PACS in the Cloud – Clinical Care Revolution or Revolt?
For clinical users, PACS in the Cloud can mean nearly instant access to full diagnostic quality medical images, regardless of the location of the user. This revolutionary evolution in clinical practice, while providing many positives, is not without a few negatives. Are the negatives sufficient to cause a revolt in the Cloud?
Pluses of PACS in the Cloud
Arguably, with the right Vendor-neutral product, PACS in the Cloud delivers high quality managed PACS service. In fact, today, most disruptions in PACS service are reported with locally installed PACS (hospital-based hardware and software), not with Cloud PACS. This is likely because a Cloud PACS has all its hardware and software running in a highly secure, fully-managed, resilient dual-data center, resulting in a more reliable, high performing system that better serves multiple hospitals and varying clinical needs.
The IT advantages of cloud PACS are abundantly clear: less hardware and software across multiple clinical settings means fewer mechanics to break and less software to crash. Cloud PACS resides in the vendor’s data center, where configuration and updates are managed by the vendor’s staff, normally following a tightly controlled schedule of testing and procedures. Co-located redundant systems virtually eliminate catastrophic failure due to unplanned disasters.
With a vendor-neutral cloud PACS system, hospitals use a single, virtual location for storing diagnostic imaging, enabling clinicians to access a single patient record, no matter what department they are in. This consolidation of patient records and images provides and a more consistent patient experience throughout the clinic or hospital setting, even including remote hospitals that may not be part of the same system. With permission based access, the hospital or the patient can provide a secure link that enables any authorized clinician to view the patient records from any location.
By using a web accessible cloud PACS system, clinicians from different geographic locations and hospital sites can access the same patient images without waiting for physical file transfer, which can take days. This provides exceptional care in urgent cases, such as stroke or major trauma, even enabling specialist radiologists from other hospitals and areas to confer at anytime from anywhere.
Negatives of PACS in the Cloud
Cloud computing can be seen to have some disadvantages, one being that, over time, the total cost of ownership (monthly subscription charges) may exceed that of PACS. Usually, however, when comparing the two, if one factors in all of the costs of hardware and software maintenance and upgrades for the life of the system, along with the maintenance and management of a data center and IT personnel, as well as compliance initiatives, backup and disaster recovery requirements, it is found that at worst case scenario, the costs for the same period are equal, and the convenience is ten-fold.
Cloud computing may make the clinic or hospital totally dependent upon the stability of the local Internet connection. In today’s internet-connected society, this is normally an issue only in very remote or rural locations. Generally, ensuring that your site's telecommunications service (wide area network [WAN]) provider offers adequate redundancy will be more important.
The question of who owns the data and how you retrieve it if you switch vendors or the vendor goes belly-up can be tricky when you don't physically possess the media or the means to read it. This is a showstopper for larger sites, where PACS-to-PACS transfer of image data can take years, but smaller sites must consider contractual language that offers a real, practical solution to this scenario.
Bottom Line: Revolution
We don’t think any hospital or clinic will revolt against the Cloud. From a clinician’s point of view, cloud-based systems make accessing images faster and easier, and can be accessed where and when they are needed. From a patient’s point of view, better care, provided more quickly, particularly in urgent situations gives the Cloud a thumbs-up. With reduced infrastructure costs, a smaller on-site hardware and software footprint, resilience against systems failure, enhanced operation efficiency and faster implementation, the Cloud PACS revolution has just begun.
Manage Medical Images Online
In today’s healthcare, medical imaging plays a big part in the diagnosis and treatment of many different diseases and injuries. With tests including x-rays, ultrasound, MRI, nuclear medicine scans, CT and Pet scans and others being used to determine what’s happening inside the body, physicians are able to correctly diagnose and treat many conditions more quickly and more accurately, leading to more positive outcomes.
As medical imaging has become a de rigueur fact of healthcare, one unanticipated result has been the corresponding increase in the amounts and types of data that require storage. Even twenty years ago, the huge files that are created by medical imaging tests were unthinkable. But as technology has advanced to provide ever-clearer and more detailed pictures of the body these sophisticated image files have become larger and larger, comprised of thousands of slices and hundreds of megabytes of data per test. Twenty years ago very few people talked about the need for terabytes of storage but with files of these magnitudes in both size and number, a terabyte is really quite small.
