DICOM Viewing and Management Solutions in the Cloud
An Interview with Manning Phillips -- Part II
This is a continuation of my interview with Manning Phillips. Last week, we covered the changing technologies of DICOM viewing and management. This week, we discuss the emerging trend toward “Cloud” technology for DICOM viewing and management solutions. This blog post is an overview of the second part of our conversation.
Mr. Phillips is the principle consultant for RadMed Technology, a consultancy practice focusing on radiology image management and interfaces for medical information systems. His extensive product knowledge and market focus brings keen observations to today’s changing medical technologies and emerging DICOM viewing and management solutions.
Question: Is the “Cloud” really a more efficient way to view and exchange DICOM images? Why or why not?
Answer: Yes, is the short answer. There are no real technical challenges that make widespread access to patient studies impossible; the existing challenges are financial or political. There is a wonderful technical standard in place that has been used very effectively in Canada, China, Chile, and many western European countries for the nearly real-time exchange of medical information. Imagine if every time a patient had a study done by a doctor, the patient, by granting permission, could make the results of the study -- whether images or a report -- instantly available to any healthcare professional to whom the patient grants access to their information. For political reasons this standard will not be implemented in the USA for some time, but there are intermediate steps that can result in progressively larger gains in efficiency. Today we can start with controlled distribution of DICOM studies and radiology reports using what generally is called the “Cloud.” What this is means is that within hours of the completion of a study, the patient’s images and report can be automatically deliverer to their referring physician or surgeon and the cost is less than ½ the cost of the older system of printing patient disks. The other huge advantage is that specialist or treatment planners can be added to the clinical team with a couple of clicks of the mouse and have full access to the images and reports as well as upload surgical or oncology treatment plans.
Question: How does the “Cloud” fit with the in overall movement toward digital medical records?
Answer: Universal-secure-access to medical records is what the USA government and most other developed countries are betting on to slow the increase in medical care cost. The “Cloud” is really the concept of using the public internet as though it were a private network for the purpose of conducting business. This of course means special considerations for security and privacy but using my previous example of the banking industry, there are very few technical issues that have not previously been solved -- all that is needed is political agreement --unlike banking which is a private industry where companies compete for your business
Question: What recommendations can you make for small to medium healthcare facilities to enable them to better view and manage DICOM Images?
It starts by doing simple things like access where you are along the continuum of “Going Digital.” This needs to be done by a group of committed individuals from all of the stakeholder groups and have a couple of clear deliverables. First, the assessment based on the needs of the whole institution and all the stakeholders, including patients and payers (not on the team but clearly one of the stakeholders that hold the keys to the future). Once the assessment is complete a plan needs to be drawn up that includes a project for each department with the sole aim of increasing interoperability and reducing the inefficiencies of delivering quality care. Of course the finances of the institution need to be taken into consideration but if institutions don’t make the necessary changes to reduce costs, then others will, and the health of the healthcare system will be impacted. If your facility is in the early stages of “Going Digital” these project can be very small, the key is that they need to be building blocks to your desired digital delivery system. Examples of small projects are: adding radiology image distribution to the ER/ICU or to the referring physicians. These both instantly benefit the groups that are key to the approval of future projects, and they both reduce costs because they eliminate films.
Question: Any last words or recommendations?
Answer: Remember that any physical media is your enemy -- be that film or patient CDs. They both cost upwards to $30 per patient study and they perpetuate keeping the whole radiology process using what we used to call “sneaker net” or “snail mail.”
DICOM Viewing and Management Solutions
An Interview with Manning Phillips --Part I
I recently had an opportunity to sit down with Manning Phillips and talk about changing medical technologies and emerging DICOM viewing and management solutions. This blog post is an overview of the first part of our conversation. Next week’s blog post will contain Part II as we delve into the “Cloud” for medical image viewing.
Who is Manning Phillips?
Mr. Phillips is the principle consultant for RadMed Technology, a consultancy practice focusing on radiology image management and interfaces for medical information systems.
Mr. Phillips has extensive knowledge of medical viewing technologies through his 20+ years career working for various medical technology manufacturers, including VIDAR Systems Corporation (PACS Add-On Equipment Designer and Manufacturer); CompuMed, Inc.(Bone Mineral Density Software); EMED (the Medical PACS division of Raytheon, E-Systems); Polaroid Corporation, Medical Division; and, General Electric (Medical Systems -PACS Business Line).
