Electronic Image Orders and Web-based EMRs: An Industry Perspective

The coming year will bring a technology wake-up call for medical imaging. Stage 2 of the federal government's meaningful use program requires medical practices to begin ordering imaging studies electronically and to capture radiology results digitally, in a certified electronic medical record (EMR). As a result, doctors increasingly demand electronic interfaces with their imaging vendors, just as they have done with pharmacies and clinical laboratories.

However, unlike pharmacies and labs, imaging centers have been slow to invest in EMR connectivity.  With 7,000 licensed imaging centers in the U.S., and a short timeline to help referring physicians meet meaningful use requirements, the EMR interfacing challenge could be daunting. Happily, modern web-based EMRs are rapidly lowering the barriers to universal connectivity, easing the burden on imaging centers and their clients.

Imaging and interfaces

Radiology services represent a core part of patient care. Data from the Centers for Disease Control and Prevention suggest that approximately 15 percent of all ambulatory patient visits result in an imaging order of some kind, and the imaging industry generates approximately $100 billion in revenue each year. While reimbursement has tightened in recent years, an aging population and the arrival of more than 30 million new insured patients in 2014 from the Affordable Care Act suggests that the number of scans performed will continue to rise.

The problem? Most of those radiology orders and results exist only on paper.

That dependence on paper sits awkwardly with the rapid pace of health IT adoption, and the regulatory imperative to connect and coordinate care across settings. According to the CDC, more than half of office-based physicians now use an EMR. And, those doctors have demonstrated a clear preference for electronic ordering and results.

In one study conducted in Bloomington, Minn., imaging integration reduced turnaround time from days to hours, with obvious benefits for providers and their patients. Simultaneously, research published last year in the Journal of the American College of Radiology found that referring physicians and radiologists rapidly embraced electronic ordering for imaging, and the existence of this computerized physician order entry functionality allowed for clinical decision support which helped ensure patient safety.

The imaging technology gap

Why is imaging connectivity so far behind labs and pharmacies? First, radiology services were largely left out of the first stage of meaningful use. Stage 2 changes that picture sharply: Providers must now send 30 percent of imaging orders electronically and capture at least 10 percent of the results within the EMR - and increased pressure from referring physicians follows accordingly.

Second, the imaging space is highly fragmented, particularly in comparison to the lab industry, and EMR vendors have been far less active in building interfacing hubs and other solutions which can facilitate affordable, efficient connections for smaller, more dispersed imaging centers, whether independent or hospital-based.

In turn, EMR vendors' relative slowness in rolling out imaging connectivity is rooted in part in legacy technology and outdated business models. Simply put, server-based, locally-installed EMR systems in hundreds of thousands of independent practices are not conducive to efficient interface creation, and point-to-point connections (imaging center to practice) with upfront costs can be prohibitive for many imaging centers and the small practices they serve.

Where do we go from here?

To connect hundreds of thousands of ambulatory providers in practices across the U.S. with thousands of independent imaging facilities, healthcare needs to look at new innovative models. Modern, Web-based EMR technology can help. With an EMR "in the cloud," imaging centers create a single point of connection to the vendor instead of enabling direct connections with each individual medical practice - one pipe reaches thousands of referring providers.

And, the subscription-based business models common to the Web create flexible economics for the imaging center, which can support the cost of an interface on a "pay as you use" basis. Technical barriers fall, referring physicians can easily find a convenient, connected imaging center, and a sustainable business model supports long-term integration across care settings.

Can imaging catch up to labs and pharmacies? Absolutely. Doctors are ready, the roadmap is clear, and Web-based EMR vendors are innovating to solve the connectivity conundrum.

Dan O'Neill is senior director of business development at Practice Fusion, a free Web-based EMR platform that connects medical professionals and patients to labs, pharmacies and imaging centers via APIs.