This growing volume of data has led to a growing number of data management problems. No matter how accurate and useful the medical imaging tests and data are, the information compiled in those tests has to be organized and readily accessible in order to be meaningful. The fact of the matter is that in today’s healthcare organizations, the volume of information is simply too large for any one person or system to manage, especially in the high-volume fields of medical imaging.
This need to address the storage and access of medical images has grown at nearly the same pace as the concept of Cloud technology. Cloud technology has shifted the paradigm for both storage and access of medical imagery as well as for healthcare delivery as a whole. Beginning with the push to transfer paper medical records to electronic medical records and moving into Stage 2 Meaningful Use, which includes the option to include medical imagery in EMR, the ubiquitous Cloud has been heralded as a simpler, easier, more cost effective tool.
While medical images are often stored, viewed and managed on separate PACs systems, when viewed as an extension of the EMR, these images are simply another form of clinical content, and all this clinical content can benefit from Cloud technology:
· General EMR Storage and Access
EMR storage and access is a perfect fit for the cloud and there are a number of ways that files can be stored there. First, you can use one of the companies that specialize in EMR in the cloud. These allow physicians to pay a monthly subscription fee to access their EMR rather than having to purchase it. That means not having to buy an expensive server for your practice with its associated hardware and software; all you need is a computer with an Internet connection.
Rather than being stored on a single server, your EMR information may be stored across a network of data storage centers and in no one particular place at any time, i.e., in the “cloud.”
Or, you can take a more traditional client-based approach, while still making use of the Cloud. In this approach, you install an appliance in your data center, which acts as a file server. However, when you save files to it, they are saved to the appliance vendor's cloud service. The appliance acts as another file server. It caches files locally and syncs them with the cloud service as needed.
Generally cloud-based EMRs are less expensive to set up, but client-based systems may have a better long-term ROI. The problem is that it usually takes about five years to break even, and with rapidly changing technology, after five years, you may need to upgrade and update. Cloud based subscription services are always current, and updates/upgrades are part of the subscription price
· Big Data – Like Medical Images
Big data and the cloud go hand in hand. Most healthcare organizations can't afford the cost of building a complete big data analytics environment. So, many of them push the heavy lifting to cloud providers and just download the results. In this way, the organization gets the best of both worlds -- local and fast to work with data, but massive capacity to store and access, with the added advantage of being able to share the data with a secure link and login with any other physician or healthcare organization anywhere in the world. .
These kinds of medical imaging cloud systems play a key role in completing the electronic medical record (EMR) by integrating and incorporating the vast amount of medical imagery information and attendant reports that are not otherwise captured by the EMR. A cloud vendor-neutral solution that is accessed by a single log-in to the EMR provides integration of medical images in a way that most physicians and clinicians view as a seamless part of the EMR. They are unaware that this important medical imaging information is actually being captured and displayed by an independent
Cloud solution. This can even include access to content which has been converted or archived from legacy picture archiving and communication systems (PACS), EMR and practice management systems.
This, “anytime, anywhere” access usually proves to aid in compliance, improve operational efficiencies and patient outcomes, while also increasing profitability.
The Five Essentials of an Enterprise Medical Imaging Repository
Over the past few years, the practice of healthcare has moved into electronic record keeping. Most modern practices today either have an EMR system in place or have plans to convert to EMR in the near future. The goal of this move to electronic data is increased access to patient medical records and better patient care.
All best intentions aside, many healthcare practices have neglected an important aspect necessary for a comprehensive EMR – medical images.
Defining the Terms
When discussing electronic medical data, it’s important to have a basic understanding of the many terms that you will encounter:
CIS – Clinical Information System is often the entry point to patient records. Generally a CIS provides an array of integrated, patient-centric applications that enable the ordering and scheduling of tests and procedures, patient documentation and reporting functions. The CIS manages the healthcare organization’s workflow.
EMR – Electronic Medical Records houses all of the data that is required to create a time line of medical data for patients. An EMR contains not only current records, but also past records to provide a longitudinal reference for each patient.
DMS – Data Management System manages and controls paper –based processes. It provides capabilities such as revision control, and information such as author, document type, check-in/check-out procedures and permissions. The one thing that all of these systems have in common is that they are generally deployed enterprise-wide. However, medical imaging information such as diagnostic images, reports, x-rays, CRTs, MRIs, etc are usually deployed and stored department-by-department. The need, then, is for an EMR solution that provides a Medical Imaging Repository and Visualization as a core enterprise service, bringing your long-term patient imaging records out of individual department managed systems into the IT enterprise with your CIS and EMR.
