Guest post by Matthew A. Michela, CEO, lifeIMAGE
The U.S. Department of Health and Human Services Secretary Sylvia Burwell, CMS Acting Administrator Andy Slavitt and national health IT coordinator Karen DeSalvo, M.D., were in lockstep with their themes at the 2016 Healthcare Information and Management Systems Society’s annual conference: Whatever — and whoever — is holding up health data interoperability will be made public. Not only will “data blockers,” as Congress calls them, be accountable to federal administrators, but to lawmakers who enact HHS’s powers to promulgate regulations.
Medical imaging interoperability issues, when solved, will be a big part of moving U.S. healthcare forward, as health systems evolve from fee-for-service to value-based care. Furthermore, with mergers and acquisitions of healthcare organizations large and small occurring what seems like daily across the healthcare industry, the challenge of providing needed imaging data to clinicians and the patients relying on their expertise grows exponentially.
Our healthcare system has long been plagued by the challenge of operating in data silos, which can result in costly and unnecessary duplicate testing, additional costs to the consumer in the form of multiple copays and dangerous delays in needed care. Patients and payers alike have taken notice and the industry is in the midst of a sea change forcing organizations to make significant strides in embracing and facilitating data interoperability.
Where we are now
To achieve this, healthcare organizations are evolving into clinically integrated networks and, as such, are investing in population health infrastructure and health information exchanges to provide system-wide, timely access to information and patients’ medical records. They are also seeking out strategies for better engaging patients in care processes.
So what does this mean relative to medical images? If U.S. healthcare goes where HHS is steering health IT vendors, through efforts such as DeSalvo’s 10-year interoperability roadmap, the industry can achieve interoperability with vendor, provider and payer cooperation.
Primary care physicians are, ideally, at the center of each individual patient’s care — they know a patient’s history, have an ongoing relationship and make the call when an outside or specialist opinion is needed. In the first stage of interoperability, when one practitioner attempts to send imaging or video results to another — a primary care physician to a specialist, vice versa, or specialist to specialist — the first hurdle is getting data onto a health system’s network.
Initially, this often required the cumbersome exchange of CDs or films, with today’s continuity of care documents (CCDs) being the equivalent of faxes or PDFs attached to a patient’s medical record. The result is unsearchable, unintelligent data — dead weight on a health system’s network. Actionable data cannot simply be a digital replication of a proprietary image or a fuzzy photo of a fax. To meaningfully impact care delivery, imaging data must include normalizing information allowing clinicians to easily search for and retrieve it, when needed.
Where we are going
Over the next few years as payers and patients demand freer data flow to not only see the big picture of prior care and today’s appointment, the medical image and EHR data exchange process will become simplified and more automated.
Image-intensive specialists, like radiologists, cardiologists, oncologists and emergency medicine clinicians, can provide a requesting physician with usable data coupled with a patient identifier. Some organizations have taken this a step further by creating a convenient electronic workflow among a trusted directory of physicians and normalized patient identifiers.
By doing so, all imaging data and reports can flow freely through a back-end network. This largely describes where leading healthcare organizations are with image exchange today — some can do it with EHR data, too — but there’s much room for improvement. Although data exchange is automated and accelerated, it often still requires a human touch to pull needed data and initiate the exchange process.
But that’s not enough. In order to facilitate better, more efficient healthcare delivery, data exchange needs to take place on a network that can locate a patient’s information and make it immediately available to clinicians providing treatment.
When health IT achieves this highest state of automation, physicians will be collaborative without requiring physical interaction. They will be able to summon test results and radiology studies as well as access consult notes and other data contributing to care delivery. For clinicians and caregivers, patient information will be indexed and available in a form akin to a Web search. Those searches would return a relevant list of available patient data.
The rewards will come
The Healthcare Information and Management Systems Society (HIMSS) is already on board. It is emphasizing to members how shifting payment models and new quality measures have increased the focus on coordination of care within and across enterprises. Patients typically do not receive care from only one network in a given region — and their choice of provider cannot be limited because of non-interoperability — so in order for providers to have access to a complete medical record, health systems are devising more comprehensive information interoperability strategies.
A truly comprehensive patient record needs to also include access to a patient’s complete imaging history. Such data may be the deciding factor as to whether or not a patient needs a second opinion, additional testing or a procedure.
When every provider within a patient’s circle of care can access and view their medical images, in the context of the broader medical record, the U.S. health system will see improvements in quality, safety and care coordination. That is the job of healthcare providers and health IT vendors. HHS outlined its goals at HIMSS16; it’s up to those in the trenches to connect the data to provide the ultimate benefit to patients.
