May 4, 2009

Got Interoperability?
By Jim Knaub
Radiology Today
Vol. 10 No. 9 P. 6

A COW brought my mother’s x-rays into her hospital room—a rolling computer on wheels, not a mooing bovine. The images were there on the screen: an anterior-posterior and a lateral view of her new left knee. In the upper left-hand corner was an IDX Imagecast PACS logo identifying the PACS. The images showed a left leg that was straight for the first time in many years.

Later that evening, the COW returned with the nurse to confirm my mom’s medications. (These things aren’t robots wandering around on their own.) She confirmed each pill with the doctors’ order on the Cerner Millennium electronic medical record (EMR) and computerized physician order entry (CPOE). The nurse also verbally confirmed the prescribed pills with a nurse’s aide, scanned the bar-coded identification bracelet on my mother’s wrist, and asked my mom to confirm her name before administering the pills.

The brands of the PACS and EMR were two of the first things I checked for when looking at the screen on the COW. With this impromptu case study in interoperability, my mother’s knee replacement surgery had crossed paths with my job.

The following morning, both her surgeon and her family physician came by the hospital on rounds and commented on lab results that had come back and made their way into the EMR. It was good news, ruling out a potential concern they’d both had. (It’s OK, my mom authorized me to use this personal information; there’s no need to call the HIPAA police.)

Going Live
As it turns out, York Hospital, part of WellSpan Health in southcentral Pennsylvania, was in the process of taking its EMR live while my mother was in for her knee replacement. In the three nights she was in the hospital, I saw how digital information and interoperability can—and should—help healthcare. At the same time, the experience showed how a number of factors have to come together for it to work as smoothly as it appeared to during this hospital stay. It also pointed out some of the challenges to broadly implementing an EMR.

One big factor for creating this network is that my mother’s physician works in a practice owned by the healthcare system and thus is tightly integrated to the hospital network, overcoming one of the big hurdles of centralizing and exchanging healthcare information.

Also, the x-ray images on the PACS were taken postoperatively in the hospital and were there for us to see. No prior images, including preoperative films from the orthopedic surgeon, were on the system.

 In many cases, these circumstances represent a best-case scenario of how PACS and EMR imaging can work. While there’s still much work to be done—and the Obama administration’s $19 billion commitment to EMRs is just a down payment—the potential showed me why such a system should be the target.

The hospital staff had tremendous information available at the patient’s bedside to keep them on top of the care they delivered. Several times during my mom’s three-night stay, a doctor or nurse raised a question about something and was able to have their question answered on the spot from the EMR. It was impressive, but there was also evidence of the learning curve. At one nursing station, I saw a posted list of abbreviations that were not to be used in the new systems, which makes sense considering there are 29 different medical definitions for the acronym ACC, ranging from access to adrenocortical carcinoma, according to A uniform set of standard acronyms has long been an issue with EMRs.

The York Hospital staff seemed comfortable working its way through its transition to digital record keeping, generally starting to see that the changes they were going through in the transition would prove worthwhile.

Room to Grow
The April 16 issue of The New England Journal of Medicine recently reported that 9% of hospitals use an EMR, far less than the roughly three quarters of the facilities that use digital imaging for at least some of their modalities. The journal reported that only 1.5% of U.S. hospitals have an EMR present in all clinical units, and an additional 7.6% have a system present in at least one clinical unit. CPOE for medications has been implemented in only 17% of hospitals.

The journal cited interoperability as a stumbling block to adopting digital record keeping. The Integrating the Healthcare Enterprise (IHE) initiative is an important step toward achieving broad interoperability. As consumers in the digital imaging marketplace, radiology groups and imaging facilities should demand that their vendors are working within the IHE to meet interoperability objectives.

— Jim Knaub is editor of Radiology Today.