Look, No Hands: Reports Go Directly to Referrer EMRs

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John Griffith, CIO of Epic Imaging, Portland, Ore, says, “They asked us for it, and we had to come up with a solution.” The radiology practice provides imaging for close to 2,000 physician referrers; what they wanted was electronically delivered radiology reports sent to their practices not via fax, nor even over the Web, where they had to reside as part of some queue. The physicians wanted the reports to show up automatically in each patient’s electronic medical record (EMR). They wanted to open the patient’s EMR and have the report right there waiting for them, with no staff time spent clicking links or handling paper.

“We realized we needed a solution, so we started looking for an HL7 interface.”
—John Griffith, CIO, Epic Imaging

The physicians’ requests came in 2006. Epic Imaging had successfully gone down the electronic report-delivery road once before, but had found the cost prohibitive. According to Griffith, the radiology practice had built an interface that would allow it to send reports to patient EMRs at the Kaiser Permanente hospitals in Portland. Epic picked up overflow imaging for Kaiser and provided studies that Kaiser didn’t have then, like PET/CT, Griffith says.

Building a one-off, customized interface for Kaiser, however, cost Epic about $20,000. That was far too much per interface if Epic was going to offer direct EMR delivery to its many referrers. Increasingly, though, the referrers were asking for it.

Gold Standard

Epic’s name comes from East Portland Imaging Center, the company’s progenitor that began with two radiography machines in 1964. Epic now has a vastly expanded East Portland site that includes women’s imaging and PET facilities, in addition to the main center. It also has a stand-alone center in Beaverton, a suburb on Portland’s West Side. Epic has the full range of modalities and employs about 20 radiologists, including subspecialists. Griffith says that the internal imaging volume is about 120,000 studies per year, with another 30,000 studies read for outside entities.

“We have been held as the gold standard for providing service,” Griffith says, but Epic administrators knew that if they were to retain that gold-standard mark in the face of increasing competition, they would have to answer the demand for electronic report delivery. “If our customers ask for it, we can’t help but provide it, because we know they have a choice in where they can send their business,” Griffith says.

Epic reads for Portland’s major subspecialty clinics and oncology practices, but hundreds of its clients are single-physician practices and small groups. Griffith says that Epic was determined to find a report-delivery system that would treat all EMR recipients equally, regardless of size. It also had to drop the interfacing cost way below the $20,000 range that Epic had experienced with Kaiser.

The Solution

Epic found the answer in a Plano, Tex-based software company called NeoTool that had developed what it called a NeoIntegrate health care integration engine. The NeoIntegrate software created an HL7 interface with the referring physicians' EMR systems. It could deliver radiology reports right into the patient’s record automatically. For Epic, that meant that a report would move to a patient's record when a radiologist signed off on the report. The NeoIntegrate system routed it to the EMR, with an electronic note asking the referrer's system to acknowledge receipt.

“We could not have used a Web-based system because the physician would still have had to log in, look up the patient, and move the report into the chart,” Griffith says. “The demand was to get that report seamlessly into the chart with very little human interaction.” The NeoIntegrate system, Griffith says, does that.

Griffith says that one reason that NeoTool was chosen to provide the HL7 interface was that it offered extensive training, including direct assistance with initial installations. Griffith sent his network administrator through the company’s training program.

Getting Technical

Installing the NeoIntegrate system is definitely not a plug-and-play situation. Both on Epic’s end and on the referring physician or clinic’s end, technical pieces had to be in place for the system to work. This meant that when an installation was done, the Epic network administrator had to do a fair amount of specific programming.

The first thing that Epic had to do was adapt its own equipment to the NeoIntegrate system. Epic, by the time