Don Dennison

It Matters – Who moved my PACS?

June 26, 2015
A number of industry trends will shape the IT tools used within imaging over the next several years. Driven by market forces and policy changes, health care providers will need to adapt the imaging platform they use.

Market forces
There are market forces that are driving changes to imaging IT systems. These changes include:

EMR Adoption
With the HITECH Act and Meaningful Use in full swing, the adoption of EMR systems is at its peak. These systems affect virtually every part of the health care enterprise and imaging is no exception. A new EMR can often change how procedures are ordered and scheduled, how information gets to modalities, how exams are read, and how results are stored and presented. Including diagnostic and clinical image viewing from within the EMR is highly desired by users.

Facility consolidation
To provide improved services integration and coordination of care—as well as reduce costs through elimination of redundancy—mergers and acquisitions of independent facilities into regional and national networks are occurring at a rapid pace. Integrating enterprises that have operated independently is no small feat. Often, systems, data, and people need to be changed.

Payment reform
To stem the tide of health care delivery costs, there are several initiatives to not only reduce transactional costs, but to also shift payment from volume to value and outcomes. Price transparency, patient steerage, and bundled payments will also be sought to drive costs down. This will fundamentally change the incentives that drive many standards of practice today. The necessity of some imaging procedures will need to be proved.

System changes
To address market forces, providers will need to evolve their imaging platform. Here are some of the key changes that will occur:

Departmental RIS to EMR transition
With embedded RIS functions—including ordering and scheduling, integrated clinical decision support, radiology reading worklists, billing, and DICOM modality worklists—all available within the EMR, a dedicated departmental RIS is no longer necessary. Departmental staff will still be required to have the workflow knowledge and perform the necessary tasks, but the system will be managed by the EMR team.

VNA adopted to address complete and longitudinal imaging record
With multiple PACS operating at all the acquired facilities, getting all the imaging records consolidated into a common repository, and integrating them across all the different historic patient identity domains, is essential to provide an effective method to integrate the images within the shared EMR. A vendor neutral archive, with an integrated enterprise viewer, is most often employed. Once the imaging records are all collected, managed, and available within the EMR, a program of consolidating the various PACS into as few as possible (to reduce costs and complexity and to improve collaboration) will be launched.

Clinical imaging shift to enterprise viewer
As clinicians shift from using the PACS to an enterprise viewer, mostly from within the EMR, they will look for that application to provide the necessary tools. For specialties that have specific tools, this may result in an integration that was previously provided in the PACS being replaced by one with the enterprise viewer. As clinicians make the enterprise viewer in the EMR their default method of image access, the usage of PACS will actually decline (fewer user log-ins, fewer client installs needed) after years of rapid expansion.

Results structured and coded
The adoption of structured reporting within radiology has trailed cardiology for years, with procedure-specific report templates being used primarily for productivity benefits. By providing a comprehensive library of structured report templates validated by clinicians for consistent comprehension, the quality of the radiology report can be improved. Improved integration with EMR to automate the inclusion of specific patient data elements, as well as methods for extracting structured measurement data from PACS for findings, can increase the value of the report even further. The use of a coding scheme also allows secondary usage of the data, such as the use of registries for data analytics and benchmarking.

Enterprise imaging captured and available in the EMR
As evidence-based best practices are defined for the recommended care activities for given patient conditions, incentives will be aligned with the adherence to these best practices. If there is evidence that the correlation of data, including images, is the most effective approach, the need to incorporate enterprise images along with diagnostic exam images will become a much higher priority. Early adopters will be more prepared for the challenging transition to such a data collection and integration program.

About the author: Don Dennison is an industry consultant, a speaker and panelist on topics such as medical imaging record interoperability and integration of imaging data within the EMR. He has published numerous articles on various imaging informatics topics. Don serves on the Board of Directors of SIIM and chairs the ACR Connect committee.