The future of connected healthcare is here today. End users evaluating a system want to know that they are taking a step forward, not backward, and that a system that works with everyone using standards to interconnect is the only way healthcare can meet its stated goals.
Connected healthcare dates back to the late 1960’s yet has never held more promise than today. Healthcare cost, quality and efficiency are key, as is making healthcare more patient-centric by educating consumers and encouraging their participation in the entire process. The consolidation and sharing of data generated outside of traditional healthcare settings through RHIO’s, HIE’s, and others also creates the need for a comprehensive electronic health record.
Many facilities have realized the need to have a fully integrated system. The IHE (Integrating the Healthcare Environment) infrastructure outlines a host of methods to integrate documents and data, as does HL7 and even DICOM at the modality level. The goal of all these standards is to allow the seamless integration of disparate clinical systems into a single electronic health record (or EHR) that can take advantage of high speed networks and mobile devices.
Many vendors have begun to integrate their clinical imaging systems using a single viewer that displays radiology, cardiology, medical records and other clinical imaging system data using a single off-the-shelf monitor. Archives are moving in the same direction with a single vendor neutral archive (VNA) storing all the data for the required number of years, supplanting the single silos that used to be connected to each system. While a broker can bring together numerous disparate systems, minimizing the number of required integration’s is the name of the game.
By having systems connected, data can be shared and the patient engaged more easily. More importantly, larger health care systems like the HCA, Kaiser, Tenant, CHI, CHS and others, can provide not just a central clearing house for their patients but also allow their patients to use physicians associated with them. This is crucial for these entities to provide high quality care as healthcare moves towards a value-based system.
Collaborative Medicine Wins Through Multi-Department Use of Enterprise PACS
Situated near the shores of Lake of the Ozarks in Osage Beach, Missouri, Lake of the Ozarks General Hospital (as it was known in 1978 when it first opened its doors) has grown over the past 25 years to become a state-of-the-art medical facility. Known now as Lake Regional Health System, the facility supports a full range of medical and surgical services, including complete cardiovascular care. Additionally, because of the increased summer population, Lake Regional also has one of the state’s busiest emergency departments. In keeping with the tradition of the community-minded visionaries who founded the hospital, Lake Regional continues to innovate and adopt new technologies. Today, Lake Regional is one of only a handful of medical centers in the country that is collecting,storing and distributing data from multiple departments (primarily cardiology and radiology) in electronic format.
Early this year, Lake Regional purchased ScImage’s PICOM Solution. The product gives the cardiac and radiology services at Lake Regional the ability to review, distribute and archive patient studies, including reports and procedure data along with patient demographic data using ScImage’s Web- enabled Electronic Patient Folder (EPF). The EPF allows authorized users to securely access patient data stored in uniquely identified individual EPFs on the PICOMEnterprise server.
Overall, the PICOM Solution has given physicians at Lake Regional the tools they need to practice collaborative medicine and the hospital a means for reducing capital expenditures, improving workflow efficiency and providing the flexibility to integrate data from imaging studies with data from patient procedures from multiple departments in the hospital.
Cardiologists and referring physicians can now access a variety of data generated in the cardiac services department and stored on ScImage’s PICOMEnterprise server from the lab, their office and even from home. This includes cardiac stress tests and hemodynamic information from the cath lab’s hemodynamic monitoring system,as well as reporting for the cardiac cath and echo labs. Soon, the physicians will be able to view EKG waveforms and reporting from vascular procedures. All of this data is or will be linked to the patient’s medical record number and made available to authorized attending and referring physicians.
Cath lab manager Connie Rugen sees the benefits everyday. “Our cardiology department is logically integrated to enhance workflow for surgeons and cathing physicians. They have been anticipating an easy way to access patient information from any location, and are pleased with ScImage’s solution. Physicians can now review imaging and non-imaging studies alongside hemo data and stress results. Efficiency will improve further when viewing EKG reports and vascular reporting become available.”
The PICOM Solution is also fully integrated into the radiology department. Images pertaining to all digital radiology modalities are being captured and stored in the EPFs of the PICOMEnterprise server and made available enterprise-wide. Robust 2-D and 3-D viewing tools allow physicians to read cases at the hospital and by using PICOMEnterprise’s built-in telemedicine functionality,they are also accessing studies remotely. “Being able to roll out of bed and quickly review an ED case gives me the opportunity to determine whether I need to get to [the] hospital immediately or if I can get [a] few more hours of sleep,” stated one of Lake Regional’s on-call radiologists. To supplement on-call reading, PICOMEnterprise’s intelligent scheduled routing services are automatically routing images to a remote teleradiology group for nighttime reading.
