Image-Enabling Your HIE: Why Now?

The first decade of health information exchanges (HIEs) was dedicated to the nuts and bolts of start-up, connectivity, integration, standards and sustainability—and getting users onboard. Today we are starting to reap the benefits with these data rich networks continually improving access to patient information. And there’s a new trend, too, linking physicians with images via a universal viewer. It’s time to take a look.

The Delaware Health Information Network (DHIN) is an HIE pioneer. As the first statewide HIE to go live in May 2007, DHIN today links lab results, immunization reporting, hospital in-patient summaries and 17 EMRs (and counting) at all the acute care hospitals in the state and most of the providers. Some 14 million deliveries of medical results and reports are made through DHIN each year—but images needed to be added too, says CIO Mark Jacobs. “We are the Post Office for delivery and receipt of information from healthcare providers across Delaware. That communication wasn’t complete without images.” 

DHIN’s search for an image-enabled electronic health record started with an extensive look at technologies and vendor options. The team focused on universal viewers and vendor neutral archives. Robustness of technology, widespread and practical integration know-how and ease of access and training for physicians and hospitals were essential needs. The VitreaView universal viewer from Vital Images emerged as the clear choice. The viewer supports multimodality image access to DICOM images, allowing permissioned physicians to query patient and radiology results from anywhere. Secure links to images are embedded in the radiology report. An imbedded URL launches the viewer, with most users viewing images via a secure Community Community Health Record or launched through their EMR.  

Written radiology reports have been available through DHIN’s community health record since the health information exchange launched over six years ago; but before adding universal viewer access, the image had to be physically delivered or mailed to a physician’s office from the hospital. In the future, this technology can be expanded to include information such as: photographs for pre-hospital visit assessments, dermatology consults and to provide warning to the emergency department what is coming their way.

“Offering images and results [reports] is what I believe is another pillar of interoperability and a new community offering in HIEs today,” Jacobs says. “The strength of our community health record is the depth of the care information we provide to so many providers for so many patients. It is no longer a matter of if you will share images, but when and what. It is more affordable, secure and more efficient to facilitate image exchange within an HIE to a community. We made our choice after a lot of due diligence into Vital’s technology, ease of use, and their reputation, experience, prior knowledge and ability to execute in a timely matter. They knew how to deploy the viewer, came in and did it. We were up and running with low impact on the image provider and the HIE. They know the IT, imaging solutions and how to bridge with the imaging vendors. They worked with the hospitals to get everyone connected and working.”

To the physicians, Jacobs says images add to the completeness of the report when available side-by-side. Images add to patients’ understanding when they can see what the report really means.  This can help the patient in decision making with the provider or specialist.  When the patient perceives what the specialist is talking about, he or she is happier.  Images complete that picture in many cases, helping physicians decide if they need to order another imaging exam to get additional information or if they can avoid a repeat exam. Physicians also don’t have to rely on a patient’s memory if he or she has had an image or where it is housed as images in the exchange now follow the patient. Better communication is another benefit, with physicians broadening their access to consult with radiologists and other specialists while viewing images.

Patients benefit, too. “Using a prior image and one taken during the current care experience can be powerful in bridging the relationship between the patient and physician and can really impact care,” Jacobs notes. “Patients become empowered and participants in their road to better health.” Overall, transitions of care are more informed and effective as well.

On the IT side, choosing a standard universal viewer simplifies image viewing. Images are linked via the EMR for viewing on familiar screens. There is no need for additional browsers or software. There are no security or HIPAA issues and no need to transfer images on CDs—along with all the problems, malfunctions and delays they bring. IT support of physicians and DHIN facilities is also minimized since access is automatic (once set up) and training is easy. “We see the HIE can offer images and reports—as a form of disaster recovery plan to leverage if the EMR is unavailable,” Jacobs adds.

Getting started

In a snapshot, DHIN launched into the image-enabled EMR project with a deep look at technology options—ultimately choosing a universal viewer. Simultaneous to working to set up the universal viewer, Jacobs and DHIN staffers began promoting the benefits of deploying the viewer to key stakeholders in the community. They also sought guidance on issues such as how long images would be available. “It was a new frontier for the hospitals to allow an HIE to work with their PACS to open up image access,” he says. “We needed to convince them we made the right choice in a vendor with a high level of respect and knowledge in the market to pull this project off. Neither the doctors nor the hospitals had extra resources to make this happen. It was Vital’s job to connect those very important assets, both PACS and modalities.” 

So why take a closer look at a universal viewer now? “An image-enabled electronic health record can enhance healthcare by providing the tools physicians need,” Jacobs says. He recommends not setting the target too far into the future, instead define a vision that works to solve a use-case today. The vision needs to combine viewing results and images to blend and strengthen the relationship of care among physicians and between physicians and patients.

“This is how healthcare will get better,” he says. “Access and value build loyalty to physicians and community care, strengthening the local business of healthcare. Access to data and images needs to be universal—and the universal viewer makes that happen.”