This report originally appeared in the March 2011 issue of DOTmed Business News

By Paul Merrild

According to a recent Porter Research and Billian’s HealthDATA survey of more than 120 health care executives, 43 percent of facilities are considering a move to an Accountable Care Organization model and 45 percent are seeking to improve connectivity within their hospitals and health systems. Technologies that optimize data storage and sharing will be a key focus for organizations seeking to overcome cost and funding challenges associated with planning and implementation of both public and private health information exchanges (HIE).

Interestingly, the survey’s respondents lacked clarity around HIE vendors. Nearly 50 percent were unsure of a market leader among HIE vendors, and 40 percent were unsure which vendors they’d consider. “CIOs at hospitals (are) used to making decisions about technology for the inside walls of their hospitals. The selection of an HIE solution impacts not only the hospital, but the owned affiliates, the clinics, the laboratories, the imaging centers. There are so many more stakeholders’ fingers in the cookie jar,” stated Cynthia Porter, president of Porter Research.

When it comes to electronic health records, CIOs face questions about the capabilities of various solutions to support HIE. The lack of clarity around vendors and leadership in the HIE space is compounded by the fact that many EHR solutions were not designed with interoperability in mind. When you take into account the fact that the very definition of an HIE is fluid, the challenges can be significant.



According to Porter, many organizations are increasing their focus on interoperability solutions in order to utilize existing technology. Some go about this by investing in an overlay technology, she said. This is a “slightly more promising approach,” said Porter, “as interoperability solutions were built to handle data exchange among legacy or disparate systems.”

In today’s healthcare landscape, one of the most pressing HIT issues is the cost-effective and timely sharing of diagnostic images. With all the technological advancements made in the last few years, it’s unbelievable to think that, even in the US, patients serve as a “transport mechanism.”. It is common to see patients arriving at doctor appointments, for example, with images from another care provider. In transfers from tertiary care to trauma facilities, it’s not atypical to have patients emerge from a helicopter or ambulance with a CD strapped to the stretcher.

Unfortunately, according to research published in the Journal of the American College of Radiology and carried out by Johns Hopkins University, only about 61 percent of respondents said most outside medical images digital media provided by patients were readable or importable. (See Jan. 5, 2011 DOTmed News article, “Image formatting incompatibility bedevils portable media.” DM15090)

Today, many EHRs offer access to transcribed reports; but without access to actual images, clinicians can be at a loss. In many situations, doctors need to review current and prior images to draw effective conclusions. Many physicians also want the “quantitative” data provided in an image in addition to the subjective interpretation of a colleague.

Technological advances are fueling the development of solutions to enhance health information exchange infrastructure -- including new approaches for sharing images between providers and comprehensive integration of imaging into broader HIT applications. Using the Internet as a secure transport mechanism, sophisticated review-quality images can be delivered in real-time, thus supporting an efficient patient referral process. Images can be rendered remotely on the fly, eliminating costs associated with image duplication and redundant storage. It is now possible to provide access to any image at any time and to display it on any viewing device.

We are moving into a new era with patients, providers, and payers managing the health care experience from computers, mobile devices and new types of access points such as kiosks. The electronic health record will truly be meaningful if it includes diagnostic images. And health information exchanges will truly live up to their name if diagnostic imaging data can be electronically shared across institutions, geography, systems, and time.

When seeking interoperability and evaluating image exchange solutions, organizations should ask the following:
• Can we add the solution to my existing systems to optimize monies already spent?
• Is the solution modular or componentized, thus allowing us to scale incrementally?
• Does the solution support international interoperability standards?
• Does the solution provide a completely integrated IHE XDS infrastructure suite?
• Does the solution support exchange and rendering of images from one vendor’s system to another? Is the archive truly vendor “neutral” specifically for image management?
• Does it provide connectivity even to users who are globally dispersed, or unable to move to a full XDS infrastructure?

Paul Merrild is the senior vice president for Merge Healthcare. Prior to joining Merge, Merrild served as senior vice president of marketing and business development at AMICAS. He also served as director of strategic partnerships for imaging IT solutions at GE Healthcare. Merrild started his career with Solucient. He holds a BA in economics and psychology from Northwestern University and an MBA from the University of Chicago with concentrations in finance, strategy, and entrepreneurship.