Three Medical Imaging Strategies to Help Overcome Interoperability Roadblocks in Healthcare

When the 21st Century Cures Act final rule published on May 1, the countdown to compliance deadlines began.¹

For years, organizations have used picture archiving and communication systems (PACS) as a way to store and call up images for reading. Integrating these images into the electronic health record (EHR) was an important step toward Meaningful Use in the 2010s.

With the shift from Meaningful Use to Promoting Interoperability ², and the upcoming deadlines, organizations need to go beyond putting images into patient EHRs. They also need to be able to quickly and easily take data out and share it across departments, with outside organizations and with patients.

As organizations prepare to comply with the 21st Century Cures Act, it will be important to examine existing medical imaging platforms to ensure they support an enterprise’s interoperability efforts. These strategies may help you overcome roadblocks on the path to interoperability.

Strategy 1: Shift the imaging mindset from silos to enterprise.

Interoperability is at the heart of The Office of the National Coordinator for Health Information Technology (ONC) standards around interoperability³.

As organizations work toward an open, seamless flow of data between departments, providers, organization and patients, they will need technology that supports the entire enterprise.

Many of today’s healthcare organizations don’t have the imaging infrastructure to support this goal. Typically, imaging is managed through departmental PACS, the long-standing solution that was first introduced in the 1980s. It is a vertical approach, with each -ology and service line operating its own system.

As interoperability deadlines approach, there is a need to change the imaging mindset from vertical, PACS-based imaging to horizontal, enterprise imaging. Rather than serve a single department, imaging solutions will have to serve the needs of the entire organization and its patients.

When enterprise imaging was introduced, it offered a chance to disrupt the traditional PACS approach. Rather than be limited to a single PACS system, viewer and workstation, enterprise imaging (EI) allowed organizations to access patient imaging data at any time, from anywhere. The data could be added to the patient’s electronic health record for access by the entire care team.

Along with the advance in technology often came sticker shock compared to the cost of a single department’s PACS.

In the years since enterprise imaging’s introduction, organizations who have adopted EI may notice a return on this investment in a number of ways, including:

• Easier access to images, allowing better diagnoses
• Reducing the cost per episode by delivering diagnoses sooner
• More cost-effective medical image data management
• Better collaboration among departments⁴

The benefits and ROI above will also be important to breaking down data silos in favor of interoperability and data sharing.

Strategy 2: Move away from legacy solutions to new technology designed to adapt to increasing data loads.

As organizations shift toward more interoperable practices under the 21st Century Cures Act, they may notice data limitations with current PACS systems, especially when it comes to artificial intelligence technologies.

As the ONC defined its interoperability standard, it sought to address two workflows: traditional, clinical, human-driven workflows, and modern, machine-driven workflows.

Many existing PACS applications weren’t built to handle the data loads that new imaging technology and interoperability standards require. For example, a typical PACS application is run by a user, and may use 60-70 percent of its capacity. If a clinician’s shift is 6 a.m.-6 p.m., the PACS is busy. But from 6 p.m.-6 a.m., it will go quiet because a clinician isn’t using the application.

As healthcare imaging data continues to expand, there will be a growing need to run applications at greater capacity. Artificial intelligence (AI) algorithms are starting to be applied to imaging applications to address this need, but often cannot be used with traditional PACS.

At Canon Medical, we often say that one AI algorithm works as 1,000 users. This isn’t only because of its capability to work nonstop analyzing data and sharing results. It’s also because of the data loads it requires to transmit, scan and share results.

Organizations who want to take advantage of this technology as part of their interoperability approach will need an imaging platform that supports it. Enterprise imaging’s data orchestration engine brings together patient information from a variety of sources, including AI algorithms, then distributes it to the point-of-care application – all in real time.

Another key capability for imaging platforms to support interoperability is data migration rates. With oftentimes millions of studies stored in a PACS, the ability to access and share this data is essential to interoperability.

Migrating data out of PACS can be a time-consuming effort, while EI platforms have enhanced capabilities for data migration. They often can also manage DICOM and non-DICOM images without additional effort on behalf of staff.

Strategy 3: Ensure your vendors have signed the interoperability pledge to prevent information blocking practices.

One of the foundational elements of the ONC’s work on the 21st Century Cures Act is free and seamless exchange of data among healthcare providers and organizations. To ensure this happens, the new standard prohibits information blocking by vendors and organizations.

Information blocking in healthcare prevents access, exchange and/or use of electronic health information by outside resources. It can happen at the vendor, provider, or network and information exchange level⁵.

The ONC’s Interoperability Pledge is a good place to learn which organizations and vendors have signed a commitment to interoperability and its three core areas:

• Consumer access to electronic health information
• No blocking/ensuring transparency of electronic health information from providers to other providers and patients
• Standards implementation and adopting best practices for interoperability and privacy of electronic health information⁶

By working with partners committed to interoperability, organizations can work to protect themselves from information blocking and other practices that go against the new standard.

Supporting the path to interoperability through imaging solutions

Interoperability requirements will be a driving force of change for healthcare organizations, including how these organizations work with and share information with patients and each other. With the first deadlines being six months after the final 21st Century Cures Act was published, the coming months will be crucial to preparing.

Enterprise imaging is one of the leading technologies to support access to and sharing of medical images, as well as new artificial intelligence algorithms that can change the way images are read.

¹ https://www.healthit.gov/curesrule/overview/oncs-cures-act-final-rule-highlighted-regulatory-dates
² https://www.himss.org/resource-news/cms-finalizes-changes-interoperability-initiatives-and-ehr-incentive-program
³ https://www.healthit.gov/topic/interoperability
⁴ https://www.radiologybusiness.com/topics/imaging-informatics/elusive-economics-enterprise-imaging
⁵ https://www.healthit.gov/curesrule/final-rule-policy/information-blocking
⁶ https://www.healthit.gov/topic/interoperability-pledge