A needle in the haystack: Searching for the right information, the right way

September 06, 2017
By Laurie Bergeron

Health systems have two primary imaging solutions, the EMR and the PACS, and we know that connecting those is an important aspect of an enterprise imaging strategy.

From an IT leader’s perspective, all the imaging should reside in one of these two solutions. But for radiologists who use the PACS as their primary system, finding information in an EMR is an unfamiliar process and extracting relevant clinical data can be difficult and time-consuming. For them, it’s like searching for a needle in a haystack.

In academia, it used to be common to use a Fellow – an individual – who collected, filtered and summarized all the relevant information for a radiologist so he or she had proper clinical context to perform the diagnosis. The advances in technology gave us all that clinical data and more, but they haven’t always made it easy to find, access and synthesize. Without a way to pull it all together, no one can use it. For a radiologist who is interpreting a study, clinical context comes in many forms. Sometimes knowing why an imaging study was ordered, or seeing another clinician’s notes, can shed light on the information that’s revealed in the images themselves. The Catch-22 is that these notes are stored in the EMR. That’s why it’s important to connect these two systems.

The difficulty comes from multiple avenues. A PACS sometimes exists as an isolated system for security reasons. In large health systems, there may be multiple PACS or instances of an EMR. Often, if a radiologist wants to log on to the EMR, he or she performs that task from a separate computer, with a different login. Already, you can see there are two additional steps. Then, the radiologist still has to find the patient record and review multiple files or folders for the information pertinent to the case at hand. In some systems, locating the information takes multiple steps and different searches.

Even if the EMR is easy to navigate, it still requires a radiologist to leave his primary system – the PACS – and go into another area where he’s less familiar, which takes more time.

Value-based care shifted the view of radiology from being a profit center to a cost center. Radiologists are expected to read more studies in less time with higher quality. To meet these standards, they need clinical context, which can only come by connecting them to the EMR.

We know that it is important for radiologists to access the clinical information in the EMR. Quite simply, the more smartly synthesized information you have, the better your interpretation. Radiologists want to provide useful impressions and recommendations, which is far more likely when they’re considering images along with relevant history. All the clinical data contained in pathology, lab reports and surgical history can impact how a study is interpreted. Not only that, but the additional information gives a radiologist more diagnostic confidence, or the ability to change a recommendation for the next imaging study to be done. It makes the leap from simple data to insight, which has far-reaching implications for patient care.

There are two key factors that make up an ideal scenario:
The first is to have the EMR information integrated into a diagnostic reading workflow so it’s readily accessible to the radiologist.

The second is to give radiologists the ability to control and adjust both the amount and type of information they receive. Since there are so many nuances to clinical diagnostic reading, they need flexibility and a way to intelligently configure a GUI that’s tailored to their workflow. The EMR isn’t imaging-centric, so tailoring it to a radiologist’s workflow is far more difficult and costly from an IT perspective.

Laurie Bergeron
The goal of every radiologist is to provide the best patient care – in every case, whether it’s complicated or simple. And more clinical information will help every time. Ultimately, it comes back to the same issue I mentioned earlier – more information means better quality interpretations, faster discharge and fewer unnecessary tests. When you can avoid an invasive procedure, or an unnecessary study, or save time, the value is obvious, especially for the patient.

About the author: Laurie Bergeron is a product manager for Workflow Solutions at Change Healthcare. She holds several patents for her products, and focuses on creating solutions that help her customers connect relevant clinical information to the point of care. She is a certified cardiovascular technologist and earned a B.SC from the University of Waterloo.