Implementation Strategies to Enable Enterprise Imaging in the EMR Monday February 24, 2014 Dean Balog Louis Lannum DISCLAIMER: The views and opinions expressed in this presentation are those of the author and do not necessarily represent official policy or position of HIMSS. Conflict of Interest Disclosure Dean Balog Has no real or apparent conflicts of interest to report. Louis Lannum Has no real or apparent conflicts of interest to report. © 2014 HIMSS Learning Objectives • Define the clinical value of integrating Radiology and specialty imaging into the EMR. • Construct a promotional initiative to achieve user acceptance. • Summarize the implementation program methodology to deploy enterprise imaging. • Identify and resolve the clinical – functional – technical challenges • Creating and integrating the Enterprise Imaging Department into the organization Benefits Realized for the Value of Health IT Satisfaction Improved patient experience Treatment / Clinical Collaboration – Share and exchange images anywhere among caregivers Faster, comprehensive diagnostic results Electronic Information / Data Creates a longitudinal imaging record to correspond to the clinical content in the EMR Prevention & Patient Education Savings Cost saving in both infrastructure and support Cost and risk avoidance managing a HIPAA compliant storage solution http://www.himss.org/ValueSuite Introduction Strategy • Installation of new PACS – VNA Solution • Creating the IT Enterprise Imaging Department • Image Distribution and EMR Integration • VNA implementation – Beyond Radiology Installation of new PACS – VNA Solution The decision by our Imaging Institute to move from a vendor specific PACS solution to VNA solution created the opportunity to decouple image storage and access from department system. It also created the potential to expand our enterprise image viewing capability beyond traditional Radiology images to include images from what had been considered departmental or specialty images. The selection of the VNA solution was driven by three requirements: 1. Storage requirements for the Enterprise – scalability 2. Integrated workflow engine 3. Availability of an enterprise viewer Enterprise Imaging Department What does the project and support models look like? Creating and Integrating the Enterprise Imaging Department into the Organization Created an Imaging Council Enterprise Change Management for all imaging departments and programs Support coordination at both the department and enterprise level Image Distribution and EMR Integration The Promotional Initiative • Cruder integrations of Radiology image viewing with the EMR had been accomplished previously and were well received. • The expansion of available images had been requested for several years. • The new system provided a viewer that allowed for a more seamless presentation within the EMR. Rather than launching a separate application, the new viewer appears as part of the EMR itself. Image Distribution and EMR Integration The Promotional Initiative • Institute and Department staff meetings • Separate meetings specifically for the presentations. • Announcements – Main intranet home page – Regional hospital home pages – Physician specific home pages – Staff newsletters – Institute and departmental newsletters Image Distribution and EMR Integration Project Management • As Radiology image viewing was well established, the project first focused on replacing the links to the old viewer. • To minimize the overall impact, a phased approach was taken, based on geography, working across our Main Campus first and moving out to our community hospitals, east, west, and south. • Prior to activating the new viewer, the “Advanced Tools” package, a fat client, was “silently” distributed over the course of several weeks to all known users of the old system. • Once the new system was in place and accepted by the client community, the plans for the first non-radiology integrations were set in motion. VNA implementation Beyond Radiology The goal of the program was to insure all the areas of the enterprise that generated digital images were able to make them available in EMR. • Integration of department imaging systems into the Core imaging library (DICOM formatted images) • Development of Point-of-Care imaging model (nonDICOM formatted images) 60 Imaging Generating Departments How will you provide workflow for imaging study acquisition? • Allergy • ICU Imaging • Pulmonology • Anesthesiology • Infertility • Radiation Oncology • Audiology • Laboratory Pathology • Radiology • Behavioral Medicine • Medical Oncology/Hematology • Rheumatology • Nephrology • Rehabilitation • Neurology • Respiratory Care • Neurosurgery • Skilled Nursing • Nuclear