Image Enabled EMR / EHR

ScImage Solution Series

I m a g e E n a b l e d E M R / E H R

A strategic approach to EMR integration and interoperability for diagnostic imaging and related reports

The Challenge:

In healthcare, imaging is routinely used as a tool for patient screening, diagnosis and therapy. Thus, images and their corresponding reports are vital to comprehensive evaluation in the clinical decision process. To that end, image enabling the electronic health record contributes to the collective knowledge presented in the patient’s medical record.

Abstract

Traditional interface engines alone do not provide a solution for EMR integration of diagnostic imaging and related reports. Furthermore, approaches relying upon image viewers that require client-side implementation pose formidable challenges in installation, compatibility, training and support, especially when these viewers must be installed at potentially hundreds of remote physician office locations.

The Solution:

A zero-footprint content delivery mechanism for diagnostic imaging and related documents based on ubiquitous, standards-based, portable technology. The Results:

 Single source EMR image integration utility overlaying all existing PACS or connected to a common VNA.  Reduced implementation, support and

training costs in having one EMR image viewer.

 Greater user satisfaction in having simple, high-quality access to an entire patient record, including images. The Implementation:

When designed using best-practice methodologies and industry standard technologies, this technology presents a new level of image enablement, distribution and interoperability for

Traditional interface engines alone do not provide a

solution for EMR integration of diagnostic imaging and related reports. Furthermore, approaches relying upon image viewers that require client-side implementation pose formidable challenges in installation, compatibility, training and support, especially when these viewers must be installed at potentially hundreds of remote physician office locations.

An all-inclusive electronic medical record requires interoperability with the image source for rapid, portable review of study images that provide visual context for clinical reports.

Multiple independent viewing tools not the answer

The ability to deliver images to the EMR should not arrive at the cost of end-user frustration. Linking multiple, independent PACS to the EMR using different viewers creates a perplexing medium for image review.

Users are subjected to multiple, disparate user interfaces with different visualization strengths and clinical focus; all staged for essentially the same purpose: Image presentation.

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Image Integration Benefits

patient reports.

 Improves patient understanding when used in conjunction with reports during consultation.

 Provides ubiquitous access and a more complete patient record for clinical stakeholders in all settings.  Typically includes basic window / level

and magnification tools for image content.

 More robust systems offer on demand drill-back to prior exams.

The Solution:

A zero-footprint content delivery mechanism for diagnostic imaging and related documents based on ubiquitous, standards-based, portable technology.

Zero-footprint means no download is required for image presentation. Zero-latency means no data is left behind when the viewing session is closed.

This new technology approach to image enabling healthcare information systems represents a significant benefit for referring physicians and attending medical staff.

When deployed within the scope of SSL encryption technology, this image presentation technology provides a secure, HIPAA compliant, low maintenance solution for healthcare information professionals.

A typical image integration server can aggregate any number of imaging and reporting systems and automatically forward URL link pointers to the EMR. Examples include:

 Traditional DICOM compliant PACS supporting DICOM Query / Retrieve and auto-routing.  Automatically index .pdf based reports.  Receive digital photos, video files and other

multi-media objects.

 Document imaging systems supporting and Application Programming Interface (API).

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The Results:

A

To simplify the user’s experience in the EMR, the image presentation tool should have the native ability to universally present images from any or all clinical image sources; DICOM or other multi-media format.

What this provides, along with a streamlined user experience, is a comprehensive overview of the patient’s clinical history, not a simple verbose snapshot. Pathology reports would now include the digital equivalent of a slide. Radiology observations would be supplemented with a

chest film or CT. An investigational heart catheterization would include dynamic images running 30 frames per second. And a 12-lead ECG would present the actual waveforms, with basic tools for re-sizing and magnification.

Full Diagnostic Access

In one distinct offering, the EMR image portal can also provide a one-click link to transition approved users to a diagnostic viewer complete with professional reading and analysis tools.

Simple access offers improved awareness. Improved decisions processes.

A simple URL based interface delivers image pointers to the target application (the EMR) which upon activation launches the requested clinical content in the image integration utility.

A Sample physicians’ portal application with URL links to PACS content. 

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Recommendations for

web-enabled EMR

image integration

review tools yet require no training.  Zero-install client provides anywhere

access to PACS content.

 Zero-latency presentation leaves no residual data.

 Microsoft Active Directory compliant to simplify user access management.  Capable of presenting static and

dynamic images to accommodate a broad spectrum of image sources.  Considered a plus to provide

diagnostic quality ECG traces over a self-standardized grid.

 Offers on-demand drill back access to prior images and other multi-media PACS content.

The Implementation:

S

An EMR image integration module generally requires little more than DICOM services to the source PACS and common HL7 integration to the host EMR. The core design is commonly engineered as a web service.

Most major EMR vendors currently accommodate encrypted URL pointers to the image object and subsequently present the link within the patient’s electronic folder. Some vendors offer code-to-code API interfaces for deeper integration.

In order to simplify the authentication process through your EMR, the image integration service should offer domain authentication using services such as Microsoft Active Directory. This eliminates secondary logins and maintains use of your EMR access logs, all while reducing support requirements.

Overlay existing PACS

Generally, the most efficient image source for EMR image integration is a vendor neutral archive or enterprise PACS. In the absence of either solution, a competent image integration solution should be capable of aggregating multiple independent PACS systems, regardless of the system’s clinical specialty.

From the user’s perspective, the process is simple and completely transparent: a link is presented in the EMR as a study description, the user simply clicks on the link to access the image or report object.

Standards based compatibility

A universal viewing application, by virtue of its intended use, should inherently work in all major computing platforms, including Microsoft Windows OS, Apple OS X, and Linux Desktop, along with all industry leading web browsers: Microsoft Internet Explorer, Mozilla Firefox, Apple Safari and Google Chrome. Finally, for complete portability, the EMR image utility should be optimized for operation in smart phones and web tablets, including iOS and Android.

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Implementation Scenarios

For Hospitals or Specialty Practices: Image/Report Access for the Referring Physician

Referring PCP using different EMR or no EMR Specialty Practice with image enabled EMR & PACS

Server

 Practice Management

 EDI billing / Claims Transactions  Electronic Payment Remittance  E-Prescribing

 Lab Interface  EMR

 PACS Server

 Uses local PACS for reading / reporting of exams

 Accesses images / reports in EMR via image integration web service

PCP accesses images / reports via image integration server directly

In this scenario, the image producing hospital or specialty practice needing image management uses a PACS server equipped with image integration services for internal EMR access as well as for access by referring practices.

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Implementation Scenarios

For Hospitals or Specialty Practices: Image/Report Access for the Referring Physician

ASP Based EMR Service

Hosted

EMR

Datacenter

 EDI billing / Claims Transactions  Electronic Payment Remittance  E-Prescribing  Lab Interface  EMR Other referring PCP using a different EMR or no EMR  PACS Datacenter  Long Term Archive

 Uses local caching server for reading / reporting

 Accesses images / reports in EMR via EMR image

integration utility

 Accesses images / reports in EMR via EMR image

integration utility

 Accesses images / reports via EMR image integration utility directly, by-passing EMR  Alternately, accesses images /

reports via EMR image integration utility

In this scenario, the PACS Server and image integration services are placed at the ASP hosting center. The image integration service provides image/report access via EMR or via direct access for referring physicians using a different EMR or having no EMR.