His extensive product knowledge and market focus brings keen observations to today’s changing medical technologies and emerging DICOM viewing and management solutions.
Question: How has the viewing and management of DICOM medical images changed over the last decade?
Answer: There was a time 20 years ago when all modality devices were an information island and the only way that images were delivered to a radiologist or any other user was by printing them on film. Then came DICOM and we started a slow transition to softcopy reading and digital archiving, but if anyone besides the radiologist needed to see images, we were still printing films. About 10 years ago the industry started to work out the standards to allow using Patient CDs/DVDs to replace film. It was a great idea but it still had three major drawbacks: (1) The disks were often incompatible with different viewing systems; (2) The physical process of publishing the patient disk is realistically $5.00 to $35.00/patient disk, depending on how fancy the disk is and how quickly it has to be delivered to a user; and, (3) Only one copy of the data is delivered each time a disk is requested, which means that, just like with films, there are reoccurring costs whenever a second or third copy of images is requested by a surgeon or the patient.
Question: What influence has technology had on the viewing and management of DICOM images?
Answer: First we had Teleradiology that solved the problems of not having a radiologist on-site when the study was done or for ER/ICU patients. These were simple, sometimes nothing more than “Cameras on a stick” solutions but it was the first real advancement to break the constraint of one instance of patient data, in one place, for use by one person, for one purpose. As the Digital Imaging and Communications in Medicine (DICOM) standard spread and became a requirement on all bid specifications Picture Archive and Communications Systems (PACS) came into the mainstream at large facilities. It still took a small army of IT support staff and PACS administrators, but healthcare did improve as new image capability made 3D imaging, Stack Mode reading of images, and real time communications with ER and other critical care areas became common. This also came just in time for mega-slice CT and MRI studies which could no longer be effectively read on film.
Question: How do you see medical image viewing and management being handled going into the future?
Answer: The key to the future is better not more. The absolute truth is that healthcare cost increases can NOT be sustained. This does not mean rationing, but it does mean we have to have the same kind of access to our medical images as we have to our bank accounts. Today, we can walk into any branch of any bank in virtually any country and see our account balances, withdraw money, make deposits… in short manage our affairs. There is no reason that we cannot do the same with our medical images and other health information. We can easily do 500 -1000 slice CT study and view the results on 3-5 MegaPixel monitors, do dictation on digital speak to text systems but because of our fiefdoms of healthcare which encourages hoarding of clinical information, our reimbursement system which encourages over utilization, and physicians fears about lawsuits, we often repeat expensive studies. Following my banking example which has the same security concerns, why can’t a surgeon, with a patient’s permission, easily gain access to all that patient’s studies and reports? This universal- granted-access is how we get to better health care for more people and not just more cost for the few that are working at companies with rich benefits.
Hospitals Benefit from Cloud Access to Medical Images
Most hospitals systems can benefit from an organized system that manages the increasing flow of medical images both within the system and from outside the system. While most hospital administrators agree that the “Cloud” technology offers far-reaching abilities for organizing and sharing medical images, they also express concern about the security of the Cloud. This article explores both the benefits and the potential security issues of the Cloud, which increasingly plays a role in cross-enterprise access to patient records and images.
Benefits of an Image Transportation Cloud
An Cloud-based system capable of transmitting both internally produced images as well as externally produced images directly to the point-of-care and enabling them to be viewed from any internet accessible device provides substantial benefits in both cost reduction and improved patient outcomes. With nearly 50% of healthcare workers dissatisfied with the way their hospitals currently use their IT systems and protocols to handle diagnostic images it appears that most healthcare facilities could benefit from a review of their current solutions and an exploration of alternative solutions, including Cloud-based image-sharing.
Handling Externally Produced Images
One particularly laborious part of many current image handling systems revolves around the receipt and integration of externally produced images. These outside images are generally handled by radiology departments and integrated into a PACS using many manual processes such as patient information reconciliation. If not sent to PACS, images are typically managed in a variety of informal ways by the department directly involved. Some hospital may simply store images in short-term digital files. These rather haphazard methods often result in lost images and the need for re-doing the imaging procedures.
