Got an EMR? Get an enterprise-wide ‘clinical imaging health record’

At a time when 85% of physicians are viewing diagnostic images via electronic medical records, the opportunity is ripe to realize true enterprise imaging. More of those docs should be saying goodbye to walled-off image silos and hello to a centralized, always-open image depot.

So says Louis Lannum, director of enterprise imaging with the Cleveland Clinic. Lannum led a March 27 webinar on challenges and opportunities faced by provider organizations that could and should be building a one-stop “clinical imaging health record.” The session was presented by the Society for Imaging Informatics in Medicine (SIIM).

“You’ve got an EMR that builds structured content as lab results, radiology reports, CPOE,” said Lannum. “Now how do you build a medical imaging record that aggregates all images from all points of care—the inpatient space, the outpatient space and the ambulatory space—so that the caregiver at the point of patient service has access to a longitudinal record on that patient? Enabling the EMR to be the central access point for all clinical imaging data is a sound strategy.”

To get started advancing said strategy, begin by building a governance model that brings in the CIO, the CMIO and other hospital leaders who were in on the EMR process in the first place, Lannum advised.  

“The data is the same, clinically relevant information. It’s just unstructured,” he added before suggesting that enterprise imaging is one of the biggest opportunities many hospital-based providers are missing out on. “Your EMR is the focal point for most clinical data. It should be the focal point of clinical imaging data also.”

Lannum recommended investing in an enterprise viewer that can integrate with the EMR and can access all images from every department, clinic and satellite site. He said the Cleveland Clinic, which has been pioneering enterprise imaging, uses an application programming interface (API) supplied by the vendor from whom the institution purchased an enterprise imaging solution. He noted that his group has embedded the API inside the Cleveland Clinic’s EMR.

“At the end of the day, I think what we are trying to do is create a clinical imaging health record,” Lannum said. “Think about how we progressed with the EMR. You may have had access to clinical information in a lab system, clinical information in a separate radiology system, clinical information in a separate pulmonology system. What your EMR ended up doing was aggregating all of the structured data so physicians didn’t have to go to these disparate systems. Today we are at that same place in the imaging world.”

A centralized image container

Broadening image access requires centralizing an image storage container. In the process of centralizing, the hospital’s image-producing departments can build workflows, manage content and make all imaging available at the point of care, Lannum stated.

Done right, enterprise imaging provides a technology platform, a workflow platform and an operations platform that, together, allow for the aggregation of all of the images in an EMR access point so that physicians have access to every bit of information they need at the point of care, he said.

“Wouldn’t it be nice,” he asked rhetorically, “to work for an organization where you can actually see a longitudinal record of patient wound care and watch a wound get better over a period of time, or fail to get better, as part of the EMR experience?”

When the prepared session ended, webinar moderator Alexander Towbin, MD, a radiologist with Cincinnati Children’s Hospital Medical Center, asked how a hospital might take into account the many non-physicians who work within the EMR. “How do you build workflows,” he specified, “that let people stay in the EMR while at the same time image-enabling the EMR so other people can view the images?”

“You want to build a strategy where workflows start with the EMR, with the placing of orders or scheduled events that drive the ordering of an image,” replied Lannum. “Once the image is ordered, you start developing display technologies where, with a touch of one key, you can see the longitudinal record of all images associated with that patient.”

Every time a physician has to leave the EMR, he or she loses the context of the patient’s longitudinal imaging record, Lannum added. The workflows need to be access-based and orders-based—not department-based—to keep the physician inside the EMR.

“Where it becomes a little bit challenging is figuring out how to associate a progress report or an op note with an image when there is no accession number or order driving the note. We are still working that out,” Lannum concluded. “It’s a work in progress for us. Our integration team is developing a way where we are associating an op note or a progress report with a specific image. I can probably talk more about that next year.”

SIIM has webinars scheduled for April, May and June. The series is supported by an educational grant from GE Healthcare. Click here for details.