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The 21st Century Cures Act & The Future of Enterprise Imaging

Cheryl PetersilgeA recent interview with Catherine Slotnick, Ambra Health Senior Marketing Manager, and Cheryl Petersilge, M.D., M.B.A., Founder and CEO of Vidagos Advisors which focuses on the future of enterprise imaging.

Catherine: You recently submitted feedback to the ONC (Office of the National Coordinator for Health Information Technology) regarding the 21st Century Cures Act. What caused you to get involved with these policy changes?

Cheryl: I’ve had a long career as a radiologist and then Medical Director of Information Technology at the Cleveland Clinic. I’m now working as an independent consultant and want to share my experience regarding the unique challenges of enterprise medical image management. When I attended a few HIMSS meetings on new regulations, I quickly realized that the government is not particularly knowledgeable about medical imaging and thought expert commentary could be useful.

Enterprise imaging is a unique challenge. As a radiologist, I saw how much redundant radiology goes on due to missing CDs and lost information. As our healthcare system moves in the direction of value over volume, I want to bring the visual health record to the forefront of people’s minds.

Catherine: What is unique about medical imaging that people outside healthcare may not realize?

Cheryl: First of all, they don’t understand the sheer volume! Medical images are relatively large files compared to a typical document and require a specialized viewer that can read the DICOM format. To complicate things more, some companies still use a proprietary format even though DICOM is considered the standard.

There is also a tremendous lack of standardization in reporting and DICOM tags. There are many institution defined parameters. And for images that are other formats, like photographs or videos, how do you label them? However, this aspect is more of a hurdle than a barrier. The true barrier is getting facilities to understand at an enterprise level how to really value medical imaging.

Catherine: I’ve never understood why it is such a struggle for facilities to understand the value of managing their imaging, especially when it comes to sharing among institutions. What do you think the barriers are here?

Cheryl: I think a huge blockage is financial. Even when I was first setting up image exchange programs, there were those who were nervous about connecting to competing facilities. At the end of the day, hospitals need money, and there is an enormous fear of losing business.

I think there is also a lack of awareness at the C-suite level regarding how imaging impacts healthcare. Imaging purchases are often a department-by-department decision, and we need to get them to be at the enterprise level.

And finally, there’s a lot of anxiety and unknowns around sharing patient data. Most facilities still require a signed release to share imaging information.  While we readily share information across EHR systems, most institutions don’t share images without express permission. When it’s for patient continuity of care, we need to raise awareness that such permission is not necessary.  We need to educate everyone down to the technologist on the night shift that this sharing is appropriate.

Catherine: Explicit consent can be surprisingly frustrating for patients. I myself recently had to go in person to a facility to sign off to receive my records and CD. Which may I add, involved two different floors of the hospital and plenty of wasted time!

Cheryl: Exactly! The hoops we make patients jump through are crazy. I had a colleague whose husband was in an emergency care situation down at a smaller hospital in the South. She wanted the images sent and reviewed up here (the Cleveland Clinic). The facility refused to burn her a CD so that she could upload and send us the images! She had to track down someone at the hospital who would do it for her.

We see these struggles with CDs every day. My own elderly parents have had to manage their CDs, I’ve seen patients forget to come in with a CD that was needed for an appointment, and I’ve seen smaller providers who don’t have great viewing systems in their offices. It’s a huge problem.

Catherine: I feel like I’m constantly reminding friends and family (and myself!) to keep track of their CDs, always ask for a CD, and bring them to appointments. However, this should really be the last thing a patient has to worry about when they are preparing for surgery, caring for someone else, or dealing with a serious health condition.

I do think more and more facilities are becoming aware of these challenges and how they’re negatively impacting patients’ perceptions of their facilities.

What do you think is the greatest challenge for facilities as they try to develop a better data/image management strategy?

Cheryl: I think there are a couple of key aspects here. First and foremost, the workflow has to work for everybody. You can have the best technology in the world but if the workflow isn’t good, no one is going to use it.

Another challenge is letting patients know that they can receive or share their imaging electronically. There’s a whole strategy around patient education that needs to take place.

Catherine: That’s very true regarding patient education. Many of our customers have been reaching out to our marketing and customer success teams regarding brochures and user guides for educating their patient populations about things like the patient portal or second opinion program.

Cheryl: Exactly, and to add to everything else, some institutions can add another challenge. They aren’t always willing to collaborate and share with others. For example, at the Cleveland Clinic, we got a lot of referrals for breast cancer workups where prior mammograms were coming from all over the country. Establishing workflows and willingness to send imaging and data from various hospitals and imaging centers was very difficult.

Catherine: Prior imaging is such a critical piece of the puzzle to any treatment plan or diagnosis. This goes back to an earlier point that some don’t recognize the value of the visual patient health record. Imaging data holds so many insights.

Cheryl: It does and many facilities are learning that for the first time. Academic centers especially are realizing that imaging data has value, and they want to monetize it. However, if they haven’t had good data hygiene along the way, it can be a disaster to manage.

Catherine: What are your thoughts on imaging data being used for research? Our CEO, Morris Panner, recently wrote about this topic himself.

Cheryl. I have concerns about the monetization of patients’ healthcare data; I think it’s a very complex issue. Ideally, it would be my dream that one day there would be a countrywide HIE of sorts where all this data could be stored, accessed by patients, and used for the greater good. This wouldn’t mean that EHR systems would cease to exist, just that everything would eventually filter in one single source of data.

Catherine: That reminds me of the Cancer Moonshot initiatives. It sounds like we still have a long way to go, but if more providers and patients were educated regarding the importance of image sharing and #Ditchthedisk, we could make some big breakthroughs!

Cheryl Petersilge is Founder and CEO of Vidagos Advisors, an enterprise imaging strategy firm. Vidagos guides health systems, small hospitals, and healthcare practices to a clear vision, strategy, and blueprint for cutting-edge, sustainable enterprise imaging systems. As a respected physician, imaging leader, and innovative engineer, Dr. Petersilge provides extensive expertise as a pioneer in enterprise imaging with deep knowledge in healthcare informatics. As an internationally known radiologist and highly regarded physician leader at the Cleveland Clinic, Dr. Petersilge held numerous Chair and Medical Director positions in radiology and information technology. Dr. Petersilge is recognized among the top professionals in her field, having been selected as one of three U.S. representatives on the HIMSS International Center for Excellence for development of the Digital Imaging Adoption Model (DIAM). She is the past president of the Society of Skeletal Radiology and provides leadership for numerous professional organizations and advisory boards. She earned her M.D. from the Ohio State University College of Medicine and received a B.S. in chemical engineering from Purdue University. She holds an M.B.A. from the University of Massachusetts.

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Catherine Slotnick, Marketing Manager

About Catherine Slotnick

Catherine Slotnick is a passionate healthcare marketer with a deep interest in the latest & greatest in the Health IT space. As Ambra Health's senior marketing manager, Catherine primarily focuses on creating and sharing thought leadership content in the radiology and informatics space. Catherine graduated from the University of Virginia with a BA in Psychology & Art History. When she's not writing, she enjoys cooking and petting dogs that aren't hers.

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