In Part I, the white paper makes the case for how securing access of images supports stronger outcomes, which is one of the goals of value-based care. In Part II, this white paper continues to look at how an Enterprise Imaging Platform can achieve this goal in and out of the healthcare setting.

Transitioning from Hospital to Home

As patients transition from hospital to home or to long-term acute care facilities, new caregivers enter the picture. The home health nurse may not be intimately familiar with the patient’s case, so accessing the same data and images as the hospital-based care team will give that practitioner the ability to assess the patient’s wellbeing in a more informed manner.

Imagine, for example, that a patient transitioning from hospital to home has a documented pressure ulcer. Pressure ulcers in hospitalized patients are categorized and carefully monitored throughout their stay. Their condition is well documented and digital photographs are often taken to give hospital personnel a visual record of the wound’s progression. Upon discharge, changes are documented and added to the patient’s EHR.

When the patient transitions from hospital to home, however, images are rarely available to the home health provider. When viewing the healing state of a wound, the home health nurse must be able to assess if the wound state has improved or deteriorated since the last evaluation. But without access to longitudinal images, the at-home caregiver will be forced to rely only on written – or worse, verbal – descriptions, which will inevitably be interpreted subjectively. Therefore, the home health nurse may think the condition is worsening without a concrete method for determining if that is speculation or fact. This lack of comparative visual information might result in an unnecessary trip to the Emergency Department (ED), or worse, a delay in appropriate care that might result in readmission. Informed monitoring of the wound’s condition could minimize such taxing of the healthcare system and stress of the patient – and the resulting penalties now attached to events such as readmissions.

Consider, however, the difference in quality of care if that home health nurse could view the patient’s images in a single location and select those images for side-by-side comparison viewing. That’s the strength and practicality of Enterprise Imaging, and something that many CIOs have overlooked in their EHR planning. Sharing images, regardless of the source, is key to value-based care.  It is critical that all members of the care team be able to see the same information – and the information must include images to be comprehensive.

Giving the home health provider access to the same images as the care team at the hospital, and allowing both teams to view the images in truly meaningful ways, will facilitate informed care conversations among providers and encourage better overall care coordination for the patient. It may also help prevent unnecessary return hospital visits which are costly for the patient both economically and emotionally and which may result in non-payment for the hospital under the new value-based healthcare regulations.

In the past, images such as these were simply taken with digital cameras, printed and included in a paper-based file on the patient, clearly not something which can be shared easily. Today, with a robust Enterprise Imaging platform, specialized applications integrate images taken using the camera in a practitioner’s – or the patient’s – mobile phone with the patient’s EHR. These applications work in a natural way: Practitioners snap a photo with their mobile phones, select the patient’s name and demographics from the application’s worklist, and assign a standardized name to the image set, uploading the information and image to the enterprise imaging platform which subsequently makes it available via the EHR – all with just a few quick clicks. Today’s technology advancements can even enable this type of transaction to take place in a secure cloud so the images aren’t stored on the practitioner’s phone to help protect the patient’s protected health information (PHI).

Reducing Repeat Exams

Clearly, to be of the most value and use, images must be accessible at the point of care – wherever that may be – without having to be physically moved, and an Enterprise Imaging platform provides the means to make this possible. If a patient sees multiple providers, which is certainly a typical care scenario, the goal of a successful health organization should be for all members of the patient’s care team to have access to that patient’s clinical history. Care is no longer limited by physical proximity and a true Enterprise Imaging platform must build clinical networks to suit the needs of the patient.

By enabling the patient’s entire care team to see the appropriate level of the patient’s healthcare record – including both data and images – the patient’s primary doctor and others affiliated with that healthcare system are able to access the information with relative ease, a move which can dramatically reduce the need for repeat imaging scans. The key words here are “affiliated with that healthcare system.” An additional significant problem exists when practitioners outside the patient’s primary health system who have disparate IT solutions need to access the same data and images.