Bridging the Medical Imaging Departmental Divide
First, let’s address the perceived barriers to including medical imagery in the CIS/EMR
Perceived Barrier #1: Medical images are too large to manage. In truth, DICOM images make interoperability possible and secure cloud technologies make storage and access of large files both fast and easy.
Perceived Barrier #2: Viewing medical images requires time-consuming downloads and raises privacy concerns. Actually, today’s zero-footprint viewers and an Internet-accessible cloud provide browser-speed viewing with no download. A software-as-a-service (SaaS) solution offers a Cloud application that replaces the need for expensive PACS equipment.
Perceived Barrier #3: Physicians need to see only the written report. Physicians have lived with only written reports in the past, because of the difficulties of providing film reports. But, in the digital age, physicians prefer to have the image as context to support the written report.
So, just what do healthcare organizations need to do in order to create a Medical Imaging Repository that not only stores the images, but enables access via a single sign-in to the CIS or EMR, and provides the ability to view quickly, easily and securely from any location?
Medical Imaging Repository Essentials:
Capturing the images – Capturing the images and integrating them into a Central Image Repository that effectively serves all departments can be a challenge. This is where an expert scanning and capture service can help to accurately and efficiently the best methods for performing the image capture and integration. The best solution will provide a broad array of departmental level services and create a method for capturing sufficient information to meet each department’s needs. Some processes that may need to be included are: (1) Web-based order scheduling and dispatch; (2) requisition forms; (3) transcription; (4) patient reports; (5) DICOM images; (6) claim billing selection; (7) pps invoicing; (8) reports.
Storing the images – Key capabilities for storing your medical images include availability, scalability and security. Images must be available 24/7 from any location that has an Internet connection. The system must be rapidly scalable, both up and down as needs change, and billing must reflect the current scale. It must also provide you with business continuity in the event of disaster or interruption; this is most often achieved via redundant server configurations.
Exchanging the images – The Medical Imaging Repository solution you choose should not only capture and store your imaging information, but it should also make it easy to share imaging information with all authorized caregivers and even the patients themselves. Both patients and caregivers should be able to view the images from any device.
Accessing the images –Arguably the most important aspect of a Medical Imaging Repository is the accessibility of the images. All users must have access to the complete patient imaging record at all times, from all Internet connections and locations, regardless of how many users and images there are. This universal access for all users provides long-term continuity in patient care.
Vendor Neutrality – Nearly as important as image access, is the ability to use the Medical Image Repository with all kinds of images and all brands of EMR/CIS. Included under vendor neutrality is the requirement to eliminate the need for plug-ins, downloads or additional equipment, along with the ability to seamlessly integrate into any EMR/CIS with a single log-in.
Look for a Medical Imaging Repository that provides a viewing technology far beyond the typical PACS. Make use of cloud technology and zero-footprint technologies to provide a cost effective enterprise medical image viewer across all departments with a single login to your EMR/CIS system.
Choosing the right system can provide improved patient care, expanded points of access for both referring and consulting physicians, and rapid ROI for you healthcare organization.
Can A Medical Cloud Improve Your Clinic?
The Cloud continues to evolve, invoking new technologies and benefits while reigniting discussions about issues and risks. One thing is certain…the Cloud is here to stay. More communications will take place in the Cloud; more services will be provided via the cloud; more models, more ecosystems, more vendors. The Cloud will continue to grow.
The reason that the Cloud has become so ubiquitous is because it is “a model that enables convenient, on demand network access to a shared pool of configurable computing resources (e.g., networks, servers, storage, applications, and services) that can be rapidly provisioned and released with minimal management effort or service provider interaction.” (Definition courtesy of NIST)
The Medical Cloud
Initially, the medical community was slow to adopt cloud computing, being more focused on the perceived risks of unauthorized access, lack of security and HIPAA violations than on the possible benefits. Perhaps because the practice of most medicine is based on cautious approaches, it is not surprising that the medical community as a whole maintained this air of caution when initially approaching cloud computing. However, as time has gone out, it appears that the benefits to be gained in both patient care and clinical efficiencies have far outstripped the initial cautious approach. Aided by the Federal government’s push and financial rewards for electronic medical record adoption, the medical community as a whole appears to be adopting some form of cloud technology.