An organized Cloud-based system for storing, managing, access and sharing images from inside and outside of the enterprise can reduce storage costs for all images while making it easier to archive long-term images and delete the images that that often require only short-term retention for patients who are not admitted to the hospital.
A Cloud-base image system can also eliminate the need for hand-carried images that need to be cycled through radiology and made accessible via PACS, potentially delaying treatment. A Cloud base image transportation system can also virtually eliminate data entry mistakes and delay in getting images to PACS or associated with the wrong patient.
Why External Images are Important
Externally produced images are often used for emergency cases and trauma, surgery, stroke and oncology consults. In these instances time is often of the essence and inefficient image transportation and management can slow down the diagnosis, jeopardizing patient care. In addition each of these consulting situations can require a differing medical records workflow. A Cloud image management solution that can be seamlessly integrated into any medical records workflow can provide substantial improvement in the speed with which the consult can be completed and patient care can begin.
Using a Cloud-based system to facilitate image communications throughout the hospital while efficiently transmitting images externally and internally helps to conserve hospital resources by speeding the procedures.
About Cloud Security
While the Cloud clearly brings many procedural cost saving and time saving benefits, there remain the nagging doubts about Cloud security…
You can ensure your data is secure by following through with due diligence:
· Make sure that any Cloud image storage and transportation provider you use takes proper measures to secure your patient data and any applications that are used in the Cloud. While providers have an obligation to do this for their clients, a review should be done to confirm that your expectations on Cloud security are being met.
· Hospital and providers need to ensure that all critical patient data is masked and in HIPAA compliance, so that only authorized users have access to it. They also need to ensure that individual identities and credentials are protected. At the same time, they must be aware of, and comply with any additional compliance procedures, as well as laws relating to patient protection.
· All images and applications that are accessed via the Cloud need to be secure. Additionally hospital need to work with their employees to make sure any computers or mobile devices that are used to access patient data and images in the Cloud are secure and that all access is documented.
Advantages of Online DICOM Viewing and Image Exchange
DICOM stands for “Digital Imaging and Communications in Medicine (DICOM) and is an accepted standard that improves compatibility and workflow efficiency between medical imaging systems, medical devices, and other information systems used in a healthcare organization.
Image files that conform to the DICOM standards are called DICOM images, and differ from other image formats like JPEG, TIFF, or GIF because the DICOM image contains a ‘header’ with information (such as patient demographics, machine, scan parameters, and a host of other non-image data) in addition to the image data. This additional information makes it possible to identify the origin of the image, the patient, data acquisition parameters of the study and so on, even if a single image is analyzed in isolation
Although DICOM is the accepted standard for the storage and networking of medical images, the image is encoded in a format that cannot readily be viewed on an average personal computer (PC). Viewing these images outside the radiology network, or transferring the images to another healthcare facility requires printing of the images on hardcopy films or copying the imaging data on compact discs (CDs) which can be transported, stored, and reviewed easily. Usually a proprietary DICOM viewer is written into the CD along with the image data, but it is often limited in its functionality. This is where an online solution that enables both full diagnostic viewing and the ability to transport the image to another healthcare facility can be a cost effective solution.
How Does DICOM Online View and Exchange Work?
Hospitals, clinics, imaging centers and specialists can view, administer and distribute images using a subscription based online service that allows images to be viewed on any device that has internet access. A vendor neutral system ensures that every healthcare facility can view and exchange DICOM images because it can work with any workflow or electronic health record system.
An online subscription based DICOM view /exchange system provides basic image-processing functions, such as the ability to adjust image contrast and brightness, to magnify, to perform measurements (distances, angles, areas, pixel values, etc.), to change image orientation, and the ability to annotate. Studies containing a time series of image data need a ‘cine’ viewer with the ability to change the frame rate. Another useful tool is the ability to simultaneously load and compare two sets of images; this is usually necessary when looking for enhancement on post-contrast studies and to check for response to therapy. Physicians have better access to images, which allows them to make a faster diagnosis, potentially from anywhere in the world where there is Internet access.