Integration was a key element in the decision to adopt the PICOM Solution. In addition to serving the needs of the imaging intensive departments, ScImage also provided a means for managing workflow and patient scheduling via an HL7 interface to the hospital’s Meditech patient registration and order messaging system. The integration gives the hospital a way to reduce data entry errors by capturing patient demographics that have previously been entered. In addition, procedure ordering and patient information are pushed to ScImage’s scheduling product PICOMScheduler. The scheduling software gives both departments a means for tracking patient procedures and also sends “order completed” messages back to the Meditech system. Integrating with the existing solution gives the hospital the opportunity to reduce capital expenditure costs and increase workflow efficiency at the same time.
“ScImage seamlessly interfaced their PICOMEnterprise solution to our different point-of-care clinical systems and imaging modalities including CT, ultrasound, MRI, nuclear medicine, cardiac cath and echo,” according to Steve Grotewiel, Director of Medical Imaging. “Now, physicians at Lake Regional have near real- time remote access to procedural images, reports and other clinical information. Getting clinical information into the hands of every caregiver at Lake Regional Health System is a top priority for the facility and for me personally.The result is that physicians have the right tools to make the best decisions when treating patients. We evaluated many systems but went with ScImage because they were able to provide us with a cost effective, integrated solution.”
About Lake Regional Health System:
Lake Regional Health System supports medical and surgical services in orthopedics, complete cardiovascular care reconstructive surgery, obstetrics and gynecology, outpatient services, community health education and prevention. Credentialed by the Joint Commission on Accreditation of Healthcare Organizations, Lake Regional offers high-tech medical diagnostics and treatment, coupled with high-touch patient care. Nearly 1,000 employees support the medical expertise of 70-plus full-time medical staff. With a 100,000 square foot expansion in 1999 — larger than the facility’s original structure — the 140-bed facility now includes a 12-bed observation unit, an 18-bed intensive care unit, rehab therapies, cardiac rehabilitation, an additional cardiac catheterization lab, an oncology suite, physician offices, an expanded outpatient surgery area and a chapel. Lake Regional also features a network of clinics, pharmacies and rehabilitation services located throughout the region. The organization’s vision is to transition from a primary/secondary hospital into a regional, tertiary care medical center and related clinical services.
Enterprise-Wide Solution Integrates Cardiac and Radiographic Studies, Enabling Facility to Practice Collaborative Medicine
Founded in 1937, the 222-bed Alton Memorial Hospital located in Alton, IL, served more than 90,000 patients in 2003. The local leader in cardiology services and a member of BJC HealthCare based in St. Louis, Alton Memorial Hospital opened the region’s first diagnostic cardiac catheterization lab in 1988 and the first balloon angioplasty program in 2000. The hospital provides numerous other heart care services, including enhanced external counterpulsation and a complete cardiac rehabilitation program that features state-of- the-art exercise and monitoring equipment.
Alton Memorial Hospital performs approximately 900 diagnostic cardiac cath cases per year and also performs more than 70,000 radiology exams annually. Recently, Alton Memorial Hospital announced an enterprise-wide digital imaging initiative. The hospital intends to implement the project in multiple phases, with the initial phase beginning with cath, echo and EKG capture, information analysis, integrated reporting and system management for the Cardiac Services Group.
Assisting Alton with their digital initiative is Los Altos-based ScImage. The enterprise PACS provider will serve both radiology and cardiology to provide a single point of access for patient studies and information generated in both the cardiology and radiology departments. Once all phases of the project are completed, ScImage’s enterprise-wide PACS, PICOMEnterprise, will give caregivers at Alton Memorial — and eventually at other institutions in BJC — an overall centralized integrated solution with the means for accessing data collected in multiple departments. As part of the digital initiative, ScImage will also integrate the capture of reports from legacy reporting systems and use PICOMEnterprise’s Web-enabled Electronic Patient Folder to store those reports alongside patient images to provide a more complete record of patient exams for both attending and referring physicians. Once in place, physicians will be able to access all available patient images and the associated information from a single login.