Today, cloud computing is more than just a passing technology trend. It's the current and future means for conducting business around the world, whether your business is retail sales or health care.
A medical cloud is more than just subscription based software that can be accessed via the internet. A medical cloud is an extension of physician services that escalates the quality of healthcare and improves patient satisfaction and patient outcomes. By harnessing software, knowledge and service across geographic boundaries, a cloud based system can improve the scope of your health care organization and enable it to thrive even in tight economic environments. With high level security protocols, today’s medical cloud systems are proving to be more secure than paper-based systems.
The Power of a Medical Cloud
Understanding of the cloud in health care varies. A physician's exposure may be limited to knowing how to use his office’s electronic medical records system. A hospital CIO may have more direct exposure to the workings of the cloud as a cost-effective technology that can replace aging legacy systems. He is aware of the original cost of that legacy system and how much it will cost to replace it with a similar infrastructure vs. adopting a cloud infrastructure going forward. A medical visionary will see the cloud not only in terms of office efficiency and hospital savings, but also in terms of caring for people. The cloud extends the medical arm further and in more directions to encompass better health care for more people. Consider the rural clinic that can use the cloud to share medical images with an urban specialist who can aid in the diagnosis of a sick child. This is where the true power of the medical cloud hits home. A medical cloud enables remote physicians to work with content that's available at a shared online location, providing quicker diagnosis and treatment; faster second opinions and consultations. When time is of the essence the cloud beats all other forms of communication.
Unlike conventional ways to manage medical records and medical imagery, the cloud enables on-demand self-service to any authorized user, much as your online banking service allows you to check your balance at any time of the day or night, even from your smart phone. Because access is location independent—medical personnel can access patient files from any standard device, like a PC or tablet, no matter their locations.
From a business perspective, a medical cloud brings these benefits:
- System upgrades can be made and applied across the network on one instance of software
- Broad network access with availability ensured via redundant servers and disaster recovery methods built into the system
- Shared resources enable many to use the network at one time, accessing the same records and images
- Rapid scalability means that a cloud-based network can easily accommodate, and respond to, a rapid increase in the number of users as well as spikes in demand
- Subscription service based on use –a provider of medical cloud services measures and bills service in the same way as an energy utility does, by amount used on a month to month basis. This is called a SaaS/Cloud.
For the health care industry, this SaaS/Cloud model provides marked advantages over in-house IT systems. This model can easily support a nationwide provider database for health care needs like orders, referrals, billings, etc. It can also act as a single communications connection to multitudes of physicians, insurance agencies, hospitals, and pharmacies.
With little or no up-front investment and improved patient outcomes, a medical cloud just makes sense.
Connecting Radiologists in the Cloud
The Cloud allows radiologists to store, share and connect more easily than ever before. Since radiologists work with large images such as CT scans and X-Rays, the ability to store and share images on a cloud-based system can maximize efficiencies. Newer medical devices often generate complex imagery with very large file sizes. The Cloud provides a platform that is capable of supporting very large image files. This is just one of the benefits radiologists can expect when they adopt the Cloud.
With the Cloud comes the ability to quickly share exams and reports with other healthcare facilities, even if the files are very large. Just as radiology has improved patient care, the Cloud improves patient care by allowing radiologists to provide services without actually having to be at the location of the patient.
Whether the radiologist needs to share exams and reports with other healthcare facilities, distribute radiology records to patients digitally, view patient images and reports prior to a patient’s appointment, or request a second opinions from radiologists or subspecialists in a specific network or a different location entirely, the Cloud enables better medical care via 24/7 access.
In addition to the efficiencies that the Cloud provides on the provider side, it also adds control on the patient side. With more patients taking charge of their health via personal health records, the Cloud is fast becoming a necessity. In the medicine today, as in so many other industries, Cloud computing is no longer a luxury -- it’s a prerequisite for optimal service.
What should radiologists look for in a Cloud service?
As more radiology companies warm to the idea of leveraging Cloud computing, Cloud providers have begun to proliferate. With this larger scale availability and advances in the healthcare industry it’s important for radiologists to choose a Cloud provider that can provide the greatest efficiencies, savings, and patient care.
HIPAA Compliance is a must! The HIPAA Privacy Rule requires establishing and implementing measures that ensure confidentiality, integrity and availability of all Protected Health Information (PHI), while the Security Rule addresses safeguards specific to security of electronic data. Health plans, healthcare clearinghouses, healthcare providers, business associates to whom they provide health information must all comply. This also means that any third-party partners and associates be compliant as well. So, it is fundamentally important when choosing a Cloud provider to ensure that this partner understands all of the issues that enable you to maintain HIPAA compliance.
