Managing the Flow in Radiology
Surveys Show Paper Legacy Tough to Shake
by Cat Vasko
A series of recent member surveys conducted by the College of Healthcare Information Management Executives (CHIME), Ann Arbor, Mich, show that, while hospitals are implementing and using electronic medical records (EMRs), more than 50% continue to print and distribute paper lab and imaging reports. The most recent of these, taken in May, indicates that the goal of paperless medical records is still a far-off dream.
“We asked questions like, does your organization have an EMR? Do you still print and distribute lab results for the physicians’ offices? Do you still print imaging reports?” explained Suzy Marzano, director of education at CHIME. “And then we asked for comments on the report distribution process.”
In analyzing the survey results, Marzano found that 59% of respondents continue to print and distribute laboratory results despite having implemented an EMR; 54% said they also print and distribute imaging reports, and 55% print and distribute paper HIM reports.
“We were really surprised to see that more than half of them are still printing,” Marzano said. “A lot of doctors’ offices really aren’t up to speed with regard to technology. A lot of them need printed reports because they just don’t have an electronic system. It’s futile trying to wean them off if they don’t even have the technology. And then we have some comments along the lines of ‘old habits die hard, and this is how we’ve always done things.’ So you can put a system in place, but you still have to change the work process.”
A new Stark exception allows hospitals to donate health information technology in the form of an EMR to private physicians. But another CHIME survey shows that very few hospitals are taking advantage of this safe harbor; 62% of hospital executives surveyed in February said their organization had no plans to donate technology.
“They’re waiting to see how the government changes the landscape,” Marzano said. “How will it affect their nonprofit standing, that kind of thing. Furthermore, the doctors’ offices still have to come up with a large percentage of the cost, and sometimes they don’t have the funds to make it work.”
Comments on the Stark survey reveal the executives’ insecurities. One respondent wrote, “Among other concerns, we fear that with the change in Congress, the relaxation of Stark will be reversed.” Another noted, “We feel that the physicians are using the safe harbor to get pretty much free services from as many hospitals as possible, without any real intention of utilizing what is provided . . . therefore we are not biting into this yet.”
That uncertainty is reflected in the comments respondents offered during the May survey. “The EMR contains all imaging reports, but most offices still maintain paper files and those that have an EHR don’t interface with our HIS,” noted one respondent. Another said, “Trying to wean them off. Old school docs still want them faxed.”
The data paint a clear picture: getting the physicians’ offices to change their ways is key. “Obviously money is the big issue for both hospitals and doctors’ offices,” Marzano said. “But they have to get the doctors’ offices to adopt the technology. That’s the challenge.”
Tech Zoom: NovaRIS 6.2
by Cat Vasko
New from NovaRad Corp, American Fork, Utah, is the latest version of its Web-based open standards RIS. NovaRIS 6.2 generates reports, measures profitability, and facilitates paperless management of patient records, with the ability to filter workflow by modality and launch dictation from workflow.
“Radiology departments no longer need to struggle with PACS and RIS integration issues,” said Paul Shumway, senior vice president at NovaRad. “They can realize NovaRIS and our KLAS top-rated PACS are built on the same platform, meaning that integration is effortless. And because the platform is based on open standards, NovaRIS can easily be integrated with third-party PACS as well.”
Additional NovaRIS features include automated distribution of reports through e-mail, phone, or fax with receipt verification; customizable menus by user; electronic signature for radiologists; audit trail; seamless integration with NovaPACS or other third-party PACS or HIS systems; and workflow tracker.
NovaRIS also contains specialized worklists and reports for stalled and cancelled procedures.
St Elizabeth’s Finds Right Solution for Archiving and Disaster Recovery
by Renee Diiulio
Storage space is always an issue, whether talking about shoes in a closet, tools in a garage, or files on a server. In medicine, however, items cannot be thrown away or donated to Goodwill—or even stored in the corner of a basement behind some boxes filled with other stuff. In medicine, files must be secure but accessible, and often available for a number of years.
