By Karen Appold
Cree Gaskin, MD, University of Virginia Health System
While working closely with the electronic medical record (EMR) vendor during the pre-implementation phase, Cree Gaskin, MD, associate professor of radiology and orthopedic surgery and vice-chair of informatics, University of Virginia Health System, Charlottesville, discovered the potential to improve workflow by synchronizing the EMR with the picture archiving and communication system (PACS). “Still, I had to see it work well before becoming convinced that it was time to move past our existing conventional workflow,” he said. “I began working with synchronized EMR-PACS workflow in our production environment, and it quickly became obvious that it was better than the status quo. We worked out the kinks and people began to recognize the benefits of moving to this new model.”
Benefits Abound
Gaskin believes that there are many advantages to synchronizing PACS with an EMR. First and foremost, it improves workflow efficiency because the synchronization keeps the patient’s electronic chart at the radiologist’s fingertips when interpreting studies—reducing unnecessary manual effort by the radiologist to learn relevant clinical data. In addition, the EMR can be set to display boiled-down, prefiltered data relevant to radiology interpretations—again reducing manual effort and increasing the likelihood that the radiologist is aware of useful clinical information. It also makes referring physicians’ notes about a patient’s condition immediately available. “Ultimately, these benefits lead to improved care, because radiologists are more informed when reading studies,” said Gaskin. “This leads to more relevant and appropriately focused reports.”
Synchronizing PACS with an EMR also improves communication because radiologists are able to highlight a serious diagnosis or unexpected condition in the EMR for the referring provider; this may take place via chart notes, documentation on the problem list, or direct EMR messaging to providers (similar to an e-mail but within the EMR). For example, the radiologist can add a personal note to the report that says, “Heads up—unexpected metastatic disease.” This note is flagged by the EMR as a physician-to-physician note. It will pop up when the referring physician logs on and the radiologist can track when the physician views the note to make sure it has been received.
Another benefit is that it improves centralization of radiologists’ tasks. Radiologists complete many tasks in the EMR, so it makes sense to have them tuned into the EMR. “It makes the workflow more of a one-stop shop for their tasks, rather than it being fragmented,” Gaskin explained. Synchronizing PACS with an EMR also will improve radiologists’ likelihood of meeting federal EMR-meaningful use requirements.
Overcoming Implementation Challenges
In order to synchronize PACS with an EMR, you must use products that can be integrated. The EMR and PACS must be technically able to stay synchronized to maintain patient and exam context between the two applications. Your EMR also must be set up to display filtered and boiled down data, making it relevant to the radiologist’s interpretation. You must identify the data you want pulled down and placed in front of the radiologist.
The University of Virginia Health System’s model for synchronization uses the EMR to drive workflow, rather than conventional PACS-driven workflow. “In this case, overcoming the status quo—or cultural hurdle—can be challenging,” Gaskin said. “You must convince staff that it’s worthwhile to change from something that already seems to work well.”
To overcome synchronization challenges, Gaskin advises choosing vendor integrations that have already been used successfully at other sites. “If you are happy with your existing vendors and they don’t have integration, then engage their teams to design and develop workflow with synchronization,” he advised.
To make the synchronization relevant, radiologists should be involved in describing the patient data they want served up for their image interpretations. For example, for nuclear medicine thyroid studies, you would want recent thyroid lab results on display so that you never need to look them up.
If the integration is smooth and the displayed data have been chosen intelligently, then radiologists will want it when they see it. “You need vision to get the project going, but once it’s established, it will win radiologists over,” said Gaskin.