Benefits of Cloud Computing for Radiology
With no capital equipment to purchase, no software to download and a zero footprint, even small medical centers can benefit from Cloud based technologies. Using a robust Medical Imaging cloud provides image archiving and communications through a full array of advanced visualization tools for digital images. Because it's in the cloud, or web-based, it's accessible anywhere, anytime as long as the authorized user has an internet connection.
Radiology Services Online is an example of a SaaS/Cloud solution that supports the display and maneuvering of medical images in full diagnostic resolution on any Internet-enabled PC or mobile digital device. This cloud solution hosts and manages data and images via the web providing primary, secondary and disaster recovery storage solutions that are scalable to any user's needs.
Today’s medical environment demands efficient and cost-effective workflow providing access throughout healthcare to be able to make more informed patient care choices. Radiology Services Online offers a unique digital imaging turnkey solution for all modalities with a modest “per use” fee structure. A full suite of imagine interpretation, management and billing tools allow faster and more accurate diagnosis.
HIPAA 2014 – Are You Ready to Be Audited?
With numerous HIPAA breaches having come to light in the past year, Federal regulators are revitalizing the HIPAA audit program. The audits will be narrower in scope than the original 115 audits done in the 2012 pilot program, but the narrower scope means that there will be a larger number of organizations that will be audited. The audits will be performed by the Department of Health and Human Services' Office for Civil Rights (OCR).
Beginning in 2014, HIPAA audits are part of a permanent program, and will include not only the covered entities, but also business associates of covered entities, because they're liable for HIPAA compliance under the HIPAA Omnibus Rule. Business associates include contractors and subcontractors and others working with the covered entitiy. It is reported that some of the largest breaches reported to HHS have involved business associates. Penalties are increased for noncompliance based on the level of negligence with a maximum penalty of $1.5 million per violation.
HIPAA Omnibus Rule
The HIPAA Omnibus Rule implements a number of provisions of the Health Information Technology for Economic and Clinical Health (HITECH) Act, enacted as part of the American Recovery and Reinvestment Act of 2009, to strengthen the privacy and security protections for health information established under the Health Insurance Portability and Accountability Act of 1996 (HIPAA).
The goal of this new rule making and tweaking of older rules is to provide the public with increased protection and control of personal health information. Individual rights are expanded in important ways. Patients can ask for a copy of their electronic medical record in an electronic form. When individuals pay by cash they can instruct their provider not to share information about their treatment with their health plan. The final omnibus rule sets new limits on how information is used and disclosed for marketing and fundraising purposes and prohibits the sale of individuals’ health information without their permission.
HHS Office for Civil Rights Director Leon Rodriguez is reported to have said that these are “the most sweeping changes to the HIPAA Privacy and Security Rules since they were first implemented.”
In addition to vigorously supporting patient’s rights to privacy protection, the new changes also give additional enforcement abilities to OCR, regardless of whether the health information is held by a health provider, a health plan or one of their contractors or business associates.
A major weakness found during the pilot audit program, as well as through OCR breach investigations, has been a lack of thorough risk analysis. Covered entities would do well to analyze the risk of breach that they are entertaining with their current systems, policies and procedures.
Conducting a risk analysis should be the first step in identifying and implementing safeguards that comply with and carry out the standards and implementation specifications required by HIPAA and the Omnibus Rule. It is our understanding that OCR can provide guidance in conducting a risk analysis.
In addition the National Institute of Standards and Technology (NIST) publishes material that is readily available in the public domain, including guidelines that represent industry standards for various types of compliance –security, business practices, etc. Cover entities would do well to make use of this information when performing their risk analysis and developing their HIPAA and Omnibus Rule compliance.
All personal health information that is electronically created, received, maintained or transmitted by an organization is subject to HIPAA security rules and the organization must evaluate risks and vulnerabilities in their environments and to implement reasonable and appropriate security measures to protect this information against reasonably anticipated threats or hazards to the security or integrity of the information.
As a start on risk analysis, NIST Special Publication (SP)800-66 recommends asking questions like these:
- Have you identified all sources of electronic personal health information (e-PHI) within your organization? This includes e-PHI that you create, receive, maintain or transmit.