Beyond View and Exchange
A direct extension of the capabilities of a DICOM online view/exchange system is the ability to access, store and retrieve, transmit, display, and process images that were generated by DICOM-compatible equipment. This type of WebPACS is a subscription based system that can interact with the hospital information system/radiology information system (HIS/RIS), electronic medical record systems, and web servers.
Setting up of such a system and its integration with the imaging equipment could require the help of a network administrator and other IT personnel, but a bona-fide SaaS/Cloud WebPACS makes use of Cloud technology to render in-house IT assistance all but unnecessary. Such a cloud solution can also be of use for arranging viewing stations for monitoring imaging studies from the radiologist's office, for printing images using DICOM printers or paper printers, and for teleradiology.
This online approach involves secure redundant Web servers that allow authorized personnel to query and retrieve images stored in a DICOM archive. The images can be viewed at browser speed, allowing any authorized person with internet access to view the images, regardless of their physical location.
An online system such as this offers several advantages over more traditional picture archiving and communication systems (PACS): (1) It is zero-footprint, requiring no installation of additional hardware or software; (2) It allows DICOM images to be manipulated and displayed efficiently using whatever hanging protocol the user desires; (3) it is easy to integrate with existing systems that are already making use of Web technologies (such as EMR systems that don’t offer DICOM viewing.
The Integrated Healthcare Enterprise: EHRs and Images
What is an Integrated Healthcare Enterprise?
An Integrated Healthcare Enterprise (IHE) is systematic way to improve the way health care systems share information in order to provide optimal patient care. Optimal patient care requires that physicians and patients be able to create, manage and access comprehensive electronic health records (EHRs) efficiently and securely. Comprehensive electronic health records include doctor’s records, lab and radiology reports, as well as actual images upon which the radiology reports are based. Including images is essential, because most physicians want to see the images as well as read the reports.
An Integrated the Healthcare Enterprise not only improves the way healthcare systems communicate with one another, but also accelerates the diagnosis and care of patients, while offering budgetary stability.
IHE promotes the coordinated use of established standards such as DICOM and HL7 to address specific clinical imaging needs in support of optimal patient care. Systems developed in accordance with these standards communicate with one another better, are easier to implement, and enable care providers to use information more effectively.
IHE and Access to Radiology Information
Referring physicians should be able to access radiology information—both images and reports—withi one login to the information systems they use. Furthermore, when they access a patient’s radiology information, the physicians need to be confident that they are getting the images they expect in a format that is displayed correctly.
While today’s digital radiology systems offer a return on investment that comes from film cost reductions, it is also imperative that the costs associated with managing the digital images and the requests for radiology information be mitigated. Authorized users of radiology information should be able to query and retrieve the information they need for patient care from within their patient information systems so that radiologists don’t have to manage pushing this information to them.
Filmless, but not Paperless
Even though radiology procedures are mostly filmless, radiology departments still generate and manipulate too much paper… orders are on paper, requisitions, protocol sheets, flow sheets, quality assurance sheets, and patient history sheets are also mostly on paper. There are manual logbooks and protocol notebooks, as well as manual scheduling of patients into the system. This kind of manual entry reduces efficiency and adds to the overall cost of healthcare.
Managing the radiology workflow electronically and being assured at the completion of a procedure on a modality workstation, that the images are permanently stored and available for viewing by all treating physicians eliminates wasted time and effort.
Are IHE Images and Paper in the Cloud?
Integration of medical imaging into electronic health record (EHR) systems is now fully on the Integrated Healthcare Enterprise agenda now that it is part of Stage 2 of the Meaningful Use notice of proposed rulemaking (NPRM). The rule requires electronic health record systems to support “download and transmit” digital images to third-parties. Although, in the final rule this requirement was curtailed to only demonstrating the ability to view of clinical images within the EHR, but is still very challenging.
We believe that the right Cloud based SaaS (Software as a Service) system that can integrate EHRs and medical imaging can offer cost savings and improved accuracy in the interpretation of clinical images. In addition if the Cloud system can also address the radiology workflow issues in order to become paperless as well as filmless, it can be even more of a boon to the radiology department and the Integrated Healthcare Enterprise as a whole.