About the Hospital:
Founded in 1936, Alton Memorial Hospital is a JCAHO-accredited, full-service hospital serving the River Bend area of southwestern Illinois. Recognized for its heart services, orthopedic surgery, oncology services, women’s health services, outpatient surgery and testing, gastroenterology, pain management, pulmonary medicine, rehabilitation and sports medicine, the hospital also provides numerous health education and wellness programs to the people of Alton, IL and the surrounding communities.In addition to boasting the area’s only balloon angioplasty program, Alton Memorial Hospital offers open MRI through Twin Rivers MRI Center,CT services, PET imaging, nuclear medicine and cardiac and pulmonary rehabilitation. The hospital operates a 24-hour emergency center and the area’s only hospital-based ambulance service. 225 medical staff members and 596 FTEs provide these services.
Phase two will connect all of the DICOM compatible modalities in the Radiology Services Group so that digital images can be captured, stored and distributed throughout the enterprise. Integration with the hospital’s radiology information system (RIS) was critical to Alton’s digital imaging initiative. In addition to storage for the hospital’s images, ScImage will also provide a means for managing workflow and patient scheduling via an HL7 interface to the hospital’s Siemens Novius RIS. The integration will provide the hospital a way to reduce data entry errors by utilizing patient demographics that were entered at the time of admission. This second phase of the project will begin in the fall of 2004 and will also include conflict resolution and DICOM modality worklist functionality.
Phase three will bring the remainder of the modalities in the Radiology Services Group up to the DICOM standard and also add computed radiography modalities to enable standard films to be read digitally. During this phase, the hospital will also add high-powered radiology review stations for use by the reading radiologists. Once phase three is complete, the hospital’s vision includes connecting the system to BJC HealthCare’s multiple campuses for image and information access.
“We took a lot of time to evaluate different vendors including extensive site visits to narrow the search that brought us to choose ScImage,” stated Al Hibbett, manager of Cardiopulmonary Services. “In the end, it was an easy decision because they were able to meet our requirements of cost effectiveness, use of non-proprietary hardware and satisfy multiple service lines all under just one roof.”
In addition to the web-enabled Electronic Patient Folder, PICOMEnterprise also employs ScImage’s ForeverOnline architecture. ForeverOnline is a low-cost, high- availability solution that employs intelligent image routing to serve high-volume, centralized reading environments. This configuration of PICOMEnterprise combines a powerful multi-processor server with a highly scale-able storage solution that eliminates the wait for image and information retrieval by keeping everything online. Alton Memorial Hospital will also coordinate its digital initiative using ScImage PicomOnline Web-based disaster recovery hot site for both secondary secure storage and backup application delivery for teleradiology and remote access.
“We selected ScImage because this project will be critical to the ongoing success of the hospital and we knew that they could meet our aggressive requirements for integration,” stated Jack Wepler, manager of Medical Imaging Services at Alton Memorial Hospital.
PICOMEnterprise will allow multiple departments to store and distribute patient information both inside and outside the hospital. This will allow attending and referring physicians at Alton Memorial Hospital to practice collaborative medicine, which will ultimately lead to better patient care.
Single Database Solution Unifies Group’s Approach to Reading In Rural Oklahoma
Founded in 1969, Diagnostic Imaging Associates (DIA) initially provided Oklahoma’s rural hospitals and clinics with “circuit-riding” radiologists that would read cases once per week for a few hours before moving on to the next facility on their list. While these circuit riders provided a valuable service to the rural communities, as technology advanced, it became clear that there was more that could be done for these communities. Today, DIA has grown from a two-man operation into a radiology physician group with more than a dozen radiologists that specialize in MRI, CT, X-ray and all interventional radiology procedures. The group relies heavily on a robust telecommunication network that is run by the state of Oklahoma to provide radiological testing for patients and diagnostic image interpretation. DIA’s focus is on treating patients with the least invasive means at the highest success rate. Among their customers are Tulsa Regional Medical Center and its affiliates, Cancer Treatment Centers of America and several small community hospitals throughout the state. DIA also provides fellowship opportunities in interventional radiology and a residency program for radiologists in training.
