legacy that comes from these early pioneers. You can imagine the enthusiasm of these youth switching from video games to handcarts. We had a lot of fun, but there were also some reverent moments when we walked by the gravesites of those that died on the trail. It was a touching moment for these young individuals to see the sacrifices of those who had come before them, and for them to take inspiration from the dead to move forward in life”

This personalized vision of in the midst of sensationalized health stories about predicting death and shiny technology, we are charged with caring for people’s lives. There are solutions that save lives, and for many patients access to images across providers allows them to get critical medical care.

Adam Gale went on to mention Mark Twain’s quote:

“Do the right thing. It will gratify some and astonish the rest.”

Leaders from the KLAS summit met together to outline what that “right thing” looks like and create a way to measure if Enterprise imaging was on track, and how to get on track. Current and expected functionality was outlined for five areas, including: Capture, Storage, Viewing, Interoperability and Analytics. They also outlined common delivery and implementation failures and Executive Recommendations.

Enterprise Imaging is a vital part of healthcare delivery and care and often doesn’t translate well between hospital systems or between providers. Don Woodstock, VP and GM of enterprise imaging for GE Healthcare, spoke about this vision of patient centered care and the collaborative effort:

“Images are an absolutely vital component of patient-centered care.  Providing every physician and caregiver that full comprehensive view of the patient to feed into their diagnostic and treatment decisions is so important but to date has been challenged.  This collective effort with KLAS, leading providers, and the major imaging vendors is leading the way for us to realize this vision.”

One of the complexities surrounding enterprise imaging is that each healthcare system is personalized. Richard Wiggins MD, is the Director of Imaging Informatics for the University of Utah Health Science Center and directs the Society for Imaging Informatics in Medicine. I spoke with him about some of the important aspects of Imaging Informatics as a field and developing a structure for enterprise imaging. Diversity of workflow in each health care system makes a one sized fits all enterprise imaging strategy untenable. He spoke about his experience working with the University of Utah:

“The University of Utah started incorporating visible light images for Enterprise imaging (EI) into our PACS in 2012. We believe that the PACS should be the repository for all digital imaging, not the EMR. Initially there was the usual issue of changing the mindset from individual silos of data to an enterprise imaging strategy for UUHSC.  Usually institutional imaging strategies are focused on being an individual service line, the changes in governance take time and energy.

Radiology already has an established workflow for digital imaging, with the order, RIS interface (or EMR if integrated) which drives a modality worklist to allow the tech to identify the patient, then the image is created on the modality, and then the image is sent to PACS in an organized fashion with metadata that is searchable. An order is needed for this system because it provides a clear entry point and assignment of a unique ID with some contextual information, but there are other imaging workflows that require an encounter workflow running in parallel to the traditional radiology order workflow. We need this workflow to allow for mobile devices, since they are ubiquitous not only for the medical professional, but also for the patient, with authentication, security, and the ability to have an app iOS and Android that will allow for multiple high resolution images and video to be acquired in a fashion that they can easily be incorporated into PACS, possibly through the EMR, while the images or video is not stored permanently on the device.”

This collaborative patient centered event reviewed some of the challenges and successes which each stakeholder had with enterprise imaging. They also made official recommendations for leadership. These recommendations for provider leadership are a must read for healthcare executives responsible for understanding. The recommendations from the KLAS whitepaper are:

  • Providers often fail to prepare enough for the deep commitment of an enterprise imaging journey. This preparation includes the investment of resources, personnel, and understanding. Organizations need to understand, prepare and commit that these deployments often take years.
  • Providers often ask vendors for quotes without knowing what they want to accomplish as an organization. Providers need to do more work upfront and have alignment on the scope and goals. When the provider customers do not know what they want to accomplish, vendors are put into a box. How can a vendor provide a solution to customers who do not know what they want to solve?
  • The views of clinical users must be included in an enterprise imaging strategy. The number of image users/viewers dwarfs the number of image producers, and if the systems are built only by the producers, we will miss the mark.
  • The C-suite really needs to lead out with enterprise imaging, but today, enterprise imaging is regulated to a position of limited resources and alignment. That hurts the likelihood of success. The message of value to the c-suite is lacking today, and that is a challenge. Vendors and providers need to work together to educate c-suite leaders.
  • Governance is difficult to set up because it takes a group of people who are willing to govern as well as a group of people who are willing to be governed. Leaders from many departments need to be drawn into this conversation. If a provider organization does not have multiple departments and specialties involved in the governance, they don’t have a true governance model, and the governance will die on the vine.