We see a need to unite the radiologist, the technician and the facility with a fast, scalable and economically viable solution, which enables the images and data to be seen and stored in the Cloud, and available anywhere, anytime to any authorized user. This kind of Cloud-based automation is a key factor in keeping costs down and improving patient outcomes.
WebPACS -- DICOM Image Distribution in the Cloud
DICOM stands for Digital Imaging and Communications in Medicine and is standard developed by ACR-NEMA (American College of Radiology - National Electrical Manufacturer's Association) for communications between medical imaging devices. It conforms to the ISO reference model for network communications and incorporates object-oriented design concepts.
PACS is abbreviation for Picture Archiving and Communications System and refers to a network of computers used by radiology departments that replaces film with electronically stored and displayed DICOM images. It provides archives for storage of multimodality images, integrates images with patient database information, facilitates laser printing of images, and displays both images and patient information at work stations throughout the network. It also allows viewing of images in remote locations.
WebPACS is the generic terminology for the next generation of technology that allows for DICOM image distribution via Cloud Computing. Cloud computing is the use of computing resources (hardware and software) that are delivered as a service over a network (typically the Internet). The name is derived from the common use of a cloud-shaped symbol to represent its complex infrastructure in system diagrams. WebPACS enables the use of remote services for secure storage and transmission of DICOM images.
One WebPACS System is that provided by Radiology Services Online (RSO).
This article will discuss the generalities of WebPACS cloud computing, with references to specific applications available within RSO.
Benefits of WebPACS Cloud Computing
In the SaaS/Cloud business model, software is provided as a service, and users are provided access to the application software via the internet. Cloud providers manage the infrastructure and platforms that run the applications. SaaS is sometimes referred to as "on-demand software" and is usually priced on a pay-per-use basis. SaaS providers generally price applications using a subscription fee.
With WebPACS, users access cloud-based medical images a web browser and view via a Cloud DICOM viewer. With a solution the RSO solution, the Cloud DICOM viewer serves up diagnostic quality images without downloading. This is not the case with all WebPACS systems. Many serve up only a thumbnail in the viewer, but require actual download for full diagnostic viewing. Medical images can be huge files and can take long periods of time to download, even on fast connections Serving up a diagnostic DICOM image without download saves time and provides for faster sharing, diagnosis, second opinions and treatment.
Users of WebPACS systems are fast to point out that cloud computing allows healthcare organizations to avoid upfront infrastructure costs, and to focus on patient diagnosis and treatment. Healthcare personnel like the fact that cloud base medical imaging systems get their applications up and running faster, with improved manageability and less maintenance, allowing them to focus more fully on the health of their patients.
SaaS systems like RSO allow a healthcare organization the potential to reduce IT operational costs by outsourcing hardware and software maintenance, as well as imaging storage, backup and support to the cloud provider. This enables the medical providers to reallocate IT operations costs away from hardware/software spending and IT expenses, towards meeting their patient care goals. In addition, with the imaging software hosted centrally, users are assured of always having the most current version, without the need for users to install new software.
One concern that many users have with Cloud/SaaS DICOM image storage and viewing is that because the medical images are stored on the cloud provider's server, there could be unauthorized access to the data. In truth, this is a possibility with any computer system, and reliable SaaS/Cloud WebPACS systems like RSO take great care to ensure HIPAA conformance, as well as maintaining commonly accepted practices for secure access, backup and protection of patient medical image privacy and security.
WebPACS – Cost Effective, Scalable, Secure
The right WebPACS SaaS/Cloud solution can provide your healthcare organization with a cost-effective, scalable DICOM image system that enables you to store, access, view, and distribute your CTs, MRIs, UltraSounds, x-rays and other medical images quickly and easily.
HIPAA Compliance for Medical Records Scanning
When a healthcare organization decides to move to Electronic Medical Records (EMR), one of the first requirements is the conversion of paper records to the new digital system. One easy solution for document conversion is to outsource the scanning process to a scanning service. However, when the documents to be converted are medical records, the conversion process involves much more than just scanning. In fact, medical records scanning touches on all aspects of records management and HIPAA compliance and can comprise both paper and film conversion and management, digital storage, archiving and disaster recovery, as well as the transport and transmission of patient information through the healthcare organization.
