Radiologists call on AMA to push for new federal IT interoperability standards
The American College of Radiology and other physician societies now have the support of the American Medical Association in efforts to change federal health IT interoperability standards to include the Digital Imaging and Communications in Medicine (DICOM) format.
This was a resolution adopted by the AMA House of Delegates at its June meeting, asking AMA to take action to support this federal policy change.
Despite more than 20 years of electronic medical record development and federal mandates for EMR adoption, the DICOM radiology image format was never made a standard in federal interoperability rules. This means radiology images often cannot be shared or accessed through EMRs. In the modern electronic era where consumers have instant access to everything from news to online shopping, banking, and weather, most patients are shocked to find their doctors cannot quickly view their medical imaging, due varying image protocols.
"Many are surprised we still don't have standards and requirements that allow all of those systems to talk to each other," Smetherman said in an interview with Radiology Business at the AMA meeting.
"As a practicing physician, I had patients who would come for a screening mammogram, but they had never been to our facility and they were astounded we couldn't just pull up on a computer the images from her previous mammograms and compare them. Things have not really been optimized so that all these IT systems are speaking the same language to enable a nice seamless transfer," Smetherman said.
In testimony, those supporting the resolution said imaging remains excluded from the federal standards that govern clinical data exchange, creating a critical gap that burdens patients, delays care, and leads to unnecessary repeat imaging and radiation exposure.
The AMA measure was proposed by neurology and orthopedic groups, who rely heavily on radiology images to evaluate patients and plan procedures. But the lack of standards has become a barrier to care. ACR joined as a co-sponsor of the resolution, along with the American Association of Neurological Surgeons, Congress of Neurological Surgeons, and the American Academy of Orthopaedic Surgeons.
The resolution calls for the AMA to advocate for including DICOM in the U.S. Core Data for Interoperability (USCDI), so it is easier for image sharing across healthcare systems. It also calls on the AMA to advocate for policies and regulations requiring EMR and imaging archive system vendors to support the secure, efficient and interoperable exchange of DICOM imaging data between healthcare entities.
Testimony at AMA emphasized that the 21st Century CURES Act has requirements in place that mandate that health data be accessible and shareable amongst diverse platforms. However, additional testimony noted that due to the HITECH Act, radiologists are not considered to be patient-facing providers, so they were granted an exemption in CMS’s reporting program. This exemption has allowed DICOM imaging to remain separate from USCDI up to this point. But speakers at the AMA House of Delegates said this exemption has caused significant problems for radiologists and other physicians when accessing imaging in a timely manner is vital to patient care.
"Patients come in the emergency department and they may have been seen in another ED quite recently, but you don't have those prior images. This is a pain point to everyone, especially the patients," Smetherman said.
Dave Fornell has covered healthcare for more than 17 years, with a focus in cardiology and radiology. Fornell is a 5-time winner of a Jesse H. Neal Award, the most prestigious editorial honors in the field of specialized journalism. The wins included best technical content, best use of social media and best COVID-19 coverage. Fornell was also a three-time Neal finalist for best range of work by a single author. He produces more than 100 editorial videos each year, most of them interviews with key opinion leaders in medicine. He also writes technical articles, covers key trends, conducts video hospital site visits, and is very involved with social media. E-mail: [email protected]