Medicine • Sleep Disorder • Nursing • Obstetrics/Gynecology • Speech Pathology • Spine Center • Sports Health • Birthing • Breast Center • Burn Unit • Cardiology • Cardio -Pulmonary Rehab • Colorectal Surgery • Oncology • Dermatology • Ophthalmology • Dentistry/Oral Surgery • Orthopedics • Surgery • Emergency Department • Otolaryngology • Urgent Care • Endocrinology • Pathology • Urology • Endoscopy • Pediatrics • Vascular Medicine • EP Lab • Pediatric Gastroenterology • Vascular Surgery • Family Medicine • Pediatric Hematology/Oncology • Wound Care • Gastroenterology • Perinatology • General Internal Medicine • Plastic Surgery • Geriatrics • Podiatry • Hematology • Psychology 60 Imaging Generating Departments How will you provide workflow for imaging study acquisition? • Allergy • ICU Imaging • Pulmonology • Anesthesiology • Infertility • Radiation Oncology • Audiology • Laboratory Pathology • Radiology • Behavioral Medicine • Medical Oncology/Hematology • Rheumatology • Nephrology • Rehabilitation • Neurology • Respiratory Care • Neurosurgery • Skilled Nursing • Nuclear Medicine • Sleep Disorder • Nursing • Obstetrics/Gynecology • Speech Pathology • Spine Center • Sports Health • Birthing • Breast Center • Burn Unit • Cardiology • Cardio -Pulmonary Rehab • Colorectal Surgery • Oncology • Dermatology • Ophthalmology • Dentistry/Oral Surgery • Orthopedics • Surgery • Emergency Department • Otolaryngology • Urgent Care • Endocrinology • Pathology • Urology • Endoscopy • Pediatrics • Vascular Medicine • EP Lab • Pediatric Gastroenterology • Vascular Surgery • Family Medicine • Pediatric Hematology/Oncology • Wound Care • Gastroenterology • Perinatology • General Internal Medicine • Plastic Surgery • Geriatrics • Podiatry • Hematology • Psychology VNA implementation Beyond Radiology Institute / Clinical Function Radiology MR CT Mammography General Maternal Fetal Medicine Ultrasound VNA implementation Beyond Radiology Institute / Clinical Function OR Surgical Services Orthopaedic Surgery Arthroscopy Gastroenterology Endoscopy Ophthalmology Fundus Camera VNA implementation Beyond Radiology Institute / Clinical Function Point of Care Ultrasound Ultrasound Anesthesia Emergency Medicine Endocrinology / Metabolism MSK Orthopaedics Rheumatology Digital Photography—Program Emergency Medicine Plastics Dermatology Head and Neck Institute General Surgery Medical Photography Department Anatomical Pathology Digital Camera Enhanced Dermatology Workflow (Automated process to normalize data to EMR data) Patient Images are acquired DICOM Images Photographer selects patient and procedure from worklist and loads images into image capture application DICOM Images Image Repository Patient images available on any EPIC workstation DICOM Modality Worklist DICOM Images Workflow engine Procedure Accession # ADT Scheduled Event EMR Point-of-Care Programs Clinical Photography POC Ultrasound Enhanced Workflow GI Lab Women’s Health Provati on GE ViewPoint Eye Institute Radiology PACS are designed to enhance Radiologist’s productivity – not share data among a larger group of healthcare providers. PACS Workflow Services EMR Image Management Services (Clinical Content) Storage Services Image Access Management Distribution / Access Benefits Realized for the Value of Health IT Satisfaction • Improves information sharing among all providers along the continuum of care Treatment / Clinical • Reduces subjective interpretation of written findings • Combines visual and narrative information to create a more comprehensive patient record Electronic Information / Data Prevention & Patient Education Savings • Creates a longitudinal imaging history within the context of the patient’s EMR • Single point of integration between EMR and images • Collapses multiple silos into a single imaging storage and access solution • Informs the patient visually engaging them in the diagnosis and treatment process. • Reviewing images with the patient enhances their understanding of their condition and treatment plans. • Cost saving in both infrastructure and support • Reducing the amount of money spent within the individual department silos • Cost and risk avoidance managing a HIPAA compliant storage solution http://www.himss.org/ValueSuite Example: Sports Health Unified Management & Integration of Intra-Op Images Reduces Printing Related Costs • Estimated saving of $18K/year/5 rooms Increases Operational Efficiency • Eliminate image scanning –Estimate $75K labor/year • Patient Demographics Are Automatically Populated During Room Setup – 38 second gained/case Questions? Thank You! • Dean Balog 216-738-4293 [email protected] • Louis Lannum 216-738-5032 [email protected]
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