- What are the external sources of e-PHI? For example, do vendors or consultants create, receive, maintain or transmit e-PHI?
- What are the human, natural, and environmental threats to information systems that contain e-PHI?
Once these questions are fully answered, then an organizations can go on to develop appropriate security measures to guard their e-PHI. This may include, for example:
- Design appropriate personnel screening processes
- Identify what data to backup and how
- Decide whether and how to use encryption
- Address what data must be authenticated in particular situations to protect data integrity
- Determine the appropriate manner of protecting health information transmissions
If performing your own risk analysis and creating your own secure systems seems daunting, consider using vendors and solutions that are already vetted for HIPAA compliance.
How to Solve the Biggest Problems of Medical Data Management
We’re told that for hospitals, 2014 is the year of improved patient safety, improved patient experience and stringent data management requirements. Some say that as many as half of all hospitals are at risk of going out of business in 2014 if they don’t make substantial changes to their data management strategies.
A modern data management approach saves time and money while improving efficiencies and lessening patient data mix-ups or loss. The burgeoning use of digital data from medical imaging and electronic health records requires an easily unified system for both EHR and images that offers scalable storage and access without requiring hospitals to invest in additional hardware, software, floor space and personnel to manage and secure the data.
Big Changes – Short Time Span
Having come from film imaging and paper records to the world of digital in a relatively short time span, is it any wonder that hospitals and other healthcare organizations are struggling to keep up with the changing world of data management and improved patient care? The ubiquitous cloud can come to the rescue.
Hospitals and other healthcare organizations can achieve many benefits and reach for new possibilities with cloud applications. One of the benefits is the ability to reach across the enterprise, regardless of location in order to connect healthcare providers with patient information. Secure links can even enable physician access from outside the enterprise when it is in the patient’s best interest.
Cloud image viewing systems allow radiologists to view diagnostic quality images as well as to share the images with radiologists or specialists in other locations in order to confer on diagnosis. Cloud based medical records enable access to full medical documentation for patients in order to provide more holistic care. This shift to cloud technologies opens up the possibility of better medical care for rural and underdeveloped areas, as well as more dynamic workflow processes in urban and developed areas.
Benefits of Cloud/SaaS
These cloud image and records sharing platforms can be used a subscription-based service (SaaS), so they are scalable, as well as secure. When health care facilities move to this type of platform from the existing legacy desktop solutions, better patient care often follows.
With mobile viewing on smartphones and tablets, diagnosis can be more immediate and patient care can be accelerated, with better outcomes, shorter hospital stays and lower costs, enabling struggling hospitals to improve bottom lines and solvent hospitals to innovate toward better patient care.
As this combination of modern technology and instant information simplifies and speeds daily tasks, the healthcare community is able to focus more specifically on improving patient care and patient experience.
What About Standards?
While the healthcare industry as a whole, struggles to work out and agree upon future standardization issues, privacy concerns and potential security problems, there are excellent vendor neutral solutions available today that expertly tackle the storage, access and sharing of all kinds of medical imagery and medical records.
Vendor neutral systems enable hospitals to make use of their existing technology while moving into the cloud to help reduce waste and inefficiency. Vendor neutral cloud systems help to minimize some of the work normally required for an enterprise-wide technological change, and are intrinsically adaptable to new standards as they develop.
While there’s no such thing as a” one-size-fits-all solution, ” vendor-natural cloud technology makes it easier to scale, integrate and adapt to current hospital systems. Truly excellent vendor neutral solutions meet current established standards, such as HIPAA, and are designed in such a way that as new IHE (Integrated Healthcare Enterprise) standards are adopted, the solution can be brought into specification with minimal disruption to the organization.
Some say that the ultimate goal is to use established standards to help everyone’s systems talk to each other, but until then, if you use only vendor-neutral technology you’ll be one step ahead.
Stage Two Meaningful Use – Incorporating Medical Images into EMR
It’s not too late to get in on Stage Two Meaningful use by incorporating medical images into your Electronic Medical Records (EMR).
At the end of 2013, the Centers for Medicare & Medicaid Services extended the deadline for health care providers to meet Stage 2 meaningful use requirements for the electronic health records incentive program. Under the revised timeline, Stage 2 will be extended through 2016 and Stage 3 will begin in 2017 for those providers that have completed at least two years in Stage 2, CMS said in a release.