 

Without a strong leadership structure and clearly delineated roles, providers and hospital systems will resist even helpful change. Change has to be provider driven, not IT driven. The dedication of top leaders must be paired with end user buy in from physicians. The KLAS Keystone Summit had four provider leaders that collaborated before and during the June Meeting to developme tools for measuring progress. One of the most important aspects of a hospital system improving enterprise imaging is clear standards for workflow.

Richard Wiggins, MD of the University of Utah spoke about the value of working together and creating as a group with diverse experiences:

“The ability to have input from the executives,  providers, and vendors, and thought leaders all combined allows for a powerful forum.  The integration of short talks with table discussions and then cross table pollination of ideas and the systematic placement of providers, vendors and thought leaders all intermixed at the tables led to some good discussions. Frequently there are systems, like PACS that have features that were likely very exciting and interesting to the CS and EE people who put it together, but have no actual use in the imaging clinical workflow. In addition, we have found that each site has its own idiosyncratic workflow and productivity issues, so one PACS may work great in one shop, but not in another, and this becomes more complicated with the integration PACS/SR/RIS.  A combination of the systems at one shop may work great, and the same combination may not work well at another site.”

The measurement vehicle for enterprise imaging adoption, progress and success was defined by a group of four provider leaders:

  • Rasu B. Shrestha, MD, MBA: Chief Innovation Officer, UPMC
  • Alexander J. Towbin, MD: Associate Chief, Clinical Operations and Radiology Informatics, Cincinnati Children’s Hospital Medical Center.
  • Paul G. Nagy, Ph.D: Associate Professor of Radiology, John Hopkins University.
  • Christopher J. Roth, MD: Assistant Professor of Radiology, Vice Chair Information Technology and Clinical Informatics, Director of Imaging Informatics Strategy, Duke Health.

These measures are to be administered to organizations who have in place a multi-speciality governance and one of the following:

  1. Capture including DICOM and at least one of the following: visible light images, audio, or waveforms.
  2. Storage of images in a single enterprise archive or in a federated by connected set of archives.
  3. Viewing of images through a universal viewer integrated into the EMR.

This measurement tool will be available through KLAS research and can be used for industry wide information and ongoing system management. Alexander Towbin MD shared his experiences in creating the measurement vehicle and meeting with colleagues at the Keystone Summit:

“I was impressed that so many thought leaders in imaging IT – both on the provider side and the vendor side- were able to come together to discuss enterprise imaging.  There was palpable excitement in the room that we were working on the next BIG thing in healthcare IT and that our work would allow providers of all types to better care for their patients.”

Better patient care is always the center of Keystone Summit meetings. Creating standards for deployment and adoption of imaging will benefit doctors in providing patient care and improve collaboration within and between healthcare organizations, enabling better care for each individual. Standards development by a group of experts in the field will help improve vendor and provider clarity.

Many of the participants worked for competitors or had worked together at different points in their careers. Don Woodlock shared some of his experiences with the collaboration between key stakeholders involved in Enterprise Imaging.

“I personally loved the discussion, love taking the lead from our luminary providers, and working together across vendors to come up with the ideal workflow, user experience, and image availability solutions.  From a vendor perspective this was much more of a community trying to make patient care better than a group of competitors doing their own things.  In my case this may have been helped by personally having 4 people that worked for me over the years now at 4 different vendors at the meeting with me – friendships, a common vision, and serving the patient and the physician always trump competition.  We’ll all get our chance to innovate and create our own unique variants to this common vision down the road.”

Collaborating across interest groups and with provider entities and vendors is one of the best ways to ensure that products meet provider needs and expectations. This work will allow providers to give better care and improve future enterprise imaging product creation. KLAS research facilitated the meeting of leaders to reflect on the current state of enterprise imaging and plan for the future. Moving the needle from hype and hyperbole to hope for better patient care. KLAS Research is quietly facilitating nationwide leadership from the mountains of Utah. The pioneers of healthcare will take inspiration from current experts and lead the next generation of people dedicated to do what is right.