When a patient is transferred from one facility to another, for example, the patient’s continuity of care document (CCD), which houses that patient’s pertinent progress notes, lab results, radiology results and any related textual data, must be physically transferred to the receiving facility. Imagine having the ability to send a hyperlink to the relevant images to the receiving facility rather than physically transferring a CD or film, allowing practitioners on the receiving end to access and view the images in a secure way in the cloud, and to download images on an as-needed basis.

These are the kinds of innovations an Enterprise Imaging platform can bring about, and the positive effect on value-based, patient-centric care can be significant. Consider a neurology patient, for example, who had a CT scan just one week ago. While on vacation in another state, the patient presents at the ED with severe headaches. Clearly, it would be advantageous for the treating ED physician to be able to see the prior scans. Without access to the images, however, the ED physician orders new scans, exposing the patient to additional radiation and creating testing costs that could have been avoided. If they had access to the scans taken a week ago, the ED may not have needed to subject the patient to another $3,000 study, and in the half hour required to re-take those images, physicians might have already known what the images showed and formulated a treatment plan – or, at a minimum, they could have had the prior images to compare to the new ones, increasing their knowledge about the patient’s condition and their ability to make rapid, informed decisions.

Patients don’t have to be out of town for similar scenarios to take place. Perhaps a family practitioner orders a CT scan for a patient; the patient then decides to see a neurologist for a second opinion. If they don’t bring the original scan with them on CD or film, the specialist will need to order another test, something which costs America’s healthcare system millions of dollars a year – costs which healthcare organizations are going to be held accountable for under MACRA and the Affordable Care Act. With secure image exchange, a greater depth of clinical information is provided, which can shorten the time to diagnosis and treatment and increase the quality of care overall.

As an industry, we know we can do better. And interoperable enterprise imaging solutions are the first step to curbing this kind of enormous waste. In the same scenario, when the patient visits a specialist, if the patient had been given online access to their own medical records, including their images, they could have easily and securely shared those with the neurologist with just a few simple mouse clicks.

Just think how important that might be to snowbirds who winter in Florida but spend the rest of the year at their home in Ohio. If something happens while they’re in Florida, they could simply give the local Florida physician online access to their medical images that reside with their healthcare facility or imaging center back home in Ohio rather than bearing the responsibility for transporting those images themselves on CD or film. With today’s technology, the Florida doctor can easily access the images in Ohio, then decide if a copy of the images needs to be moved to the local system. By accessing the images through secure communication pathways via the cloud or directly using secure https, images can be shared in real time, significant storage costs can be defrayed and, most importantly, the provider caring for the patient can have access to the information needed to care for the patient without burdening the patient or the health system by repeating the exam.

Enabling Telehealth

Another – and increasingly popular – way patient images can now be shared electronically is through telehealth solutions. Like teleradiology, the forerunner of today’s telehealth, a natural extension of enterprise imaging is the secure transmission of digital photos between patient and provider, giving Enterprise Imaging a significant role in the advancement of telehealth initiatives.

If a patient has knee surgery, for example, and is at home recuperating, and three days later the incision is red and inflamed, does that patient need to return to the doctor or hospital to be evaluated? Perhaps, and perhaps not. Today, if the patient calls and describes the redness to the clinician, the physician, in most cases, will ask the patient to come into the office for an evaluation.

However, for tech-savvy patients – particularly millennials who have grown up with a mobile phone in their hands – it’s second nature to snap a quick picture of an area of interest with their phone and simply text it to their caregiver for review. This poses a possible security risk for the patient of the method of transmitting the photograph is not secure.

Secure or not, this happens every day. We live in a society powered by visual communication through applications like Snapchat and Instagram, and we’re seeing this practice extend to healthcare. Whether it’s a patient texting photos of an incision to their surgeon or parents texting photos of a rash to their pediatrician, people are simply looking for the most natural and efficient ways to share visual information with their caregivers.

Telehealth, enabled by Enterprise Imaging, provides a secure, private and documented mechanism for them to do just that. Via an integrated telehealth solution, patients can securely upload photos or other images to their doctors, sharing information with clinicians that can easily be added to their EHR and reduce the number of in-person visits the patient must make to the physician’s office. 

