Based on all of the requirements for the EHR meaningful use program, the only viable solution would be a cloud-based technology that provides a complete certified ambulatory EHR that can be used standalone or as plug-in to any HIS, RIS, CVIS, or PACS.
With an estimated $1.5 billion in incentive payments at stake and penalties looming, it would behoove radiologists to understand and implement the program for meaningful use of certified ambulatory EHRs. To best understand the next logical steps, one must first fully understand the requirements. Compliance with meaningful use presents a dual challenge:
1. One must implement a complete certified ambulatory EHR or its equivalent (a collection of certified modules that in total provide each of the technical requirements of a complete certified system). This process is regulated by the Office of the National Coordinator.
2. Each eligible provider must demonstrate meaningful use by recording and reporting a wide variety of required uses. This process is regulated by CMS.
This dual requirement means that each eligible provider must not only employ the right technology, but also document adherence to a number of highly detailed use requirements. That seems tricky enough - but there’s more.
The program is provider-centric, meaning that physicians who work at multiple locations, as is common in radiology, must aggregate their use data for reporting purposes. Since radiologists often work in both hospitals and imaging centers with disparate systems, the need to aggregate data provides an interoperability challenge.
Okay, the interoperability challenge can be solved, but you guessed it, there’s more.
Meaningful use regulations will be implemented in stages, meaning that the requirements are in flux. That means whatever systems are implemented, they will need to rapidly evolve as requirements change. And finally, there’s the issue of cost - yes $44,000 per radiologists is real money, but it’s not enough money to justify costly systems that slow down workflow.
Based on all of these requirements, we at DR Systems, an enterprise imaging and information management systems provider, concluded that the only viable solution would be a cloud-based technology that provides a complete certified ambulatory EHR that can be used standalone or as plug-in to any HIS, RIS, CVIS, or PACS.
A cloud-based solution would solve the data aggregation requirement, because it could be used in any location. Because no local hardware would be required, it could be rapidly modified and deployed at low cost by both individuals and large group practices. Because it could be used standalone, it could be deployed even before it’s used as plug-in. Because it should be a complete ambulatory system built specifically for radiologists, it would fit within the medical imaging workflow and would not require aggregation of data from other certified modules.
Furthermore, there should be no requirement to upgrade legacy RIS/CVIS/PACS, although a standards-based interface to existing information systems would speed workflow.
The bottom line is that a cloud-based solution designed specifically to meet the meaningful use needs of radiologists is sorely needed, and will soon hit the marketplace. I suspect several vendors will be offering such a solution, providing radiologists alternatives to either expensive upgrade of their legacy systems or non-compliance.
Murray A. Reicher, MD, FACR, is a board-certified diagnostic radiologist and co-founder and chairman of DR System’s Inc. His 30-year history of innovation in medical imaging includes development of early clinical applications of MRI and development of multiple, patented information systems-related inventions. Dr. Reicher is past CEO of Radiology Medical Group, Inc. and Imaging Healthcare Specialists of San Diego. He is also councilor for the California Radiological Society.