ReadsforRads is Working to Democratize Radiology

Posted on December 14, 2016 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

At the RSNA 2016 conference, Healthcare Scene learned about a new platform for radiologists that’s looking to democratize radiology. This new platform is called ReadsforRads. In our conversation with Dr. Phillip A. Templeton, Chief Medical Officer at ReadsforRads, we learned more about ReadsforRads and their mission to democratize radiology. I love the approach they’re taking to make radiology better for both radiology departments and imaging centers. Plus, doing so will ultimate benefit the patients the most.

To learn more about ReadsforRads and the way they benefit the health system, radiologists, and patients, check out our video interview with Dr. Templeton below:

No doubt ReadsforRads has some challenges as they work to scale their platform, but I was impressed by the progress they’ve already made. Their efforts on managing radiologists credentialing was quite interesting. I mentioned the ReadsforRads platform to my radiologist neighbor and his wife instantly said “Yes! Moonlight so we can buy a house.”

While the opportunity for a radiologist to make some extra cash moonlighting is interesting, I was extremely excited about ReadsforRads ability to get the right radiologist reading the radiology image. There are a lot of situations where the radiology image needs to be read by a true expert and that person might be on vacation or small institutions might not be able to afford that type of radiologist expertise in house. ReadsforRads can cover these gaps and make sure the read is done by the most qualified person. That can really benefit all of healthcare.

Bringing EHR Data to Radiologists

Posted on December 2, 2016 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

One of the most interesting things I saw at RSNA 2016 in Chicago this week was Philips’ Illumeo. Beside being a really slick radiology interface that they’ve been doing forever, they created a kind of “war room” like dashboard for the patient that included a bunch of data that is brought in from the EHR using FHIR.

When I talked with Yair Briman, General Manager for Healthcare Informatics Solutions and Services at Philips, he talked about the various algorithms and machine learning that goes into the interface that a radiologist sees in Illumeo. As has become an issue in much of healthcare IT, the amount of health data that’s available for a patient is overwhelming. In Illumeo, Philips is working to only present the information that’s needed for the patient at the time that it’s needed.

For example, if I’m working on a head injury, do I want to see the old X-ray from a knee issue you had 20 years ago? Probably not, so that information can be hidden. I may be interested in the problem list from the EHR, but do I really need to know about a cold that happened 10 years ago? Probably not. Notice the probably. The radiologist can still drill down into that other medical history if they want, but this type of smart interface that understands context and hides irrelevant info is something we’re seeing across all of healthcare IT. It’s great to see Philips working on it for radiologists.

While creating a relevant, adaptive interface for radiologists is great, I was fascinated by Philips work pulling in EHR data for the radiologist to see in their native interface. Far too often we only talk about the exchange happening in the other direction. It’s great to see third party applications utilizing data from the EHR.

In my discussion with Yair Briman, he pointed out some interesting data. He commented that Philips manages 135 billion images. For those keeping track at home, that amounts to more than 25 petabytes of data. I don’t think most reading this understand how large a petabyte of data really is. Check out this article to get an idea. Long story short: that’s a lot of data.

How much data is in every EHR? Maybe one petabyte? This is just a guess, but it’s significantly smaller than imaging since most EHR data is text. Ok, so the EHR data is probably 100 terabytes of text and 900 terabytes of scanned faxes. (Sorry, I couldn’t help but take a swipe at faxes) Regardless, this pales in comparison to the size of radiology data. With this difference in mind, should we stop thinking about trying to pull the radiology data into the EHR and start spending more time on how to pull the EHR data into a PACS viewer?

What was also great about the Philips product I saw was that it had a really slick browser based HTML 5 viewer for radiology images. Certainly this is a great way to send radiology images to a referring physician, but it also pointed to the opportunity to link all of these radiology images from the EHR. The reality is that most doctors don’t need all the radiology images in the EHR. However, if they had an easy link to access the radiology images in a browser when they did need it, that would be a powerful thing. In fact, I think many of the advanced EHR implementations have or are working on this type of integration.

Of course, we shouldn’t just stop with physicians. How about linking all your radiology images from the patient portal as well? It’s nice when they hand you a DVD of your radiology images. It would be much nicer to be able to easily access them anytime and from anywhere through the patient portal. The great part is, the technology to make this happen is there. Now we just need to implement it and open the kimono to patients.

