Children’s Hospital Colorado Reaps the Benefits of an Image-enabled EHR

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Danny G. CoxSince opening on February 17, 1910, the 375-bed Children’s Hospital Colorado (CHC), in Aurora has tried to be a leader in providing the best health-care outcomes for children. Technology plays a key role here, and it will continue to do so as construction of a new wing (which will bring an additional 125 beds into the facility by the end of 2013) proceeds on schedule. CHC is on the cutting edge of health IT with an image-enabled EMR, created by integrating the hospital’s Synapse PACS from FUJIFILM Medical Systems USA with an electronic medical record (EMR) from Epic. It works this way: They use a RIS driven workflow, meaning the to-be-read list resides within the RIS/EMR itself rather than in PACS. The benefit of this is the ease of access to the patient’s full chart to facilitate researching patient history in order to provide the best interpretation of images possible based on that patients individual needs. The radiologists launch a study to be read within the RIS/EMR, which then launches the images within PACS and opens the corresponding report macro. Radiologists then dictate and self-edit reports using a voice-recognition system from Nuance. Reports are sent to the EMR, which then routes a copy to the Synapse PACS and auto-faxes a copy to the ordering physician (but only if that physician is outside the CHC credentialed staff and doesn’t have access to the EMR). Rather than launching the PACS to view images and reports and then launching Epic to access other medical records, users are able to stay logged into the EMR to review imaging reports and can click an encrypted URL that resides below the report to launch the study. The encrypted URL expedites workflow by preventing the users from having to log into a separate system and look up the patient and then the study within PACS directly. Danny G. Cox is CHC’s radiology data systems administrator. He notes that as a pediatric facility, the hospital—which performs approximately 120,000 studies annually—is required by the state of Colorado to retain data for minor patients until they are seven years past majority, or until the patient is 25-years-old. He says, “Between the volume of studies we perform and the fact that we currently do not purge records under any conditions, our image-data repository is constantly growing. Integration is a good way to simplify access to it.” Gordon Teubner, CHC’s application coordinator for clinical application services, played a key role in ensuring that the integration and image enablement of the EHR, initially undertaken in 2006, met the needs of all stakeholders—patients, radiologists, and referring physicians. Although the value of image enablement via PACS/EMR integration was clear, Teubner states, the solution had to meet several criteria before it could be vetted. Security topped the list. The hospital’s security group insisted on airtight protection not only for images and reports, but also for all personal health information (PHI). The encrypted URL, designed by Fujifilm to enhance security when CHC migrated to Synapse in 2010, allows providers to view images in PACS with a single click from the Epic results report—without logging into PACS directly—while simultaneously protecting PHI, Teubner explains. An intuitive interface between the two systems, high-availability architecture (to minimize service interruption and minimize the possibility of data loss), and the flexibility to allow physicians access to information from inside and outside the hospital were on the roster of criteria as well. Multiple Advantages Although PACS/EMR integration and image enablement have not had an impact on the frequency with which image data and reports are accessed, the new configuration affords myriad other advantages to the hospital and its physicians. All reports are distributed through the EMR system; and 90% of images are accessed via the EMR. The majority of physicians who launch the PACS to access images are specialists—for example, orthopedic surgeons who need to manipulate images for procedure-planning purposes. Non-DICOM images—such as those that accompany biopsy reports—are manually scanned in by the hospital’s health information management department; this will change when a universal DICOM/non-DICOM viewer is deployed later in the year, along with a vendor-neutral archive e that will store all images regardless of origin. “One big plus is that the quality of patient care improves, ” Cox observes. Physicians have faster access to patient data, including images; they need only log into one system to obtain all applicable records, not just the images and reports. He continues, “Instead of taking the time to log into one system for images and reports and another for everything else, they can see patient schedules, laboratory results, nurses’ notes,” and whatever additional information physicians might need to formulate decisions pertaining to patients’ treatment. Using the encrypted URL in Epic to view images and reports in the PACS also renders it easier for affiliated providers to get their hands on exam images. Local pediatric specialty groups are trained and subsequently authorized to use a system known as PedsConnect that affords them full EMR access and permits them to use the hospital’s EMR for their own patient records, as well as for billing and documentation. Moreover, Cox notes, the integration has simplified training. He says, “There is a big difference between having to learn only one system—as happens when platforms are integrated—and having to become familiar with two separate systems. With integration, they are up on everything in a fraction of the time.” A final benefit of image enablement for the EMR: It should pave the way for meeting stage 2 meaningful-use requirements. While stage 1 sets basic functionality parameters for the EMR, stage 2 rules include the image enablement of EMRs. “Image enablement for the EMR therefore helps us to position ourselves to support meaningful-use requirements,” Teubner concludes. It also has been, as Cox puts it, a win–win all around. Julie Ritzer Ross is a contributing writer for