By Aine Cryts
Michael Minear, CIO, University of California Davis Health System
The value of image sharing is directly linked to improving patient outcomes. Image sharing matters because it allows clinicians to coordinate care for patients, especially as they get older and need access to a larger care team, says Michael Minear, chief information officer at University of California Davis Health System. Because of his team’s work, clinicians throughout the health system and its 3,700 community physicians have access to patients’ radiology images.
AXIS recently discussed image sharing strategies with Minear.
AXIS: What is your health system’s approach to sharing images with clinicians and physician practices?
Minear: University of California Davis Health System has a culture and history of fully sharing images. We have three imaging systems connected to our Epic EHR; these include PACS systems for radiology, ophthalmology, and endoscopy. Image sharing is based on role, so that physicians will have more access to images than a clerk does, but there are no barriers to image access for clinicians in the inpatient or outpatient setting. We also provide read-only access to patients’ images via our radiology PACS to the 3,700 community physicians who refer to our hospital.
AXIS: How does it work, technically speaking?
Minear: We don’t move the image. It would spend too much time on the network, and it would cost too much money to have copies of our major PACS systems.
We leave the clinical images in the PACS. In fact, we might have been the first in the country to link an endoscope PACS with an EHR. Here’s how that works: When we do an endoscope image, the patient’s record is already in the Epic EHR. Because of the interface between the EHR and the endoscope PACS, we have admitting data that goes into the EHR in the form of an order. That’s very important because when we have an ENT encounter in a clinic, we create by default an endoscope imaging order. We know that most of those encounters will have an endoscope image. It could be full-motion video or still images.
Behind the scenes, we link that patient record of an endoscope image—it’s not DICOM—and we have an inherent link between not only the systems but also that patient encounter. When you’re in Epic, within seconds that patient record has a thumbnail of the image. The clinician clicks on the thumbnail and, within microseconds, the EHR screen is replaced with a screen from the imaging system.
We have a great interface team of about 20 people. We also have a clinical imaging team who has the technical depth to do this in partnership with our interface team.
AXIS: What advice do you have for community hospitals?
Minear: A lot of our community partners have PACS systems. I’ve really seen a change over the last 5 or 6 years in that even small community hospitals have PACS. They do a pretty good job of deploying and managing it from a technical perspective, but they typically don’t have the technicians to do that interface with the EHR.
A number of small hospitals across the country are looking for partners like a large hospital or an academic medical center that has Epic or Cerner. These community hospitals are asking larger hospitals to host their EHR. In our case, we’re looking at hosting the EHR for a partnering healthcare organization. As we’re figuring out how that will work and how much that will cost, we have to make decisions: Will they use their local PACS? And will we interface to it with our Epic EHR? Will they use our PACS? Those decisions will be challenging and unique for every community partner.
One might argue that with all the regulations and security requirements, there will be a number of smaller providers that won’t be able to keep up and afford that IT infrastructure. One of the reasons they might choose to partner with a larger hospital is literally the cost and the support needed for IT.
AXIS: Does University of California Davis Health System provide patients with access to their images via your patient portal?
Minear: We don’t, unfortunately, and I think that’s pretty common today. But we will pretty soon. We have 107,000 patients accessing the patient portal provided by Epic, and we’re hoping that Epic will develop that functionality. But we’re also looking at other software options.
AXIS: Why is image sharing worth it?
Minear: It depends on the patient. Younger people who are healthy don’t really care. It’s people with chronic illnesses, regardless of their age, and older people who care about this. As we age, we tend to have more doctors and more clinical problems requiring access to care.
I’ve had this experience in my life with an older relative where he was transitioned from one care provider to the next and the clinical data didn’t follow. Often, patients have to re-do tests that are painful or uncomfortable. Costs are higher because of that repeated information. And all of this leads to slowing things down. If data isn’t shared with the next care provider, it might take longer to provide a diagnosis or treatment.
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About Michael Minear:
Michael Minear, a 37-year veteran of the healthcare industry, serves as the chief information officer of the University of California Davis Health System. Minear leads an IT division with a 400-member staff and an annual operating budget of $105 million.
He has a master’s of science degree in medical informatics from Northwestern University, a bachelor of business administration degree from the University of Iowa, and a graduate certificate in biomedical informatics from Oregon Health and Science University’s School of Medicine.
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