EHRs Are Not Truly Meaningful Without Diagnostic Images

Interoperability. Meaningful Use. Accountable Care. These are watchwords of modern-day health IT strategy. These initiatives populate the agenda of most CIOs. And on the surface, they seem to be valuable and appropriate. But if you dig a little, a few surprises are waiting to be uncovered.

The final rule for phase 1 of the federal government’s EHR meaningful use initiative, published in July 2010, failed to specify inclusion of diagnostic images as a requirement to qualify for incentives. As healthcare organizations across the country execute on plans to secure stimulus funds, most do not include diagnostic images.

This oversight is hard to believe, especially since medical images are a staple in the diagnostic process — where 20 percent of ER visits are accompanied by a CT scan and 60 percent of patient diagnoses are supported by diagnostic imaging. More than 700 million imaging procedures were performed in 2008 in the US and the numbers are expected to grow.
From a volume standpoint, diagnostic images represent more than 80 percent of stored content in an EHR. From a patient care perspective, it’s often impossible to track a patient’s disease trajectory without access to historical images. Some EHRs offer access to transcribed radiology reports, but without access to the images, clinicians are often at a loss. They want access to quantitative data such as images to draw effective conclusions.

The image exchange problem is not necessarily a technical one. CT studies are admittedly large files. The video file for the film “Titanic” is of similar size to some large imaging studies. Yet anyone can download and view the movie on demand — so why can’t clinicians access images?

Without electronic image exchange, patients have become a de facto mode of transport. Thousands of patient-delivered CDs flow through provider settings each month. Many are stored in formats that are incompatible across various providers. Often, the patient learns that the CD he transported cannot be read — and is told that another test is required. Redundancy is commonplace, creating unnecessary expense and exposure to radiation.

In trauma cases, a patient may arrive with an image CD from the tertiary care site literally strapped to a helicopter or ambulance stretcher. While research varies, as many as 30 percent of transfers to trauma centers were found unnecessary, needlessly tying up expensive and scarce resources. Providing electronic access to diagnostic images and enabling care coordination between clinicians at tertiary and trauma sites could minimize costly, unnecessary transfers.

Because images are not electronically available, as many as 30 percent of all tests are repeated. Each year, duplicate tests account for billions of dollars of waste. Even more concerning, patients are exposed to unnecessary levels of radiation. A single CT scan of the pelvis can be the equivalent of 750 chest X-rays and therefore needs to be ordered judiciously. It is estimated that CT scans alone will actually cause 2 percent of the cancers diagnosed annually in the US. In September, California became the first state to pass a law requiring collection and reporting of CT radiation dosage tracking. Others will likely follow suit.

If diagnostic images were routinely available for exchange, referral processes could be improved and time-to-treatment could be decreased. Trauma resources could be more effectively utilized and redundant tests could be reduced, thus minimizing waste and reducing unnecessary radiation exposure

Despite challenges, there is light at the end of the tunnel. Technology exists today to facilitate cost-effective image exchange within the enterprise and across organizations. A major catalyst for exchanging images electronically is the meaningful use incentive program. Now’s the time to ensure that diagnostic images are included in the federal government’s requirements.

For more information on meaningful use and how to get involved, visit Meaningful Use for Radiologists. Also check out Diagnostic Imaging's Meaningful Use Topic Center.

In considering interoperability and evaluating image exchange solutions, organizations should consider the following:
• Can I add the solution to my existing systems to optimize monies already spent?
• Is the solution modular or componentized, thus allowing me to scale incrementally?
• Does the solution support international interoperability standards?
• Does the solution provide a completely integrated IHE XDS infrastructure suite?
• Does the solution support exchange and rendering of images from one vendor’s system to another? Is the archive truly vendor “neutral” specifically for image management?
• Does it provide connectivity even to users who are globally dispersed, or unable to move to a full XDS infrastructure?

Jeff Surges is CEO of Merge Healthcare. He has served as president of sales at Allscripts and president and CEO of Extended Care Information Network, Inc. (ECIN). Surges has nearly 20 years experience managing high-growth technology companies in healthcare and information services.