All in all, I love that Philips is bringing the EHR data to the radiologists. That context can really improve healthcare. I also love that they’re working to make the interface smarter by removing data that’s irrelevant to the specific context being worked on. I also can’t wait until they make all of this imaging data available to patients.

A Complete Patient Record and You

Posted on March 9, 2016 I Written By

The following is a guest blog post by Erin Wold, Account Based Marketing Program Manager at Hitachi Data Systems. You can follow Erin on Twitter: @ErinEWold
Erin Wold
So we have discussed the first steps to getting an enterprise imaging facility but what does this and a complete patient record mean for the average patient? If I were to stop someone walking down Las Vegas Blvd (I would shoot for the more sober hours) and ask them “Who owns your medical records?” I am sure I would get the same look and response over and over. The look of confusion and the response of “my doctor’s office?”  This is exactly what enterprise data sharing is set out to change.

A complete patient record for the patient means that a patient can go from their primary care physician to sub specialist without having to call ahead and have their records faxed over. It means that in the case of an emergency room visit they don’t have to worry about leaving with paperwork and getting it back to their primary care physician. It means their records follow them to whatever doctor they (or their insurance) choose.

For example, a couple weeks ago I won myself a trip to the emergency room after cutting a chunk out of my hand while slicing vegetables on a mandolin. (OUCH!) Not knowing my experience in healthcare IT, the resident, who came in first, was checking off all the boxes and asked “do you have a primary care physician?” In my pain ridden and snarky voice I responded “Why does it matter? Your computer can’t talk to hers anyway.” He got a chuckle and said I had a good point and then asked if I was in healthcare. But we have all been there. We have seen one physician only to turn around and have to tell the story all over again with the follow-up care physician because the records just aren’t there.

Not to mention I had pictures of the wound on my phone I had taken right after the incident. My follow-up physician asked that I send her these photos so she could take a look (because she didn’t have access to photos snapped in the ER). I asked her if she could put them into my patient record being my PCP? Her response, “no I don’t have a way to get them uploaded.” Similar to what Alex Towbin, MD, Director of Radiology Informatics at Cincinnati Children’s Hospital, said in his session at HIMSS16, he has multiple pics on his phone and there is nothing wrong security wise with that, but that’s not where the belong.

A complete patient record should include all medical data related to you. This includes images or all kinds whether an X-ray or photo snapped on an iPhone, textual reports (path, lab etc), and even larger data files including genome sequencing data, and digital breast tomosynthesis. I don’t think you would find one physician who would argue that any of your data is unimportant and can be left out.  In the wise words of John Halamaka, MD, CIO of Beth Israel Deaconess Medical Center the next time you ask why your patient record can’t be all in one and they (physicians or IT) respond because there is too much data to store, you should ask them “well how does Google do it then?”

De-silo Health IT

Posted on March 8, 2016 I Written By

The following is a guest blog post by Erin Wold, Account Based Marketing Program Manager at Hitachi Data Systems. You can follow Erin on Twitter: @ErinEWold
Erin Wold
So we have started on the path of enterprise imaging with redefining the EMR, but we can’t stop there. Although, I noticed more familiar faces at HIMSS16, there weren’t enough imaging professionals. We need to de-silo the IT departments within healthcare systems and align them with the strategy that IT is just technology whether it’s radiology, cardiology, mammography etc. The overall IT department should be focused on interoperability and coming together to create a cohesive EMR including enterprise imaging.

Imaging is no longer limited to radiology, yet we still have specific radiology IT staff. This creates more siloes. I have seen it time and time again where the specialty IT departments are at odds with the hospital IT because they want to claim ownership of the data. I can’t blame them though because if something goes wrong with that data they are held responsible. So I don’t blame them, but like redefining the EMR to include all types of data we have to align the IT departments to reflect the whole EMR.

There should no longer be specific departmental IT rather there should be one large IT team with breakout teams that are dedicated to specific departmental (cardiology, radiology, pathology, billing, etc.) software and applications like the PACS or picture archiving system. They should be under the EMR and be tuned into it to create a cohesive team that can complete the patient within the EMR. No more “this is my data and you can’t touch it.” It is now this data belongs to the patient and it needs to be readily available to the patient and all the point of care physicians.

