September 2016

Imaging Informatics: Toward Full Access to Patient Records — Standards-Based Approach Links Data Siloes
By Steve Matheson
Radiology Today
Vol. 17 No. 9 P. 9

Physicians are under pressure to create better outcomes or face reduced compensation. A major contributor to better outcomes is providing physicians with easy access to full longitudinal patient records. Physicians have been promised that the longitudinal patient record would be realized, as they and their hospital shared the pain, cost, and disruption of adopting one of the new EMR systems. To date, that promise has not been delivered on, and many physicians would say their new EMR is not getting them any closer. The "why" of this is best understood when you examine the myriad of new and existing sources where patient data are generated.

Historically, the most important second source of patient data resided within the imaging systems. The most common of these, the PACS, is still being wrestled with to easily and seamlessly associate the patient data it contains with the patient data of the EMR, enabling a single integrated view for the physician. Most organizations are able to integrate medical images from a single PACS to the patient data of the EMR. Things get more complicated when multiple PACS exist in an organization.

Increasing Complexity
Many organizations have both a radiology and a cardiology PACS. Each requires integration into the EMR, and each provides its own viewer, as cardiology requires the viewer to support "cine-loops." Physicians are then required to learn two different viewers within the EMR: one for radiology and one for cardiology. This makes it more difficult to view images from both radiology and cardiology (eg, to view a chest X-ray alongside an angiogram for the same patient). The problem becomes even more complex for larger organizations that may have multiple radiology and/or cardiology PACS.

Adding to this complexity, PACS is now one of many standalone application environments creating patient data. Whether from an iPhone or a pill-sized endoscope, patient data are being created in ways not available just five years ago. The forms of those data are diverse. An endoscopy or esophageal video, a sleep study, or the photograph of a wound have little in common, other than their value to the physician; each contributes one additional detail to a full picture of the patient.

These new methods of creating patient data reinforce two realities: Physicians alone do not create the entirety of a patient's record, and the EMR does not provide access to that complete record. A patient is increasingly being seen by an extended team of care providers, inside and outside the walls of a hospital, and each provider brings a specific clinical specialty. With that clinical specialty comes another software application, disassociated from the EMR, where patient data are created and stored.

This type of environment is challenging because each application becomes its own silo of patient information. These silos cause the physician to "chase" the patient record through a series of viewers and portals that are often cobbled together by a hospital's IT staff. IT wants to provide a single access point for the patient record. Their challenge is that these many applications are not based on common architectures and standards.

Thus, each application requires a unique integration to the portal and, just as importantly, has no native facility to share data with the EMR. When there is no native facility to share data, integration often becomes a manual process, where patient data are printed and subsequently scanned into the EMR. When the application uses older technology, such as a VHS tape to store video, even a manual process might not be practical to provide the data to the EMR.

Single Source of Data
A different approach to ending the chase of patient data by the physician is to implement an independent clinical archive (ICA). The premise of the ICA is to use a standards-based approach to facilitate access to the data that reside in these applications. The ICA's value is its ability to aggregate disparate sources of patient data and facilitate the indexing, sharing, and accessing of the data, while retaining the data in their native format.

An ICA picks up the DICOM-specific capabilities of what a vendor neutral archive (VNA) provided to radiology and cardiology systems and enlarges it to include all unstructured content. It will often provide methods to pick up unstructured content, such as scanning a folder structure for patient data and obtaining the patient ID from the folder name, an XML file, or database associated with the unstructured content. These methods can allow the ICA to obtain patient information from applications that do not provide any standard methods of integration for patient information.

The ICA can then act as the single source of patient data from multiple applications. This allows the EMR to support one primary integration to the ICA for much of the patient data, as the ICA contains DICOM data from multiple PACS and also contains other unstructured data from other specialty applications. Things are further simplified through the use of an enterprise viewer that is supported by the ICA and provides access to all data types contained within the ICA. This configuration has the advantage that it allows physicians to be trained on a single viewer to access patient data from the EMR. Another advantage of accessing data from the ICA, rather than the originating application such as the PACS, is that it removes the burden of supporting EMR access from the originating application. By removing this burden, the performance of the originating application is not affected by access to patient data from the EMR.

For many physicians and clinical staff, an ICA begins to fulfill the promise of viewing a single, complete patient record. Physicians and their IT organizations should be examining how an ICA can facilitate easier and greater access to patient data and, through that access, improve patient outcomes. For more information about ICAs, visit MarketScape: AICA/VNA Platforms for Integrated Care at

— Steve Matheson is vice president of product management and North American sales at BridgeHead Software.