McKesson seeks commonalities in IT ‘ologies’

Image management, the foundation of McKesson's success in radiology, drove the company to cardiology. But when McKesson got there, staff soon learned that cardiology involves much more than imaging.

Cardiology uses many sources to provide information whose capture is critical to healthcare providers. Some of that data had been falling through the cracks long before the advent of IT. The onset of chest pain might have been recorded but was seldom, if ever, kept as part of a patient's permanent record. Inclusion of other information important to the patient's family, such as the location and status of the patient, was hit or miss, depending on the physician.

The introduction of IT offered a way to remedy these shortcomings, making patient data part of an electronic record, then connecting the record to an LCD monitor in the family center or transferring data to a PDA so the physician could better explain to the family what was going on.

McKessson has made a point of identifying such opportunities for capturing data from diverse sources. Its achievements have taken place in board rooms as well as R&D labs, in sometimes surprising ways.

A corporate partnership three years ago provided the means for McKesson to bring its imaging-based Horizon Cardiology to the U.S. market in combination with Camtronics' Vericis, a scalable IT system spanning multiple imaging modalities, repositories of clinical data, and patient points-of-care. This partnership ended last year, however, with McKesson's acquisition of IT provider Medcon, whose TCS Symphony technology has since become the platform for Horizon Cardiology. The current system integrates a multitude of data sources: imaging modalities including cardiac cath, echo, and nuclear cardiology; hemodynamic systems; clinical data repositories; and even broad-based electronic patient records.

McKesson's efforts in cardiology reflect a corporate strategy to move aggressively into the many different aspects of healthcare. Its portfolio addresses ambulatory, home, and hospice care as well as medical imaging, claims processing, surgical services, and small physician practice management. The company has thus experienced the magnitude of the problem of recording relevant patient data.

"Every company has its own needs for information and every specialist has a specific need for interaction with that information," said George Kovacs, senior product marketing manager for McKesson's medical imaging group. "Clearly, each needs specific products that have specific interfaces for that specialty. But behind it are a lot of common elements that highlight the commonalities in workflow."

Finding these commonalities and building on them has become the focus driving McKesson's expansion of its IT throughout the healthcare enterprise. Engineers at the company are trying to connect the many pieces of healthcare to each other using an enterprise image repository as a fundamental building block. In this way, imaging is enabling the company to reach beyond radiology and will facilitate the future adoption of electronic health records, according to Kovacs.

"It enables one 'ology' to talk to another 'ology' in a seamless way, in a context they understand," he said.

The McKesson portfolio expanded at the RSNA meeting with the unveiling of a system for otolaryngology. The specialty's use of endoscopy, a type of imaging, makes Horizon Optical Imaging a natural extension of McKesson's experience in radiology. As in cardiology, critical information had not previously been part of the long-term patient record. Endoscopic data tended to be discarded as soon as the procedure was over and conclusions determined. McKesson used lessons learned in cardiology to capture these data.

Horizon Optical Imaging records information from a traditional analog device and makes it part of the electronic imaging record by transforming the data into a DICOM-compliant format that supports work list capabilities. Data then can be transferred automatically to a PACS. In this way, the IT product serves as a bridge between the otolaryngology department and the rest of the enterprise, Kovacs said.

"There's no sense in buying a digital VCR and having it as a departmental island that doesn't communicate with the rest of the enterprise," he said. "It makes more sense to make the additional objects that are captured part of the imaging section of th patient record."

The University of Wisconsin Hospital and Clinics in Madison has deployed 14 Horizon Optical Imaging Image Capture Stations and four Horizon Rad Station workstations in its otolaryngology clinic, where some 10,000 exams are performed each year. Staff there integrate visible light and radiology images on their PACS. Viewing them side by side promises to help doctors make better diagnoses, according to Dr. Gary Wendt, an associate professor of radiology and vice chair of informatics.

Future steps by the company may extend this concept of combining optical and radiological imaging to colonoscopy and bronchoscopy. The result promises to be a more robust and comprehensive patient record. And there may be something more in it for radiologists.

"Radiologists are finding that they can get the other departments to realize benefits from their PACS purchases," Kovacs said. "This opens the door to other departments sharing the costs of a PACS investment."

The possibilities are virtually endless. Many other kinds of information can be linked to imaging, even inherently nonimaging-based data, such as inventory. McKesson has written inventory control algorithms to keep track of imaging-oriented products - stents, for example. Such additions are seen as facilitating workflow, Kovacs said.

"We believe any product we put in has to add value, not only by adding functionality and capabilities, but by simplifying workflow," he said. "We need to bring the different areas of information together with imaging."

The challenge of bringing this all together was heightened for McKesson last year by the acquisition of Medcon, a provider of cardiology-based IT.

"The Medcon acquisition, with 300 installations around the world, took us to a new level," Kovacs said.

Again the company turned to commonalities to integrate the newly acquired technology into its portfolio. Workflow was the glue that stuck imaging, inventory reporting, supply management, and certification requirements all together.

"The full-fledged cardiology department solution runs from the loading dock to patient care and includes procedure management and scheduling of surgical suites. All of those things are what we do," Kovacs said.

The opportunity in cardiology, as well as other medical departments, is to increase efficiency by turning what has traditionally been a paper-based, fragmented recording system into an integrated digital process. This approach to coordinating all things related to workflow serves the company day in and day out, whether staff work with paper-based, analog, or digital functions.

"Every time you put a system into a site, you have to realize that it will not operate in a vacuum," Kovacs said. "It has to exist with other installed pieces of technology that the customer has invested in. We live in a multivendor, heterogeneous environment. Our products will only work if they gel with everything else. This is how we bring the higher value that the customer is looking for."

McKesson is getting plenty of practical experience doing just that. The company installs at least 20 IT systems per quarter, according to Kovacs. Each time it is challenged to provide a healthcare IT solution, not just an imaging solution, for a department. Whereas radiology, except for its interventional applications, is 100% image driven, other "ologies" involve practical applications of images, the interpretation of which depends on myriad other sources of information.

Just as McKesson's foray into "ologies" outside imaging uncovered other sources of data that had to be captured, it also reinforced the importance of imaging to overall data handling. It is a realization that now fuels McKesson's engine for growth.