NEW ORLEANS - The capability to view diagnostic images as part of an enterprise-wide electronic health record (EHR) is among the more attractive features helping to promote the adoption of these applications.
Although the deployment of EHR products is still in its infancy, a comprehensive and full-featured enterprise image-distribution strategy is an absolute requirement for the success of these systems, according to Dr. Paul Chang, a co-founder of the PACS firm Stentor (now part of Andover, MA-based Philips Medical Systems).
"I strongly believe that the image-enabled EHR cannot be a toy, it has to be a completely acceptable proxy for whatever it is trying to replace," Chang said. "Image integration and presentation cannot be achieved by sacrificing functionality, fidelity, or accuracy. If you just show a thumbnail or a JPEG of an image, you cannot make a diagnostic decision based on that representation."
Chang is currently the vice chairman of radiology informatics and medical director of pathology informatics at the University of Chicago Pritzker School of Medicine in Illinois, as well as the medical director of enterprise imaging at the University of Chicago Medical Center. He offered his vision of enterprise integration strategies for the image-enabled EHR in a presentation this week at the Healthcare Information and Management Systems Society (HIMSS) conference.
"Many medical decisions are made by nonradiologists looking at images," Chang noted. "They're taking the ultimate patient-management risk. So there is no way that I'm going to give them an integrated EHR where the images are crippled."
Chang's multifaceted expertise as a clinician, IT architect, and application developer have allowed him to understand that, although physicians throughout an enterprise want access to a patient's dataset, not all physicians need -- or desire -- access to that data in a similar manner.
"One size does not fit all," he said. "The presentation and functionality of images and information must be optimized for heterogeneous users and workflow."
This means that an image-enabled EHR must support all multimedia objects, such as visible light (pathology, dermatology, ophthalmology, and so on), video, waveform, and other types of non-DICOM studies, according to Chang. This is because radiologists aren't the only clinicians who generate or need images, he said.
"Today's challenge is not to just have a PACS that works only in radiology," he said. "What we really should be talking about is that PACS is just one small tactical component of a fully leveraged electronic-based workflow and practice management that supports more complex requirements, not only in radiology but throughout the enterprise that requires integration and interoperability with the EHR."
Although DICOM supports visible light images and waveforms (such as ECGs and EEGs) and has the advantage of automatically associating image data with patient demographics and other contextual information, in practice the standard has not yet seen the penetration into other medical specialties that it enjoys in radiology, according to Chang.
"Unfortunately, the majority of existing visible light image generation devices do not currently support DICOM, or do so incompletely and expensively," he said.
One possible solution for these non-DICOM images is to house them in an independent archive and database. From this virtual space, the image data could then be cloaked in a DICOM wrapper, essentially creating a metadata element of the image when it was called by a user to the presentation state of an EHR.
To achieve this end, there is a need for workflow and information management systems similar to RIS products for some of the medical specialties that generate visible light objects, Chang said.
As to the current crop of EHR products, he sees promise in the technology, but believes the market has some major challenges to resolve.
According to Chang, the limitation of current vendor EHR offerings is that there is suboptimal performance and scalability of thick clients; an inability to provide optimized or customized solutions for specific workflow domains; and a delay in responding to changing priorities and user-functional specifications.
"We need a much more agile approach from our vendors," he said. "We need a more flexible, capable, scalable architecture to achieve integration."
By Jonathan S. Batchelor
AuntMinnie.com staff writer
March 1, 2007
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