Everyone who works in health care these days is exposed to an ever-growing cornucopia of acronyms. Among this list is HIE, which, like many others, seems to mean something different depending on the context of the discussion. Health Information Exchange (HIE), as the name implies, is simply doctors, nurses, pharmacists, other health care providers, and patients securely sharing medical information electronically. HIE may also refer to the entity or organization that collects and facilitates the exchange of this health information. An HIE entity is often organized to collect and share such data within a health system or geographic community.
Ideally, the exchange of this information would allow for improved patient care at a lower cost. On paper, this makes sense, but in practice, there are relatively few formal HIE entities. Although health care providers exchange information repeatedly throughout the practical workday, that exchange rarely improves care or decreases costs. To complicate matters, there are innumerable PACS, RIS, EMR, and other systems housing vital health care information throughout the health care delivery community, thus making true interoperability beyond the HIE an incredible challenge for radiology providers.
Despite these challenges, radiology groups must highly prioritize delivery of quality patient care at a lower cost. One way to accomplish this is to be a leader in your health care delivery system and community by working to improve HIE, regardless of whether a formal HIE exists in your marketplace. For radiology groups, there are several key considerations for optimizing the flow of information, including the following:
• creating a system by which radiologists can fill the role of consultant to their referring clinicians;
• making sure radiologists receive all pertinent clinical information, eg, prior imaging and patient history from clinicians;
• creating seamless delivery of final radiology reports from the radiology providers directly to referring provider EMR systems; and
• participating with Integrating the Healthcare Enterprise (IHE)—yes, another acronym—to help shape the standardization of radiology interoperability going forward.
In days gone by, radiologists were often referred to as "the doctor's doctor." Interactions with referring clinicians often took place in the radiology department over a set of films. In the digital age, this physician-to-physician interaction has, in many cases, dwindled or gone away completely. This has created a perception of radiologists as "order takers" who are responsible for merely providing reports or performing procedures ordered by referral sources. Radiology providers must dispel this myth and get back to being consultants to referring physicians.
The information exchange that must take place in this scenario is twofold. First, systems must be created that allow radiologists to access information that will enable them to understand referring clinicians' and patients' chief concerns and clinical interests from an imaging standpoint. Armed with this information, radiologists can tailor the imaging exams to produce optimal clinical diagnoses.
Secondly, such systems should allow radiologists to consult with referring clinicians and help them order more relevant and clinically appropriate studies. The free flow of information among providers will bring back the "doctor's doctor" mindset. While clinical decision support, along with appropriate use criteria, may be coming down the road to facilitate some of these discussions, we should begin developing consultative radiology processes and reestablishing the doctor's doctor concept immediately, sooner rather than later.
Pertinent Clinical Information
When designing information exchange processes, it is imperative to make sure all pertinent clinical information is provided from the referring clinician to the radiologist. For example, having access to review all prior imaging studies and radiologist reports will improve accuracy and unequivocal interpretive or procedural services. Also, patient signs and symptoms and any physical observations made by technologists or nurses should be captured and presented to the radiologists so that patient care will be optimized. Too often, images are presented to radiologists to interpret without having a backstory. Finding Waldo is hard to do, but it becomes easier if as much information as available is provided; it can help focus the search to specific areas. Similarly, if radiologists are given pertinent clinical information, it gives them valuable insight to diagnose and treat more specifically and clearly.
Radiology Report Distribution
Creating seamless delivery of final radiology reports from radiology providers directly to referring provider EMR systems and patient portals will close the information exchange loop. A chief executive of a large health system once referred to radiology reports as "fire-and-forget missiles." This was an interesting way of saying that, too often, radiologists complete a report and don't give enough thought to where the report goes, who reads it, if it made it to its intended destination, or whether it was acted upon appropriately. Similarly, radiologists assume that, since the report is available in PACS or RIS, the referring providers can find the report and access it if needed. We can't have final radiology reports being "fired and forgotten," and we must make sure that reports flow directly to referring clinicians as well as patient portals. Although a discussion of structured reports and critical results reporting is a topic for an entire article of its own, needless to say, there are plenty of references to best practices in these areas to call upon. The bottom line is that optimal information exchange must include a very specific report delivery strategy, and it starts with delivering reports directly to a clinician's clinical systems.
Participate With IHE
Do not be confused; you are still reading an article about HIE. Part of looking ahead and optimizing HIE is making sure to take part in the IHE. We promise this isn't a cruel acronym joke. IHE is the Integrating the Healthcare Enterprise organization and was established to promote the use of existing standards to improve interoperability among health care information systems. It is safe to say that the more IHE is successful, the more effective and efficient HIE will become. Radiology providers should join IHE to learn how exchange of radiology information should occur. Go to http://www.ihe.net/Join to learn more.
Exchange of health care information happens all day, every day in our practices and facility locations. As we wait for more formal guidance on HIE, radiologists should make sure the key areas are addressed in their daily information exchange.
— Michael Langbenberg, CPA, is the executive director for University Radiology in Knoxville, Tennessee. He also serves on the board of directors of the Radiology Business Management Association and is president of the East Tennessee Radiology Society.
— Laura K. Findeiss, MD, is a professor and chair of the department of radiology at the University of Tennessee Medical Center in Knoxville, Tennessee. She has served on the board of directors of the Society of Interventional Radiology (SIR) Foundation and currently sits on the executive council of SIR , the leadership council of the Cardiovascular Radiology and Intervention Council of the American Heart Association, and the education committee of the Society for Vascular Medicine.