Radiology and diagnostic imaging centers, like their counterparts along the continuum of care, face an unprecedented demand to share clinical and billing data with others within the healthcare ecosystem. That means resources, budgets and strategic plans are tied up in pursuit of viable integration solutions.
Consider the following five areas where teleradiology is feeling the pinch:
Especially in rural areas, a hospital’s PACS may be connected to an Internet network with limited bandwidth, slowing down transmission of images for remote reads. That’s more than an inconvenience when the attending ER physician at a local facility suspects his patient may be on the verge of having a stroke. Delay in making a head CT read remotely at a regional medical center could have critical or fatal consequences.
In cases such as this, technology can accelerate image transmission and automatically format studies to HL7 and DICOM standards for sharing among facilities with diverse PACS, EHR and related systems. Turnaround times for reports may decrease from as much as 35 minutes to about five minutes with the appropriate implementation.
Inaccessibility of information
Interpretation of images “should be made with complete availability of relevant collateral information, including previous studies, electronic medical records, and details on the patient’s clinical symptoms and suspected diagnoses,” according to a white paper published by the American College of Radiology (ACR) Task Force on Teleradiology Practice. Lacking adequate access to prior reports, images or other pertinent patient information, a teleradiologist may not be able to render a complete analysis, which, in turn, could lead to costly additional testing.
“All efforts should be made to ensure meaningful comparisons of imaging studies across all settings,” the ACP report states.
Inconsistency in image sharing
Vendors of PACS, RIS and radiology reporting systems take different approaches to image sharing, at times impeding physician-patient communication. “Interoperability has been recognized as perhaps the biggest gap in what the health information technology domain has to offer patients, according to David Mendelson, MD, vice chair of radiology IT at Mount Sinai Health System in New York.
In response, the Radiological Society of North America (RSNA) and health data exchange advocate The Sequoia Project have launched a validation program for commercial systems. The joint effort aims to enable better-informed decisions about patient care — as well as more efficient utilization of imaging systems and elimination of redundant procedures. The initial pilot project tests systems’ functionality based on Integrating the Healthcare Enterprise (IHE) profiles in the areas of document source, registry/ repository, gateway and patient-focused image sharing through a personal health record system.
Persistence of manual processes
Reports generated by the teleradiology provider should be accessible through information systems used by the referring physician. Reliance on manual processes to associate reports with orders leads to patient misidentification errors and may contribute to adverse events in some cases. The emerging best practice, according to ACP, is to directly integrate between the PACS and the dictation reporting system.
Reimbursement remains a hindrance to the adoption of telemedicine — including teleradiology — in some states. “Medicare, which typically sets reimbursement standards, pays for telemedicine services only when patients live in Health Professional Shortage Areas and those who engage in face-to-face interactive video consultation services and some store-and-forward applications (e.g., teleradiology, remote electrocardiogram applications,” according to Altarum Institute, a non-profit health systems research and consulting organization.
“Without adequate reimbursement and revenue streams, providers may face obstacles in investing in these technologies,” an American Hospital Association report points out. As such, providers and health plans will need to collaborate with policy makers in discussions of teleradiology benefits and guidelines that would determine reimbursement eligibility.
Trading partner network
Despite these issues, radiologists and their colleagues have options at their disposal.
For instance, NetDirector’s cloud-based HealthData Exchange utilizes a normalization process that allows local and remote sites to map to standard HL7 or other data formats. By connecting once to HealthData Exchange, radiologists and imaging centers can communicate in real time with trading partners ranging from hospitals and physician groups to billing and insurance companies, as well as patient portals and government agencies.
The benefits of using HealthData Exchange include reduced time, cost and effort for RIS and PACS integration; streamlined clinical workflow and communications; automation of processes for paper-based practices; reduced administrative costs; and integration with existing IT investments.