Medical Image Menu Option
While adding medical images to your EMR is a Stage 2 menu option, and not a hard requirement, it’s difficult to understand why any medical facility or healthcare provider would not want to choose the inclusion of medical images as one of their required menu options. To demonstrate meaningful use under Stage 2 criteria, eligible providers must meet seventeen core objectives and three menu objectives that they select from a total list of six for a total of twenty core objectives; eligible hospitals and CAHs must meet sixteen core objectives and three menu objectives that they select from a total list of six, or a total of nineteen core objectives.
The Physicians’ Viewpoint
For their part, most physicians heartily support the opinion that medical imaging is a necessary component of clinical diagnosis and treatment. Furthermore, they tend to agree that the lack of access to imaging studies in the EMR often means that diagnostic imaging is repeated, exposing patients to unnecessary doses of radiation, increasing patient care costs and extending treatment times, and sometimes even delaying referral processes.
However, even though they agree that medical images should be part of their EMR, most healthcare professionals are uncertain just how to go about it. Typically, there has been no easy way to access diagnostic images through the EMR without expensive upgrade or total system replacements. For efficiency reasons many medical professionals are not willing to learn another system just to add diagnostic imaging study viewing. They want a way to access these images seamlessly right within the EMR system that they already use. Since a large percentage of installed EMR software does not offer access to diagnostic imaging studies, this can present a dilemma to anyone hoping to meet this Stage2 menu selection.
Bring Your EMR to Stage 2 Medical Imagery Compliance
If you want to add medical images to your EMR for this Stage 2 menu option compliance, then consider making use of advanced web services and the cloud. Cloud services - like Radiology Services Online(RSO) - provide a linkable cloud module within your existing EMR software, and enable viewing of full DICOM images with one login to your EMR software. By using a zero-footprint viewer, there is no need for downloading the massive images, no concerns about patient privacy and no need to buy additional hardware or install additional software. It doesn’t require a new learning curve, and no user setups, so support requirements are minimal. All images can be stored and archived in the RSO cloud and are available when you need them, and where you need them…in the office, the hospital or from home.
Vendor Neutral Solution
Using an enterprise-wide Medical Imaging Repository that enables vendor-neutral integration with any EMR system and that provides a zero-footprint viewing capability that requires no download is an elegant solution for fulfilling one of the three required menu options for the Stage 2 Meaningful use. It’s simple, it’s efficient, and it’s cost effective.
A PACS Vendor -neutral solution remains current even in environments where PACS and imaging systems may change over time. Because it is subscription based, it is always the current version of software. Because it is standards based, it is not limited to storing proprietary data formats. Cloud systems in general are readily available from any location, anytime; secure and redundant; rapidly scalable; and, support multiple locations and departments.
Make your meaningful use count with the addition of medical images to your EMR.
How to Convert X-Ray Film to Digital
Do you still have X-ray film that needs to be saved? Scanning or digitizing your old X-ray film can help streamline your business and save storage space. When you convert traditional analog film x-rays into a more efficient digital-based approach, you increase your practice’s efficiency by making the studies available via computer or in your PACS. Storing the digitized images in the Cloud – called a WebPACS -- so that they are accessible to authorized users anywhere, anytime adds even more efficiency.
You can scan or digitize x-rays into DICOM, .tif, .jpg or pdf formats, allowing automation of the workflow and information throughout your practice. You save time because you no longer have to hunt for misplaced film, and, you save money duplicating film images or shipping film for second opinions.
The Importance of X-Ray Image Quality
One of the most important considerations for successful XRay film digitization is image quality.
If you plan to purchase an X-ray film digitizer and scan the films yourself, then purchase the best X-ray film scanner you can afford. You will want a digitizer that has clinically proven reliability, image quality, consistency, and overall productivity. The product should be cost effective, lightweight and require little space. Also ask about customer service and support. Vidar, Kodak and Howtek are some of the Xray scanners that are generally considered to meet these crieteria.
If you plan to outsource your Xray film digitizing, then find an outsource firm that has the experience of scanning thousands of Xrays of all types and sizes. They should be able to recognize spots as small as 44mm. They should support most PACS systems and offer direct support of DICOM in order to provide appropriate image compression to avoid bottle necks in imaging.
Proper Disposal of X-Ray Film
Often, when practices decide to convert their X-ray film to digital they neglect to think about what they will do with the film after it’s digitized. You can’t just throw the film away. There are privacy issues as well as EPA regulations regarding proper disposal of X-ray film.
