Image Exchange Down Under — Australian Health Information Exchange Utilizes VNA
By David Yeager
Vol. 13 No. 10 P. 6
The idea of health information exchanges (HIEs) for patient data has been around for a while, but interest increased in 2009 when the American Recovery and Reinvestment Act was passed, providing grants to support statewide exchange efforts. Several states, including Delaware, Indiana, Maryland, and North Carolina, are now expanding or moving forward with statewide HIEs.
However, federal and state regulations for these exchanges are still being defined and, for the most part, most HIEs are struggling to achieve sustainability. With few examples of large-scale HIEs to draw from, an HIE pilot program for medical images and reports launched earlier this year in New South Wales, Australia, may provide some helpful insight.
New South Wales’ enterprise imaging repository, part of the Australian state’s Medical Imaging Program, uses a vendor-neutral archive to link 130 facilities in 15 geographically dispersed health districts as well as a specialty children’s hospital network. Those facilities were chosen because they have a considerable cross-border patient flow and use different PACS/RIS products. TeraMedica's Evercore archive is the system that was selected for the project.
Because a project of this nature had never been tried in Australia, Joe Hughes, program manager at Health Support Services for the New South Wales Health Medical Imaging Program, says pulling it all together required significant resources and support from New South Wales’ government. It also required integration among the health districts and close cooperation between the HIE and the various technology vendors.
“You can’t expect a PACS or RIS vendor who’s never done this before to be able to do it quickly and easily,” Hughes says. “They’re going to have to be brought along on the journey as well, and it’s going to mean working very closely with them to ensure that they apply the resources that are required.”
The implementation requires two steps in each district. The first is a statewide patient registry that links to the federal government’s national health identifier service, which allows management of patient identities throughout the network. The second step is to enable medical image sharing across sites, which requires integrating disparate IT systems from each health district so they could use uniform data. When a patient is admitted to a hospital, the imaging repository inserts a link into the patient’s file in the facility’s EMR. Clinicians then are able to access a compressed medical image at the point of care, which saves time and bandwidth.
New South Wales’ government expects the imaging repository to become a critical piece of its HIT infrastructure. The replicated archive runs across two data centers that are 10 miles apart, minimizing the risk of data loss in the event of a disaster. It also reduces the need for storage at the local facilities, saving money, disk space, and valuable data center footage.
The imaging repository may reduce image transfers as well. Although its effect hasn’t been measured yet, Hughes surmises that eliminating the need to use manual data transfer methods, such as DICOM Push, CDs, or film, will save money and transport costs associated with unnecessary image transfers. If a patient is transferred without images, a doctor can look them up in the imaging repository. It’s also expected to reduce the need for duplicate imaging, reducing patients’ radiation exposure and saving money. But the benefits extend beyond radiology.
“Don’t get too caught up in the value to radiology alone,” Hughes says. “There is definitely value there, but that in itself, in our case, isn’t the main value. The message is to ensure that the clinical value is sold to the stakeholders involved.”
While radiologists appreciate the increased access to prior studies, implementing the imaging repository required extra work for radiology departments. Hughes says explaining how the repository would help its referrers—its customers—helped to get them on board. Since the imaging repository became operational, the response from radiologists and referrers has been good.
“The clinicians and radiologists are all very excited and positive and passionate about what we’ve done, and it’s actually an easy program to work on, in that regard, because the benefits are fairly immediate as soon as you switch it on,” Hughes says. “It’s similar to PACS/RIS in that as soon as you turn a PACS/RIS system on, if they haven’t had one before, clinicians just love it from day one.”
Although there have been inquiries from other Australian states about how New South Wales is implementing the repository, Hughes says there are no plans for a national imaging repository. Instead, Australia is moving forward with plans for personally controlled EHRs that will eventually be able to access patient studies in the repository.
In the United States
So how does this translate to the United States? There won’t be a centralized effort like New South Wales’, but the federal government has become increasingly interested in medical data exchange, notably through the Office of the National Coordinator’s (ONC) meaningful use rules governing EHRs. And the recent inclusion of medical image provisions in the stage 2 rules demonstrates that the ONC recognizes the importance of medical imaging in care delivery. Although HIE adoption will most likely occur in a less coordinated way, Hughes says smaller entities can derive significant benefit from HIE implementation.
“If you’ve got a group of hospitals that specialize in different treatments in a [geographical] area, or even if they’re owned by different providers, then I would imagine a system like what we’re implementing would be of value,” Hughes says. “If they have a requirement to share imaging across different jurisdictions and different organizations, then I think doing it with a vendor-neutral archive, in the way we’ve done it, is well worth the journey.”
— David Yeager is a freelance writer and editor based in Royersford, Pennsylvania. He is a frequent contributor to Radiology Today.