This complexity of medical records scanning requires the use of an experience document conversion service provider who can help you move easily into the world of digital medical records while ensuring HIPAA compliance throughout the process.
What HIPAA Compliance Requires
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.
Who Must Comply
Health plans, healthcare clearinghouses, healthcare providers, business associates to whom they provide health information. Not only is it important that your healthcare organization be compliant, but HIPAA also requires any third-party partners and associates be compliant as well. This means that it is fundamentally important when choosing a medical records conversion service to ensure that this partner understands all of the issues that enable you to maintain HIPAA compliance and any new government initiatives that may come about.
What HIPAA Compliance Covers
HIPAA compliance covers any personal health information that includes any information about health condition, treatment or payment for care that can be related to an individual. Because this is so broad, it generally is taken to include all of the information contained in a patient’s medical record and payment history. This is why HIPAA compliance requirements extend to the medical records scanning service provider.
Enforcement and penalties related to the protection of patient information can reach a maximum of $1.5 million annually per type of violation. State attorneys general, as well as the Department of Health and Human Services (HHS), have the authority to prosecute HIPAA violations.
Choosing a HIPAA Compliant Scanning Service
The scanning process itself is pretty straightforward. Documents are scanned, usually using a high-speed document scanner, saved in a digital format an uploaded into the Electronic Medical Records System. But there are complex issues related to the conversion process itself as well as to compliance and transition that require consideration:
- How will you manage redundancies and inconsistencies that are common in paper-based systems?
- How will you control workflows during the hybrid stages (both paper and digital) of the conversion?
- Have you planned for accessible, compliant and affordable electronic records storage?
- Have you provided for retention and destruction schedules for both paper and digital files that meet both legal regulations and your organization’s requirements?
As long as you do your due diligence BEFORE you start the conversion process, and ensure that you choose a document conversion service that understands all of the issues incumbent with medical records scanning and conversion, you will be able to move forward confidently, efficiently and cost-effectively toward electronic medical records management.
Due Diligence Questions
- How should we prepare our medical records for transportation to the scanning facility?
- What procedures are at place at the scanning facility to ensure HIPAA compliance?
- How will the medical records be handled and stored during the conversion process?
- What type of scanning equipment do you use?
- What are the technical qualifications for your scanning personnel?
- How do you handle quality control?
- Do you provide indexing services?
- How do you deliver our digital files; will you upload them directly to our EMR?
- How do you dispose of the records after the conversion is completed?
These are some of the most obvious questions that you should get satisfactory answers to before you contract with a medical records scanning service. There may be additional questions that are pertinent to your medical organization. Make sure you get all promises and agreements in writing!
Medical Records Scanning – What You Need to Know
Medical Records Scanning is backfile conversion with the additional caveat of HIPAA privacy requirements. Conversion of any type of paper records to digital files is an enormous task that requires organizational skills, expert knowledge and the patience to do tedious, time consuming work. Add to that the HIPAA requirements, and you may find that this is work best left to a scanning service bureau that provides a comprehensive medical record scanning service.
Medical records scanning is most often done in conjunction with a medical organization moving to an Electronic Medical Records (EMR) system. Because the medical practice doesn’t close its doors while the conversion is in process, it’s important to maintain a way to use the paper files for ongoing patient care while the conversion is taking place, and to determine the most effective way to receive the scanned documents so that these documents can also be easily accessed. Do you want the scanned files uploaded directly to your EMR, do you want them burned to a CD or DVD? Are there portions of the files that will need to be OCRd and transformed into searchable pdf files?
Most often, it will take members of the staff, the EMR representative and the scanning service bureau to determine the best processes to undertake for your particular medical practice and the way you do business and follow patients. Interestingly, we find that medical personnel are not prepared for the enormous flexibility that digital medical records provide. For instance, most practitioners don’t review historical trends in a patient’s lab work over any period of time, other than possibly looking at the most recent lab work to compare to the current. This is generally because with paper files, it’s next to impossible to do, but with searchable pdf files, the physician can find every reference to a particular lab test in the patient’s records, so a historical trend becomes easy to see.
Advising a medical practice just what benefits scanned medical records can provide is just one of the activities that an expert medical records scanning service bureau can offer.
Should We Scan all Charts and Upload to our EMR?
