Methodist Le Bonheur Healthcare (MLH), a Memphis, Tennessee-based health care system of eight hospitals, found both its general PACS and cardiology PACS aging past viability at the same time, raising an interesting question: Was the organization prepared to explore an integrated imaging platform and vendor-neutral archive (VNA)? “I wanted our selection committee to consider that since both our cardiology and general PACS were put in place eight years ago, had the marketplace moved on to a higher level of maturity and integration with general and cardiology PACS?” recalls Alastair MacGregor, MB ChB, chief health information officer at MLH.
The problem was one familiar to most health IT professionals: reconciling the needs and demands of separate clinical silos to find a solution that would work equally well for everyone. The transition often represents a philosophical and strategic change as much as it does an architectural one. “It was going to be challenging enlisting all the users who saw their needs, from the clinical and service perspectives, as being greater than the enterprise needs,” MacGregor says. “We didn’t know if there was a vendor that could meet everyone’s functional requirements.”
Strategic Considerations
MLH issued a Request For Proposals that was, by necessity, “very detailed,” MacGregor says. Of particular importance were strategic considerations for cardiology, especially pediatric cardiology. “The complexity in cardiology at MLH is that we have a cardiology service line, but also a tertiary care pediatric cardiology service line,” he says. “We’re one of the leading pediatric cardiology centers in the Mid-South, and that service line is growing and will continue to grow as part of our long-term strategic plan.”
The health system enlisted radiologists, cardiology interventionalists, cardiologists, and pediatric cardiologists for its selection committee. In the end, it selected McKesson to supply its new integrated PACS and enterprise archive: “McKesson was the only company that could offer us the integration we were looking for,” MacGregor says. “They have a single solution that meets the needs of general PACS, as well as the specific needs of cardiology and radiology.”
For instance, MacGregor says, the McKesson solution will help automate reporting and dose tracking in pediatric cardiology, while it will offer radiologists web-based access to the PACS for the first time. “We just recently reached an agreement with them to read for some of our outpatient services,” MacGregor notes. “We’re really going through a whole transformation of our radiological services, of which the McKesson contract is one phase.” For instance, he says, the health system also implemented voice recognition in early 2013, reducing its average radiology report turnaround times by 60% and by as high as 90% in the emergency departments.
The integrated platform also will support the development of new, more integrated service lines at MLH. “We believe that our strategic service lines like neuro, orthopedic, and adult abdominal transplant will benefit from all advanced imaging techniques, like 3-D imaging and image enhancement, [which] will be a boon to our physicians,” MacGregor says. “I’ve been thrilled with the leadership and open-mindedness of our medical staff as they came together to reach a consensus on a single enterprise PACS solution.”
Looking Ahead
MLH will begin transitioning to the new platform in July, starting with the cardiology department, whose legacy PACS is sunsetting. MacGregor sees integrated image management as an imperative going forward: “Health reform has raised the bar on the strategic importance of health IT,” he says. “As a result, rather than balancing multiple best-of-breed solutions, I believe we will see more organizations going to a single enterprise solution that is both interoperable and integrated. There was always a loss of functionality going from one system to another when using interfaces.”
Health reform also will put pressure on the market that may result in the end of health information exchanges (HIEs) as a way for organizations to exchange data, MacGregor predicts. “With the competitiveness of the market and the risk of accountable care organizations, it’s fine to share a minimum common dataset, but wide-open sharing is not necessarily in the best interest of competing providers,” he says. “We’re beginning to see what I believe will be a major shift, where large EMR vendors will take market share away from stand-alone HIEs.”
As evidence, he points to the announcement at the 2013 meeting of the Healthcare Information and Management Systems Society (HIMSS) that McKesson, Cerner, Allscripts, Greenway, RelayHealth, and athenahealth would join together in an alliance aimed at creating seamless interoperability between their respective health IT platforms. “The vendors are going to do this, and find a way to do it at a very low cost,” MacGregor says. “They claim they feel a moral obligation to make health information interoperable. Our strategy will continue to evolve as the marketplace evolves.”
Cat Vasko is editor of HealthIT Executive Forum.