Informatics is a fast growing discipline within healthcare as new technology and increased amounts of patient data converge. But how exactly does informatics relate to medical imaging? And more importantly, how can it be leveraged to optimize and streamline the flow of medical imaging across radiology and beyond?
In a live webinar event, Ambra Health CEO, Morris Panner, was joined by Keith Hentel, MD MS Executive Vice Chairman, Department of Radiology Weill Cornell Medicine and Krishna Juluru, MD, Director, Imaging Informatics, Memorial Sloan Kettering Cancer Center to discuss imaging informatics.
Throughout the webinar, several poll questions were asked of the audience that highlighted a heightened awareness towards informatics, radiology operations, and a continued goal of improving patient care.
What Is Your Greatest Image Management Frustration?
While the majority of webinar attendees were frustrated with multiple items in regards to medical image management, 33% placed an emphasis on lack of easy image sharing technology. In today’s changing healthcare environment, radiology is evolving; it’s no longer enough to issue reports. Adding value to health care delivery means that radiology leaders need to provide timely and efficient turnaround, track performance and follow-up, and even shift from being the “doctor’s doctor” to engaging directly with the patients and even competing for them.
Currently, healthcare organizations are dominated by on-premise solutions that have a way of locking information inside. On the intake side you have modalities, PACs, maybe you’re using CDs, or VPNs. On the management front, you need a good way to process incoming exams and distribute data. On top of that, providers are starting to ask, can I tie imaging into the EHR, my HIE, or patient portal? In the same vein, people want to know, how can I give patients access, and how do I make it easier to receive information for referrals and second opinions?
Dr. Hentel discussed how Weill Cornell ‘s patients arrive from across the New York region with imaging that may have been completed within or outside of their system. Weill Cornell dealt with frustrations surrounding CD upload and local PACS systems, but today, they have moved to a cloud image management solution to route images to the right place at the right time.
Dr. Juluru faces a unique challenge at Memorial Sloan Kettering Cancer Center since care coordination is of the highest importance in the world of oncology. For example, the ovarian cancer disease management team may be compromised of a surgeon, oncologist, radiologist, and radiation oncologist who may all want to review imaging and offer the best report to a referring physician. Dr. Juluru also highlighted a common dilemma where a radiologist is given a CD by another radiologist who wants a second opinion. However, opening the CD, using its native viewer, and re-learning the unique viewing tools each time is frustrating and slows down the read.
MACRA & Metrics – Has The Shift To Value-Based Care Affected Your Organization?
The majority of respondents have seen some impact from changes in legislation and expect to see more in the near term. This is where informatics data frequently comes into play. Dr. Juluru highlighted how Memorial Sloan Kettering keeps metrics on a large array of radiology operations ranging from which facilities are doing the most scans, to the average number of reads a radiologist is completing, to the most common body parts being scanned, and more. They also measure referral patterns to determine the level of satisfaction across their network.
Dr. Hentel also relies on metrics to see the supply and demand of imaging at Weill Cornell. Particularly, Manhattan is atypical as patients often come in at unique hours for medical imaging, like 7am, 11pm, and weekends. All of this is tracked to best operate a schedule that coordinates with these exam times.
Dr. Juluru shared that imaging is particularly targeted by value-based care initiatives as it is a major expense for most facilities. Particularly, PAMA (Protecting Access to Medicare Act) wants to make sure that when advanced and expensive imaging, like a MRI gets done, it’s being done for appropriate reasons. Developing appropriate methodologies and clinical decision support lines to deliver best imaging for diagnosis is critical.
Dr. Hentel agrees and says,
If you don’t have a decision support mechanism yet, you should look for one at RSNA 2017.
Weill Cornell is also part of a general radiology and mammography database which helps to organize data and provide benchmarking data to recognize areas for improvement.
Delivery & Output Across Network – Cloud Delivery?
Dr. Hentel highlighted that,
Just as important as completing imaging is getting imaging out to where it needs to be.
Less than 50% of the ordering providers at Weill Cornell have access to their PACS. Today, they use Ambra Health’s cloud image management suite to get images back to ordering providers. Previously, they were burning CDs, printing reports, faxing, mailing etc. which could take 2-3 days. Today, a referring physician could get images and report within just a few hours.
And he feels very strongly that patients are their best own advocates. Patients used to get CDs but now can access their own imaging through the cloud and share when needed. Patients are interested in this information, as a recent study conducted by Ambra Health found that 80% of respondents said they would like to have access to their imaging alongside their test results, also implying the need for patient facing reports that can be easily understood.
And, at Memorial Sloan Kettering, Dr. Juluru says,
Physicians now want to see everything in regards to a patient in a unified platform.
They are actively looking at new solutions to combine both DICOM and non-DICOM imaging into their patient history to provide a more holistic record. What’s clear is that informatics is no longer just a numbers game, but a way to provide patients with the fastest and most accurate care possible.