The Oklahoma Telemedicine Network and OneNet
Circuit riders supplied by DIA and other subspecialty groups served a valuable purpose to the residents of rural Oklahoma. In an effort to provide better service using the technology available, the Oklahoma State Legislature signed a bill in the early 1990s to create the Telemedicine Advisory Council. This council set about leveraging advancements in Internet technologies which led to the creation and initial development of the Oklahoma Telemedicine Network (OTN) in 1993. OTN placed new high-bandwidth connections or used existing high-bandwidth connections between 45 hospitals throughout rural Oklahoma to better serve these communities. The communications lines were used for telemedicine, video conferencing and other types of point- to-point communication between hospitals, physicians and their patients. Toward the end of the 1990s, OTN was turned over to OneNet, which is run by the Oklahoma State Regents for Higher Education and is operated in coopera- tion with the Oklahoma Office of State Finance.
A native of rural Oklahoma himself, DIA’s president and a long-time proponent of telemedicine, Dean Fullingim, D.O., understood that the state’s rural population required access to radiology services. However, because fewer and fewer physicians were being trained as radiologists, access to those services was limited. Dr. Fullingim saw potential in the network being run by the state and set about making use of this valuable resource. Working at Oklahoma State University at the time, he devised a way to put the medical school’s telecommunications infrastructure to work in order to provide teleradiology services to rural Oklahoma. Leveraging OneNet’s infrastructure Dr. Fullingim made it possible for patients in rural communities to receive diagnosis and treatment without traveling long distances or waiting for a circuit-riding radiologist’s weekly visit.
“I no longer have to maintain three solutions and the data being stored is seamlessly delivered to our physicians..”
Allen Noland – DIA Director of Systems Technology
DIA has grown considerably since inception. Today DIA comprises a dozen radiologists reading for 41 facilities from eight central locations around the state. This growth and the advancement of technology by way of advanced visualization applications for CT and MR has meant using solutions from multiple vendors to get the work done. Dr. Fullingim and DIA’s director, systems technology, Allen Noland, knew it could be done more efficiently.
From Multiple Vendors to One Solution
In late 2004, DIA set out to consolidate their efforts. The group practice was using systems from three different vendors to provide interpretive radiology services to their customers. DIA’s homespun radiology information system, DIA RIS, tied the three solutions together so any solution they selected needed to be standards base d and must interface to the RIS seamlessly. This is because DIA RIS currently handles patient scheduling, film requisitions and reporting for the group’s busy reading environments. In an effort to end the frustration associated with using several solutions to complete their work, Dr. Fullingim and Noland needed a single solution to provide cross-sectional imaging tools, efficient telemedicine and standard radiology imaging — all features that their current three vendors provided.
After considerable research and evaluation of several solutions at the annual Radiological Society of North America (RSNA) exhibition in Chicago, DIA launched a pilot project to evaluate ScImage’s Enterprise PACS, PicomEnterprise. What attracted the two telemedicine veterans to the PicomEnterprise solution was its Web-based design, combined functionality for key components of their workflow and consistent user experience. The solution was also cost competitive. Shortly after the evaluation began, a decision was made to move the entire group off the existing combined product approach and onto ScImage’s PicomEnterprise solution. The impetus for the decision was that DIA could begin reading all exams from their 40-plus institutions using a unified platform.
According to Noland, “Because of ScImage’s single database approach, the solution is easy to manage and administer. I no longer have to maintain three solutions and the data being stored on our PicomEnterprise server is seamlessly delivered to our physicians through our DIA RIS front-end. In addition, the built-in visualization tools for MPR and Oblique Slicing make image interpretation and manipulation much easier because our radiologists don’t have to move to a separate workstation.”
In fact, DIA currently reads an average of 900 radiology exams per day from outlying facilities that are interconnected via the OneNet network. Using the Web-based PicomEnterprise solution, a dozen reading radiologists provide primary interpretations for CR, CT, MR and ultrasound from eight facilities around the state. By eliminating the circuit-riding radiologists, physicians can now stay in one place and provide more efficient service to more patients, more rapidly.
“DIA has been providing world class teleradiology services to the residents of rural Oklahoma for the last 17 years,” stated Dr. Fullingim. “We have worked with multiple vendors during this time. We interpret more than 200,000 exams annually that come from 41 facilities around the state. ScImage helped us unify our approach to reading and now we all use the same system, the same tools and the same interface. We couldn’t do that without ScImage.”