Federate? Migrate? Capitulate?

ACO Driven Workflow & Interoperability Mike LaChance, Vital Images

Young Woman? Elderly Woman?

The Situation:

This woman is sick and we need a diagnosis, we also need to know if she is ‘Young’ or ‘Elderly’

• An incorrect age assessment endangers her life

• Prior photos and descriptions exist

Original 1915 by the cartoonist W.E. Hill

Young Woman? Elderly Woman? Donald Balance

Start $10

Diagnostic Procedure, cost $5 $5

Diagnostic Procedure, cost $5 $0

Reimbursed $14 $14

Net $4

Accountable Claws Backs

Standard of Care, cost $7 $7

Quality of Care, cost $2 $5

HCAHPS, cost $2 $3

Total Net: $7 Loss

* Will be penalized with future penalties

Bernie Balance

Start $10

Diagnostic Procedure, cost $5 $5

Reimbursed $7 $12

Total Net $2

* Will be rewarded with future incentives

Accountable Care … … ‘Do Better with Less’

CMS’s CJR: Compressive Care for Joint Replacement

• 90 day episode retrospective

• Fee-for-Service during care

• Cost & Quality retrospective

inc. Patient Engagement (HCAHPS)

Providers’ Success Requires Great:

Communication, Coordination, Care

Interoperability Standards Alphabet Soup … … or Very Promising Initiatives?

HL7 … DICOM … IHE XDS SNOMED … LOINC … ICD … The Direct Project CommonWell Health Alliance Sequoia Project Carequality HL7 FHIR – “… the HTML of healthcare …” John Halamka, MD, MS CIO Harvard BIDMC

Argonaut Project DICOMweb ONC Interoperability Roadmap

(New) Reality…

2014 and 2015:

‘Meaningful Use, ICD-10, and keeping the lights on’ (HISTalk survey comment)

Today:

Accountable Care is the new reality – we have to find ways to extract more ‘meaningful’ value from the results of our Meaningful Use initiatives …

The good news is that there is lots of very relevant potential in our systems …

And, a number of contemporary technologies and solutions to help us harness that potential … and minimize change management …

IT Interoperability is … … Important & Challenging

In the News …

Somewhere along the way … … we forgot Departmental Workflow

Today’s ‘Departments’ now span

• Multiple locations

• Multiple Patient ID domains

• Multiple EMRs, HISs, HIMs

• Disparate departmental applications

You can’t change/upgrade all of your systems at once … but even if you could, there would still be workflow & interoperability challenges … make your current investments work for you …

Population Health versus Patient Health

‘Departments’ provide bulk of diagnostic care

Very Promising News … … Modern Middleware Solutions

Expect more from a contemporary Workflow & Interoperability Engine:

• ‘Listen’ to all messaging, e.g., HL7, DICOM

• Keep track of messages … expand the temporal dimension

• Be able to read and act upon all messages and structured data (discrete and codified) including morphing, translating data, and triggering messages, dataflows and workflow

• Be an Interface Engine .. be a Routing Engine … be an ‘intelligent’ Rules Engine

• Function as a distributed service spanning the enterprise, not a box

• Provide aggregated access to federated and/or centralized data sources (traditional ECM/VNA)

• Provide, or at least facilitate, records-of-truth for workflow, analytics, population health

• Patient Matching (internal eMPI)

• Leverage Contemporary Technologies (FHIR, XDS, DICOMweb)

Simple Enterprise Viewer Example

Challenge: major teaching institution rolls out an enterprise viewer on top of an existing VNA and several new caches … but users complain of poor performance and IT doesn’t like caches

Solution: DICOMweb enable the storage and the enterprise viewer

Outcome: clinical users thrilled with experience, IT happy to eliminate caches, everyone relieved to eliminate potential data synchronization issues

VNA

Cache Cache

DICOMweb DICOMweb

DICOMweb

DICOMweb

Lessons Learned from a Existing VNA Deployments

Consolidated Information In a traditional VNA

• PACS are pointed at the VNA

• Historical studies were migrated to the VNA

… but …

• Enterprise viewing performance is slow

• Relevant priors don’t display properly

• Information not in the VNA is not available

Solution: ‘frontend’ the VNA with a contemporary Workflow & Interoperability Engine

Images and reports are updated and morphed based on destination

‘Un-migrated’ information is effectively accessible

Cardiology Example

Multi-facility IDN • Disparate MRNs

• Intent to systematically sunset departmental applications

• Eventually rolling out IDN-wide EMR, including some departmental applications

Where to start? Some of the functionality:

• Provide patient matching

• Relevant priors engine, image & report morphing

• Translating measurements and reports, DMWL, etc.

• Triggering orders and billing events

• Various data migration plans

Benefits:

Achieve IDN goals now, including Quality & Cost

Sunset existing applications fearlessly and responsibly

Rollout EMR and departmental applications when ready

Accountable Care … … Enterprise Imaging Platform

Top 9 Recommendations

9. Develop an Enterprise Imaging Informatics Platform Strategy

8. Take the Accountable Care movement seriously

7. Enable Cross Enterprise Sharing & Collaboration

6. Demand enterprise class performance, reliability, and TCO (perhaps an SLA-based partnership*)

5. Consolidate data access, migrate for the right reasons, embrace a ‘hybrid’ environment

4. Leverage Contemporary Standards and Technologies

3. Data Liquidity, Security … and Integrity

2. Focus on both Population & Patient Health

1. Delighting your stakeholders, starting with the clinicians and patients

Thank You!

Mike LaChance Vital Images Exhibit #732

Contribute and learn! The IHE Radiology Technical Committee!

Publish new IHE Radiology Profiles:

• Address the interoperability use cases defined • Select appropriate standards • Developed the detailed implementation specifications

Key Dates: (approximate annual cycle dates)

• December – initial Tech Committee meeting • February – meeting to publish profiles for Public Comment • April – meeting to review Public Comments and publish for

Trial Implementation

www.ihe.net and wiki.ihe.net