By Kurt Woock
The Cleveland Clinic is a sprawling network of health care facilities. As its namesake suggests, many Cleveland Clinic sites can be found in Ohio, but the 92-year-old institution also has locations in Florida and Nevada. Needless to say, effective data management, especially image management, is not optional. Ensuring that images are where physicians need them, when they need them, is essential for Cleveland Clinic to deliver care in such an environment.
Lou Lannum is Cleveland Clinic’s director of enterprise imaging. “We’ve had an image distribution method for years, but it was radiology centric,” he said. “When we purchased Agfa HealthCare as a replacement PACS, we saw added value in the ICIS platform, and not just as an extension of radiology: Now, we can capture imaging from across the imaging specialties.” Those specialties include the many disciplines that generate images, such as ophthalmology and dermatology. Agfa HealthCare’s ICIS unifies imaging data from across regions, facilities, and departments. It creates a longitudinal patient-imaging record by linking imaging data to patient records.
ICIS takes methods developed over time in radiology departments and applies them throughout health care facilities. ICIS allows users to build workflows and associate data and images with that—a no-brainer within the walls of radiology, but not as simple outside its walls. “Radiologists have a RIS that drives their workflow,” Lannum said. “But if you have a digital camera or something else, there’s no inherent workflow.” ICIS changes that. It allows users to upload images and integrates them into the EMR, infusing it with meta-data from the patient record along the way.
Lannum said that when the radiology department decided to replace its legacy PACS system, they saw in ICIS the potential to revamp imaging on a larger scale. They even revamped the way they talk about image storage. “We don’t refer to it as a VNA [vendor neutral archive] anymore,” Lannum said. “We refer to it as a clinical imaging library. It’s more than storage.” Lannum said that the radiology department was quick to embrace the new system. “At the same time, we developed a strategy to bring in images beyond radiology,” he said. “And as we brought more images into that core and made them available to physicians through the EMR, I didn’t have to sell the project as much. Everyone wanted to have access to the images they were collecting.”
ICIS has helped advance multiple fronts at Cleveland Clinic, including Meaningful Use. “We believe the imaging piece completes the EMR,” Lannum said. “That was a primary driver for us. We’re able to associate clinical content with the visualization, regardless of source. All of a sudden, we are storing images, which were taken in silos, and integrating them within a larger EMR project.”
The clinic is still in the process of acquiring images from its myriad departments. The radiology department is the largest contributor of images, with approximately 2 million studies per year, but “there’s an awful lot of imaging going outside of radiology,” according to Lannum. Getting everyone uploaded and online will take a while. Facilities that use ICIS can add modules for enhanced capability. One such module, the result of a collaboration between Agfa HealthCare and Orion Health, will give patient access to the images.
A comprehensive imaging solution, ICIS signifies a shift from a world of data dumping to a data-driven world. When surrounded by clinical context and embedded in a clear workflow, the images, though themselves unchanged, transform from a record to a tool. “It’s all about providing access to patient results across a continuum of care,” Lannum said. “We believe that the image is part of that strategy.”