This is particularly true of images, which feature data physicians use to judge results and decide on future courses of treatment. HIPAA requires these images to be safe—not only from human hackers but from natural disasters as well. Facilities must develop storage and disaster recovery plans that work within the guidelines they are subject to; state laws can require additional requirements to those of HIPAA and accrediting organizations.
St Elizabeth’s Regional Medical Center in Lincoln, Neb, began to seek a solution to its storage challenges 2 years after the implementation of its PACS system. The hospital performs more than 160,000 studies a year, and Steve Gerdes, the hospital’s PACS/RIS administrator, was becoming concerned about remaining PACS capacity: the files generated by multislice CT, MRI, and full-field digital mammography were large. The system also supported CR, DR, ultrasound, nuclear medicine, CT, PET/CT, MRI, mammography, and special procedures/interventional angiography.
The hospital wanted to implement a solution that would provide additional storage in addition to disaster recovery services, and selected InDex (Internet DICOM Express) NearLine from InSiteOne, Inc, Wallingford, Conn.
The system’s open architecture integrates with any DICOM-compliant PACS and provides on-demand access to images residing locally or at a storage facility linked through the Internet or a VPN (virtual private network). At St Elizabeth’s, images can be accessed in less than 1 minute and prior images are automatically loaded after a patient checks in (but before they are prepped).
For the first 60 days, images are archived in three places: the PACS, the NearLine server, and two remote sites for disaster recovery. The hospital wanted 60 days of images on the site due to concerns about transmission speeds, according to Gerdes.
Fees are charged on a per-use basis, resulting in a less expensive option than the addition of an archive solution. According to Mike Hopkins, the hospital’s radiology director, the department has been able to conserve capital dollars, reinvesting them in new technologies rather than hardware upgrades and image management. Since the NearLine service has been implemented, the department has added 64-slice CT, 3.0T MRI, and image-guided radiation therapy (IGRT).
The impact on patient care has, therefore, been positive. In addition to the new services, physicians are able to retrieve images quickly from remote locations, creating greater efficiencies.
InSiteOne has announced enhancements to the InDex Archive technology that will increase the system’s response capacity and expand online data management to further improve performance and ultimately patient care. These include larger core memory configurations, new database reporting capability, new service configurations, and a 64-bit server processor Linux platform, modifications intended to help facilities save even more time and money.
eHGT and PIMS Partner on MedicKey
by Cat Vasko
A new partnership between eHealth Global Technologies Inc (eHGT), Rochester, NY, and Portable Information Management Systems Inc (PIMS), Ventura, Calif, will bring together both companies’ assets to enhance a new product from PIMS, the MedicKey personal health record. Under the terms of the deal, PIMS will provide eHGT’s eRetriever service to customers who purchase a MedicKey; in return, eHGT will promote MedicKey with its clinical institution customers.
The eRetriever service will help MedicKey customers collect their medical records, after which eHGT will populate their personal data on their MedicKey device, including scanned-in documents and medical images. This service simplifies the process of obtaining a customer’s relevant health information, while making it easy for their care providers to access. The MedicKey is a password-protected USB storage device.
“While the MedicKey Personal Health Record device is created to be simple for the consumer, we recognize that many people may not have the capability of collecting and adding all of the information and images they would like, or simply wish to have another party do it for them,” said Michael Bick, MD, CEO of PIMS. “This partnership with eHealth Global provides a means for all consumers to have their critical health information with them, whenever and wherever needed.”
In addition to initially providing the eRetriever service, eHGT will securely and privately archive copies of customers’ MedicKey data, so if a key is lost, a replacement can be easily supplied. Customers can also subscribe to eHGT’s services on a monthly basis, allowing the company to collect and update their MedicKey with any new medical reports, tests, or images.
“eHealth Global is excited to work with PIMS and the unique MedicKey product,” said Ken Rosenfeld, president of eHGT. “We hope to make it even easier for patients to take advantage of this technology, by helping them with the time-consuming and frustrating process of collecting their existing medical records. The end result for health care providers is more valuable information about that patient so they can make the most informed and confident decision regarding patient care.”
MedicKeys with eRetriever service are available now.