The Road to Interoperability

January 4, 2016

The case for clinical image sharing platforms.

Patients are demanding access to their imaging studies, because they are getting savvy to the fact that digital data can help them avoid unnecessary, dangerous, and time-wasting testing; fend off co-pays; take charge of getting second opinions; and see specialists outside of their home health system’s network.

Yet the current technology of EHR/RIS/PACS data system silos create technology roadblocks between medical images and patients, as well as their care teams. It does not have to be this way – some health care providers have already solved it – and the rest will follow suit before long.

It’s not just patients who are demanding access. In order to cut unnecessary costs from health care delivery, payers, too, are beginning to show interest in working with providers who open up their networks to image sharing. Likewise, they are beginning to demand that their health care systems embrace data interoperability.

Accountable care organizations are also seeing health information exchange as a way to increase the quality of care, decrease expenses, and make the most out of risk-based payer contracts.

Where do we stand with imaging interoperability? We are, perhaps, halfway through what could ultimately be – judging by HHS’s Office of the National Coordinator for Health IT’s

– a technology evolution lasting up to two decades. While that may seem like a long time to wait, from the insights we have through our work with data-standards organizations and participating in interoperability groups such as Carequality, it sounds about right.

Even though US health care is only partially down the path to image interoperability, by remaining focused on those who matter most – patients -- we have already made significant progress.

Health Data Interoperability’s Evolution
There are three phases in the evolution of health data interoperability. Imaging is roughly halfway through the second phase, thanks to standards like DICOM. However, the greater health care world, I believe, is just emerging out of the first stage.

Stage One: Static Data Exchange
When one practitioner attempts to send imaging or video results to another – very often when primary care physicians refer patients to specialists or when one specialist reaches out to another for a second opinion – the first problem is getting the digital content onto the network from films or CDs. Imaging vendors solved this problem years ago.

Today’s EHR equivalents of CDs are faxes and PDFs attached to the medical record. Like those first attempts at image exchange, faxes and PDFs are unsearchable, unintelligent data deadweight. Data intake cannot be just a digital replication of a proprietary image or a picture of a fax. To be actionable, it must include normalizing information for all to view and search.[[{"type":"media","view_mode":"media_crop","fid":"44583","attributes":{"alt":"Matthew A. Michela, lifeIMAGE President & CEO ","class":"media-image media-image-right","id":"media_crop_9520843780941","media_crop_h":"0","media_crop_image_style":"-1","media_crop_instance":"5001","media_crop_rotate":"0","media_crop_scale_h":"0","media_crop_scale_w":"0","media_crop_w":"0","media_crop_x":"0","media_crop_y":"0","style":"height: 254px; width: 180px; border-width: 0px; border-style: solid; margin: 1px; float: right;","title":"Matthew A. Michela, lifeIMAGE President & CEO ","typeof":"foaf:Image"}}]]

Stage Two: Provider-to-provider Exchange
With this stage of interoperability comes the ability for the radiologist, cardiologist, oncologist, ER physician, or any other image-intensive specialist to send an imaging or video study with usable data and a patient identifier to a requesting physician. This process is more automated, searchable, and locally usable than the exchange described in the first phase.

More sophisticated interoperability requires a way to normalize patient identifiers, a trusted directory of physicians, and a convenient electronic workflow backed by a network through which the image data and report can pass. This is where leaders in image exchange are today, and where some health care providers are with EHR data.

This second phase of health data interoperability automates and accelerates processes that involve paper, but there’s a long way to go, because it still involves humans “pulling” data.

Stage Three: The Intelligent Network
Where we – I’m saying our team and other health IT innovators such as the ONC – should be headed is an intelligent network that knows where a patient’s information is located. The ONC’s Interoperability Roadmap is one way to get there. A physician shouldn’t have to physically interact with another physician to send or summon test results, radiology studies, EHR visit details, or new data for his or her patients.

Somewhat analogous to a web search, available information about a subject or patient will have been indexed. Search results provide a list of potentially interesting and contextually relevant information. The intelligent network for sharing patients’ records will know about the relevant data. It will securely and conveniently make the information available to authorized users leading to better, more efficient health care delivery.

The Real Impact on Care
Radiology has come far in the interoperability realm. Today’s digital medical data means patients mostly don’t have to carry CDs (and even film!) from provider to provider anymore. Medical imaging studies, in some facilities, can be securely accessed directly within a patient’s EMR, or outside a hospital’s network from the cloud.

One patient story involving radiology image sharing that has gone viral is that of Piper Gibson, a five-year-old girl depicted in Laura Landro’s Wall Street Journal story. Piper showed up to an emergency room presenting with potentially life-threatening symptoms; image-sharing enabled quick online validation of an Oklahoma City hospital’s diagnosis when the family sought a second opinion at Boston Children’s Hospital, giving everyone confidence that a course of blood thinners – and not major surgery – was indicated for her treatment. These stories are recurring daily, thanks to digital image-sharing services.

It was not that long ago in our health care experience when diagnosing and treating providers did not have access to laboratory data for their patients. Solving that problem required removing significant historical technology and business model barriers.

We can also remember the times when physicians could not access their patients’ medication lists and had to make treatment decisions without the information. Solving that problem in pharmacy required upgrading technology, rethinking workflows, and implementing new business principles. 

Medical imaging is, in many ways, analogous: Practitioners must have access to images to provide the best patient care and our industry is filled with examples where technological challenges are overcome with progress.

So, you can be certain that the future of medical image sharing is coming, and more quickly than many think: An automated, intelligent network where imaging data flows to the right people, at the right time – alerting the parties who need it – for seamless patient care. It will take a bit of time to build such a network, but rest assured, it’s coming. Patients demand it, physicians deserve it, and government and payers will require it.