Let’s first consider privacy issues:
- X-rays and other types of radiological images are considered protected health information (PHI). By definition, PHI is health-related information that can identify a person either directly or indirectly. Personal identifiers include name, address, Social Security number, date of birth, and medical record number.
- It is worth emphasizing that while HIPAA's primary privacy concern is health information exchanged or stored electronically, the Privacy Rule also includes data that is transmitted or maintained in any other form or medium. That includes paper records, fax documents and oral communications, and, yes…X-ray film.
Now let’s look at EPA considerations:
- You should contact an X-ray film disposal company so that X-rays can be stripped of their silver in a special chemical wash. Stripping X-rays of their silver is totally safe to the environment. In this process all parts of the X-rays are recycled, including silver, film and paper envelopes. X-rays can also be destroyed according to EPA regulations and burned to recover the silver. However, this releases pollution into the air.
Do It Yourself or Outsource?
While X-ray scanners are readily available, they can be expensive and do require a knowledgeable operator. This is one reason why many practices find it most cost-effective and efficient to outsource their X-ray digitizing. Another advantage is that many X-ray scanning services can also properly dispose of the X-rays for you, freeing you from the worries of HIPAA regulation and EPA concerns.
How Small Hospitals Benefit from Cloud RIS
What is Cloud RIS?
A cloud radiology information system (RIS) is a web-based software system that facilitates the management of medical imagery and associated data. It can be used in conjunction with a picture archiving and communication system (PACS) to manage work flow and billing; or the expensive PACS technology can be eliminated, and the digital imagery can be stored, viewed and manipulated in the Cloud. An RIS is especially useful for managing radiological records and associated data in multiple locations. A Cloud RIS pushes the envelope of efficiency even further. An RIS may be used for:
- Patient management - An RIS can track a patient’s entire workflow within the radiology department; images and reports can be added to and retrieved from electronic medical records (EMRs) and viewed by authorized radiology staff.
- Scheduling - Appointments can be made for both in- and out-patients with specific radiology staff.
- Patient tracking - A patient’s entire radiology history can be tracked from admission to discharge. The history can be coordinated with past, present and future appointments.
- Results reporting - An RIS can generate statistical reports for a single patient, group of patients or particular procedure.
- Film tracking - An RIS can track individual films and their associate data.
- Billing - An RIS facilitates detailed financial record-keeping, electronic payments and automated claims submission.
Put the RIS in the Cloud, and add these benefits:
- Elimination of film
- Improved functionality for physicians
- Increased referrals
- On-line access
- Expert second opinions and long-distance diagnosis
- Radiologist retention
- Faster patient treatment; better patient outcome
- Affiliated physicians can connect from anywhere
- Online scheduling, referrals, and reports
Cloud RIS = More Efficiency for Small Hospitals
A Cloud RIS helps in storing, organizing and retrieving of radiologic data in an automatic fashion. Such a system makes the whole process of records and image storage and retrieval faster and more efficient, while also enabling the information to be transmitted to any other department within the hospital, or outside the hospital as and when necessary.
The workflow and accessibility that Cloud RIS offers enables small and rural hospitals to offer more imaging services, with the advantage of remote reads and diagnosis provided by the experts at larger city hospitals. The small hospital benefits by an increased patient base; the patients benefit by being able to have diagnosis and treatment performed locally, rather than traveling to a larger hospital.
Cloud architecture can improve the small hospital ROI. With today’s economic requirements to increase quality while reducing cost there is much to recommend employing Cloud RIS. The popularity of cloud-based, PACS-neutral archives proves this point.
In addition, Stage 2 Meaningful Use guidelines now include image access and sharing. Small hospitals should consider the funding that is available through this Stage 2 Meaningful use in order to enable Cloud RIS functionality across hospitals, IDNs and health information exchanges. Because storing all the imaging information in an EHR is not a practical, it makes sense to benefit from a web-accessed RIS. Your imaging studies be archived with private, or hybrid, cloud-based technologies in order to save on the local hardware requirements for storage.
Any Cloud RIS should ensure that a high level of security and confidentiality of data is maintained at all times, with data accessible to only to authorized personal having a valid user login and password. The system should maintain a record of who has accessed it, as well as when and where. A radiologist should be able to make specific data available to a consulting or referring physician with a secure, time-expiring link.