Because medical charts should be kept a minimum of several years after a patient’s last visit, you will either need to scan all of them or store the paper for the patients who are not current, but whose files must still be maintained for legal reasons. Storing paper on‐site costs money, when the space can be used by the practice to make money instead. Scanning the charts enables you clear the file room and re‐purpose the space for new exam rooms.
We generally recommend that only the active records, i.e., current patients or patients last seen within the last couple of year) should be scanned and uploaded into the EMR. Older records can be digitally stored on an in-house server or a Cloud document management system. This frees your EMR for current records, but still provides access to older records, when needed. And, those older records can be brought into the EMR if the patient returns.
Benefits of Medical Record Scanning
- Better HIPAA Compliance ‐ A complete audit trail of who and when charts are accessed is possible with digital charts, while paper files, by their very nature, are not secure under HIPAA.. HIPAA can level fines against medical practices that cannot produce patient charts in a timely manner. Digital records also make it easy and fast to comply with HIPAA requirements to produce a complete medical record within 30 days of a patient request.
- Improved Patient Outcome ‐ It has been shown that EMR adoption improves patient outcomes. This is likely due in large part to the fact that doctors are able to quickly review and share digital charts with other medical professionals. Once your charts are digital, they can be accessed securely and remotely via tablets or iPad, or even from amart phone.
What About Medical Images in the EMR?
When asked, most treating doctors want to see the actual image, in addition to reading the radiologist’s report. So, even with the latest EMR system, the doctor is still going to need to see the Xray, or view a DICOM image, whether or not he has a PACs machine on which to view it. Thinking about this issue before the medical facility moves to electronic medical records can streamline the process of converting to EMR, and add to the ROI of the conversion. A well done EMR implementation should include imaging provisions.
One solution for hospitals, clinics, imaging centers and specialists is a Cloud based addition to their EMR software where the can administer and distribute images regardless of whether others that the need to share with are subscribers to the system. Radiology Services Online (RSO) provides a zero foot print Web PACs system that easily integrates with any EMR system, allowing for images to be viewed via a secure internet connection that is accessed from a pull-down menu within the EMR system. The RSO system does not require an additional log-in…it is accessed from with the EMR software, with a single login.
Medical Image Management for Patient Information Systems
What is a Patient Information System?
Patient information systems are information management systems that capture and display data related to the delivery of patient health care. Patient information management systems are formatted to read like a regular medical chart, and users click on files that they want to open. Not everybody can access a patient information management system, because medical files are highly confidential documents that are protected by the HIPAA regulation. According to the U.S. Department of Health and Human Services, patient information management systems are highly restricted areas, so users are assigned (usually doctors, nurses or medical assistants) and given special permission to access information when appropriate.
Patient information systems have helped doctors’ offices become more efficient. Instead of writing everything down by hand, medical staff can input information directly into a system that will do all the storing and filing for them. Also, patient information management systems make patient data easily accessible.
Medical Images -- The Challenge of Patient Information Systems
A major challenge with using digital patient information systems is the lack of access to medical images. Ideally, medical images should be considered an essential part of every patient’s complete health information file. Including medical images within the patient information system provides a comprehensive and updated version of each individual patient’s health care information, which can be made available to any provider that the patient wishes to see. Because individuals often get their care from different providers, their medical records are distributed across multiple sites where they have received care. These records are generally not exchanged and updated unless the sites are part of a network of providers that share common information systems. Past medical records are an important input in clinical decision-making, and without the consolidation of all relevant medical information and images there is a substantial risk of medical errors, delays in diagnosis, and inefficient treatment.
Patient information systems are generally aimed at managing charts and documents via a database structure. For this reason, and because of the complexity of managing large diagnostic medical images, patient information systems tend to exclude medical images from their data. This generally means that the physician treating the patient relies solely on the reports from the studies unless that physician has duplicated a manual system to manage films in imaging data films in his office, and that is not normally the case.
Can the Cloud Answer the Challenge?