What if patients could download a secure mobile application that allowed them to snap those photos on their smartphones and easily transmit them to their physicians for review and reference? Think of it as the enablement of “medical selfies.” That’s Enterprise Imaging.

Think too about the importance of physician-to-physician telehealth consults.  The most innovative enterprise imaging solutions provide enhanced viewing, clinical depth and collaboration on a single web viewer. If a patient presents at a local hospital with serious burns, for example, the ED physician will need to decide whether to treat or transport the patient to a specialized burn center. If they had the capability to capture and upload photographs of the burn areas as well as imaging data from different departments and multiple sources and, in real time, consult with specialists at a regional burn center, the doctors could collaboratively decide whether the patient needs to be transported or if the community hospital would be able to treat the burns locally.

And, if the decision is made to treat locally, sharing images between the two facilities throughout the patient’s stay would allow the patient to receive a more informed quality of care and perhaps a better outcome at a lower cost by enacting a treatment plan guided by specialists many miles away. The Enterprise Imaging solution should allow clinicians to choose easily between “reference quality” image viewing and full fidelity, diagnostic quality image viewing. The choice broadens the available data for real time decision making at the point of care.

Images Affect Value-Based Care

If there is one takeaway from this white paper, it’s this: There is an explosion of images that are being created today, and many of those images are being mismanaged along the way. Yet, access to these images is becoming the cornerstone of high quality, value-based care, and that means the images must be available to all of a patient’s caregivers in a more organized, linear and secure fashion to help contribute to a quality outcome for the patient and fully entitled reimbursements for the provider.

As a result, enterprise imaging decision makers – which include healthcare CIOs, chief medical officers, and chief nursing officers in addition to radiology administrative and medical directors – must all understand that imaging has grown beyond the boundaries of radiology, and they must embrace this change. Because it is becoming increasingly critical for clinicians throughout the spectrum of care to have a unified, longitudinal view of the patient’s images and related contextual information, patient images can no longer reside solely within the silo of a single service line or department.

Radiology PACS workflows, therefore, are no longer sufficient when considering the need to acquire, store and share images with non-radiology disciplines. From parents who text their pediatrician photos of their children’s rashes to specialists collaborating on the toughest and most critical of cases, images play a key role in the shift from volume-based care to value-based care, and in helping achieve the goal of obtaining better outcomes for each individual patient.

Images – and, increasingly, videos and documents – of a patient’s care must be able to follow the patient throughout the progression of a health event. If a patient presents in the ED with an injury, for example, it is beneficial to document both the superficial condition as well as the internal damage. Today, an ED physician may have to include a rudimentary drawing in the EHR to denote where the superficial injury is located, then order an X-ray to complete the clinical visualization of the patient’s condition for the plastic surgeon or orthopedist who will see that patient next. But imagine the increased efficiency if the specialist had images from multiple points of acquisition (digital photo and x-ray, for example) to reflect both internal and external conditions. These images provide relevant clinical insight during diagnosis and treatment planning, and they now can be available within the EHR.

Consider, too, how useful it might be to record interviews at regular intervals with Alzheimer’s patients to track the progression of the disease, and to share those interviews with a variety of the patient’s caregivers from general practitioners to neurologists to home health providers. There are abundant use cases for quality enterprise imaging solutions that help clinicians follow the patient’s journey from hospital to home, each of which points to the need for images to be captured and shared in a more bountiful, multidisciplinary, multi-device fashion.

To enable true care coordination for the patient, we must move images out of their silos, which means image management can no longer be relegated solely to the realm of radiology or cardiology. To remain satisfied with the status quo is to ignore the obvious: Images are already being captured throughout a spectrum of disciplines, but they are not being managed in a way that provides consistency, “shareability” or regulatory compliance.

Worried about whether to deconstruct or reconstruct your PACS? No need. Enterprise Imaging provides the answer. From advanced visualization tools and measurements to “medical selfies,” health organizations must examine a comprehensive Enterprise Imaging platform in order to meet the sophisticated needs of department and referring clinicians as well as engaged patients in today’s value-based care environment.

About the Author:

Kim Garriott is the Principal Consultant, Healthcare Strategies, Logicalis Healthcare Solutions