Electronic Health Records

Adoption & Implementation News

What makes integrating imaging into the EHR problematic?

By Kyle Murphy, PhD

- Imaging plays a vital role in clinical decision-making and reducing duplicative testing is at the heart of integrating these media into the EHR system. However, image management is becoming a growing concern for IT staff given the amounts of storage necessary to maintain archives and methods available to streamline access for clinicians.

While picture archive and communication system (PACS) tends to go hand-in-hand with radiology, the term has come to encompass imaging from myriad –ologies, argues Trent Conwell, Technical Manager at Sentara Healthcare.

The Virginia-headquartered healthcare system recently signed on with Mach7 to ease their growing image management needs, particularly by deploying a vendor neutral archive (VNA) that enables providers and patients convenient access to this portion of the electronic record.

The challenge of managing images is made more difficult by Sentara’s acquisition of other health systems and hospitals, which has raised questions about how Conwell and his team integrate media from different technologies in an efficient way. As Conwell tells EHRIntelligence.com in this one-on-one interview, the solution to the challenge requires due diligence and plans to move beyond PACS.

How is Sentara currently managing its PACS infrastructure?

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We have multiple PACS systems, but the main system that we have for the majority of our hospitals is Agfa Impax. As far as the integration with the Epic EHR, we basically publish a URL into the system that then calls out to the Agfa viewer and allows a clinician to view images.

How big a concern is storage going forward?

Storage is generally one of the biggest concerns with a PACS system depending on the size of your organization. We’re large enough to where it is a concern. Prior to digitized imaging, it was quite honestly much easier to eliminate images because they took up square footage. Now in a digital world, they are out of sight, out of mind. We have not eliminated a single image in the last 12 years since we went digital.

It is a struggle within any organization between legal, corporate, IT, and clinical. Legal, corporate, and IT tend to line up on the same side of the fence. They want to eliminate as much as possible — for IT, system management, response times for corporate, the financial commitment to storage requirements; and for legal, the liability on the books the longer you keep images — whereas the clinical side simply wants access to every image ever taken. The clinical side is winning that battle right now.

How did Sentara approach the process of choosing an enterprise imaging solution?

When we started this process, we were fairly smart and went out to get educated. We spent about eight months going through an educational phase to understand exactly what the opportunities might be around more globally an enterprise imaging strategy.

First and foremost, the thing sitting in front of you that you have to get past is radiology PACS. You have to address that, and once you get beyond that, now you start to take a look at what makes the most sense. Do we just stop here? Is this good enough? And it’s not. The other -ologies are very interested in figuring out a way to manage their images — cardiology, pathology, endoscopy, etc. — and they all have their individual silos of image management. PACS was really the most mature, robust, and that’s why it got its own name, but realistically the concept of PACS is certainly not specific to radiology. We wanted an enterprise imaging solution that will allow us to go beyond radiology.

What role does the VNA play in meeting the needs of various clinical departments?

We believe that the concept of the VNA in fact allows you to do that, basically store those other -ology images in the VNA and through a unified viewer access those images just like you would radiology. Most organizations are probably accessing their radiology PACS images via their EHR by throwing a URL out there and using a standard PACS viewer. Everybody has got the access. It’s not rocket science.

Now when it comes to the VNA, you can take non-PACS images and put them in there and make them accessible via the EHR, you’re going to do the same thing more than likely. You’re going to throw a URL out there, and it’s the unified viewers playing a key role right now. In fact, they are a great stepping stone and a much cheaper, quicker step into the world of the VNA. Using any one of these unified viewer vendor products, you can implement them in a federated model to access images across your enterprise regardless of how they’re stored.

What are the benefits of the VNA/unified viewer approach down the road?

It is cheaper. It is quicker. Physician adoption is generally going to be fantastic because there is going to be a more robust tool set and certainly a standardized one across all of your PACS systems. We have multiple PACS systems which means that even though I’m only publishing a URL into the EHR it’s going to be accessing one of many different viewers to get to those PACS images whether it’s our Fuji, GE, or any other system. The unified viewer is going to give you a standard look and a more robust tool set to get to all of those images regardless of storage and backend vendors. Then if you want to tackle other -ologies, that’s certainly a path you can go down.

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