It’s a question often posed by thought-leaders and end-users in the imaging community: What prevents health IT from working as seamlessly, and with as much interoperability, as the technology that drives banking, travel or e-commerce? There are a few key issues, with the biggest one being demand, posits Steve Deaton, vice president of sales for Viztek, a PACS vendor with more than 2000 installations in hospitals and outpatient settings in the U.S.
“The primary hurdle is the generally slow pace of technology adoption in the healthcare space,” Deaton says. “The key to change is getting a critical mass of people to buy in. When you have 100 million patients demanding access to their imaging information, that is going to drive upstream adoption more powerfully than anything we’ve seen so far.”
Before that peak level of demand is reached, however, Deaton believes providers and vendors have a lot of preparation to do. Barriers to overcome include improving the basic functionality and usability of imaging and health IT, as well as surmounting some of the cultural assumptions that have allowed the medical profession to fall behind. “With reduced reimbursement driving everyone to do more with less, there is more of a sense of urgency in the medical community to leverage technology effectively,” he says.
The Device-agnostic revolution
Imaging IT experts often point out that the community’s interfaces lag well behind those seen in the consumer sphere in terms of both functionality and usability. Deaton concurs. “When the banking and travel industries moved online, they focused first on the consumer’s experience with the technology,” he says. “They built interfaces that were easy to use, friendly and readily accessible. Compared to that, it’s ridiculous that we still face situations where we can’t exchange a simple x-ray report between two organizations.”
As a result, when Viztek sought to introduce the next version of its RIS/PACS solutions, the company decided to build backward from a core goal: making the product entirely web-based and device-agnostic.
“We decided the product should be web-accessible for everything,” Deaton says. “That led us to look at internet access speeds, lack of control over or vetting of computers and workstations, and integrations of key solutions like dictation for radiology reports. We decided we wouldn’t make any sacrifices when it came to functionality—the viewer will work on any platform, the technology on any server farm. Software solutions today, just don’t offer this scope of accessibility.”
Key changes made in service of this goal included transitioning to server-side rendering and adopting coding technologies that go well beyond HTLM5 to support advanced web functionality. “Once the technology is truly accessible from anywhere, you stop thinking about where you can check your e-mail and start thinking about where your e-mail is right now,” Deaton says. “The actual device is meaningless. The same can and should be true for imaging. Workstations shouldn’t have to do the heavy lifting.”
As Deaton’s examples of the travel and banking industries indicate, interoperability is a challenge, but not an insurmountable one. “Overall technology adoption by physicians and patients alike is really the key,” he says. “Viztek has been successful in radiology because we focus on the user experience first and the data interoperability second. People have to like these products enough to want to use them.”
Most consumers have long since abandoned their reluctance to trust an ATM machine for personal banking, but healthcare continues to hold onto its fear of cloud-based transactions, a factor in the sector’s slow progress toward interoperability. “Online banking and government websites typically deploy 128-bit encryption and use standards like SSL for web security,” Deaton notes. “Similarly, we use SSL for encryption, but we up the level to 192-bit and sometimes beyond for accessing and transmitting images.”
Until healthcare organizations are willing to encrypt all patient data across the enterprise, however, Deaton believes they will continue to struggle with maintaining security. “We have customers implementing software to encrypt data at rest, where we feel it should be implemented globally for EHR, PACS and so on,” he says. “It’s best to have a global solution because ultimately it is the organization’s responsibility, and from an IT perspective, it’s always best to support a single method rather than one per vendor.”
In the meantime, Viztek is preparing itself by developing an EHR product that fully integrates with its PACS: “When the interoperability piece is in place, my PACS has all of the fields to store every piece of data that could be sent from an EHR,” he says. “Once the standards for exchanging patient records between EHRs are developed, I have the framework built and ready to go.”
Culture in transition
The real obstacle to developing and deploying those standards is culture, Deaton says. “Historically, people have seen the doctor as the be-all, end-all guiding beacon,” he says. “All of the knowledge necessary to treat the patient was thought to reside in the doctor’s mind. We all know that that’s impossible, but that’s the cultural understanding that many patients still have.”
A critical component of transitioning to a more patient-centric approach to medicine will be empowering patients to see themselves as vital players in their own care, Deaton says. “In fact, what doctors really want is for patients to be active participants in their own care. But first, patients need to embrace accepting some of the responsibility.”
It’s been a slow evolution, but thanks to programs like meaningful use, Deaton predicts that sea change is finally coming. As a result, Viztek’s EHR product also comes with a patient portal designed for widespread utilization.
“We’ve gone against the norm to bring better change faster,” he says. “Instead of looking at traditional programming code, we’ve gone and looked at companies like Facebook and Google. These companies use coding approaches that are designed for millions of users. We decided to refocus our core development team on adopting high-transaction languages, that support volume, accessibility and intuitive ease of use.”
If imaging IT can successfully shift its focus to improving the customer experience for both physicians and patients, interoperability will naturally follow, Deaton concludes. “Physicians have been practicing medicine for a long time without these capabilities, so they won’t create enough demand on their own,” he says. “We need to be focused on creating the kind of experience that makes patients want to have access to the technology as well. Once there’s enough demand, everybody will step up to the plate with the resources we need.
“Adoption by both physicians and patients,” Deaton says, “is what will force the hand of true interoperability.”