We as vendors and providers need to think of the patient record as the point of documentation rather than each individual department and physician creates their report and then sends it to the referring physician. The patient’s team of physicians and departments where studies and test are completed should be considered team data.

Next time you head into your doctor or head to the ER ask the question: “What is your hospitals standard for sharing?” If they respond with “Well we’ll send you home with a CD or we’ll provide you with a paper print out of a PDF.” RUN and run far away from that place. While a CD may sound like a good idea I am pretty sure you don’t have a DICOM viewer in your basement to view these images. Most likely your point of care physician doesn’t have the same viewer as the images were taken on and what if the CD gets scratched in transfer or even worse lost. If you get my drift, a CD is not the answer. Those images belong in the EMR and so does the radiology software and application support staff.

If you think about it, when you log into an online banking account like Chase you don’t have to log into your mortgage, credit card, savings account, checking account and investment specialists to get all the additional information. You have ONE VIEW of all these accounts as soon as you log in. I don’t know about you, but I consider all my banking information: social security number, credit score, retirement savings as vital as my healthcare information and should be kept as secure. Therefore I see no reason that HIT shouldn’t be aligned more like banking and offer a complete patient record. HIMSS gives us an ideal platform to align all of these departments.

Redefining the EMR

Posted on March 7, 2016 I Written By

The following is a guest blog post by Erin Wold, Account Based Marketing Program Manager at Hitachi Data Systems. You can follow Erin on Twitter: @ErinEWold
Erin Wold
Walking through the HIMSS 2016 exhibit hall, booth after booth I see interoperability this and interoperability that. So I decided to stop and ask the vendors, “When you say interoperability, what do you mean?” Answer after answer I heard, “We integrate with the EMR and other vendors to provide data into the patient record.” When asked to clarify what types of data, the majority mentioned all types of textual data. Never once did anyone respond with images of any sort. I actually got the response of “Why would enterprise imaging be at HIMSS?” when I asked “What about enterprise imaging?”

Here ladies and gentlemen lies our problem. When going to HIMSS vendors and attendees alike aren’t thinking of enterprise imaging for the most part. When you search for sessions, very few pop up when searching for imaging. This year’s HIMSS has seen a few more familiar faces from the imaging scene which is extremely exciting for the future of healthcare and patient engagement.

I was able to sit in on multiple imaging sessions and was lucky enough to go to one that was actually about enterprise imaging but neither were titled or tagged that way in the program. All great sessions with very informative information on why enterprise imaging is a must. It is not only easier for the point of care physician to access the patient record but it will increase patient care and reduce time between study and treatment.

As we move into the era where telemedicine is becoming a reality and anyone can receive care at their corner Walgreens, enterprise imaging is crucial to patient care. How do we get there?  How do we get the EHR gurus to work with the imaging gurus. After sitting through a session led by Alex Towbin, MD, Director of Radiology Informatics at Cincinnati Children’s Hospital; I see how it needs to start.

It started right then and there after he said we must redefine EMR.  We as vendors and providers have defined the EMR as a repository for textual data. We have done ourselves a disservice and we now have to reverse it. The EMR should be a central location where the patients care team can enter ALL data that has been collected on that patient. In essence it should be more like your teenage cousin’s Facebook page where they put everything than your Myspace page from 10 years ago where nothing has been uploaded because you can’t remember the password to gain access.

I was shocked when John Hamlaka, MD, CIO of Beth Israel Deaconess Medical Center, presented that only 50% of pediatric scans are read by the correct sub-specialist. This is in part due to the referring physician, the radiologist and the sub specialist lacking a way to share these scans and therefore the sub-specialist never knew it existed. Enterprise Imaging makes way for this to happen. Other risks that arise because of a lack of enterprise imaging: double exposure to radiation, misdiagnoses, crucial lapse in time between scan and start of treatment, and an incomplete patient record.

A step in the right direction was taken this year at HIMSS by aligning with SIIM or the Society for Imaging Informatics in Medicine and hosting dual sessions as well as a meet-up at the HIMSS Spot. Eighteen months ago they created a coalition of innovative members from both organizations. Moving forward it will take leaders from medical societies: HIMSS, SIIM, RSNA, ACR,  etc. Redefining  is only the beginning. While it seems like a long, hard road ahead we have to start somewhere.