One cost effective way to include diagnostic medical images in patient information systems is via a linkable cloud computing module that enables image access via a pull-down menu within the patient information system. This method enables full Dicom zero-footprint online imaging with one login to to the patient information software system. Advantages of cloud technology include the facts that there are no initial capital expenses, no installation or set-up requirements and minimal support needed. Most cloud applications are sold on a SaaS basis…that is Software as a Service, with minimum monthly charges based on usage. This makes it easy to scale the application for current needs, and increase or decrease usage as needed.
Reliable SaaS/Cloud solutions provide secure storage and hosting for the medical images, including backups and restore capabilities. This means that no large images are saved in or running through your patient information software, so the software runs smoothly and is not bogged down by bulky images. Those SaaS/Cloud soutions provide medical image hosting should also meet all HIPPA-required compliances, so patients' privacy is assured.
Benefits of Outsourcing Medical Image Management to the Cloud
The key to successful integration of your patient information system with a SaaS/Cloud medical image management system is to choose a vendor that has expertise in medical image cloud computing as well as a proven track record of security and compliance. With the proper vendor and the right solution, your image-enabled patient information system will provide cost savings, improved efficiency, faster diagnosis and treatment, and the ability to grow.
Health Information Technology and Medical Imaging
Health Information Technology (HIT) is a comprehensive term describing the electronic means for managing and transmitting various health care data in order to provide better patient care. This umbrella term includes, but is not limited to: (1) use of electronic health records (EHRs) instead of paper medical records to maintain people's health information; (2) electronic storage, viewing and transmission of diagnostic medical images and imaging reports; (3) management of health information across multiple computerized systems and networks; (4) secure use and sharing of health information.
Love it or loathe it, HIT is increasingly viewed as a necessary tool for improving the overall quality, safety and efficiency of the health delivery system , and sooner or later, physicians, hospitals, clinics and other healthcare establishments will need to get on board. In fact the U.S. federal government provides this map showing the adoption of Electronic Health Records by state.
It is predicted that Health Information Technology will improve health care quality; prevent medical errors; reduce health care costs; increase administrative efficiencies; decrease paperwork; and, expand access to affordable care.
Health Information Technology requires the application of information processing techniques that involve both hardware and software and requires extensive knowledge of the programming requirements for storage, retrieval and sharing of data. Nowhere else is this more evident than in the storage, retrieval and sharing of complex diagnostic medical images.
HIT and Medical Images
The efficient management of diagnostic imaging is a complex process due to the many different image types, sizes, display system resolutions, bit depths, compression, and DICOM services that are needed. In addition, proper management of imaging studies relies on compliance with a wide variety of technical standards. These standards cover everything from patient privacy, to image compatibility and workflow management. Maintaining compatibility and verifying compliance is an ongoing requirement for any HIT system that includes medical images.
Today’s medical images are more complex than ever before and medical imaging is key component of nearly every aspect of today's health care industry. As medical imaging use continues to expand, it will become necessary for Electronic Health Records to include storage, viewing and sharing capabilities for medical images such as:
- Magnetic resonance imaging (MRI)
- Magnetic resonance angiography (MRA)
- Functional magnetic resonance imaging (fMRI)
- Magnetic resonance spectrography (MRS)
- Computed tomography (CT)
- Computed tomographic angiography (CTA)
- Nuclear cardiology
- Positron emission tomography (PET)
Since most physicians benefit from having access to the actual diagnostic images in addition to the report derived from them, the integration of diagnostic quality images directly into the medical record system promises to become more necessary as HIT becomes more prevelant. This need for seamless integration between clinical information and medical imaging requires a vendor-neutral image management solution to image enable existing HIT systems, as well as being added to new systems going forward.
Interoperability between the paper records and the diagnostic images not only improves individual patient care, but can also bring many public health benefits including early detection of infectious disease outbreaks around the country and improved tracking of chronic disease management.
HIT - Positive Results, Even for Small Practices
Authors from the Office of the National Coordinator for Health Information Technology (ONC) recently published a review in Health Affairs. The review focused on the effects of Health Information Technology (health IT) and found predominantly positive effects on key aspects of care including quality and efficiency. In addition, providers outside of large integrated care networks, the original innovators in health IT, are beginning to implement, evaluate, and achieve benefits from similar systems. So the positive statistics appear to hold true, regardless of practice size. Smaller practices can also benefit from including a vendor-neutral solution for diagnostic image access in their electronic medical record systems.