What You Need to Know About Providing Image Accessibility Within the Patient Record

How to Image-Enable the EMR

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Electronic Medical Records (EMRs) hold great promise for providing clinicians everywhere with centralized access to a patient’s entire medical history - every blood test, lab report, hos-pital stay, and of course, every medical image.

All is made possible by a completely connected, electronic IT infrastructure. It’s a great idea, but challenging and costly.

The reality is, getting the most out of your EMR isn’t easy. From an IT standpoint, bridging the gaps between the EMR and other systems is complicated, yet an essential cornerstone to creating a greater and more seamless flow of information within a digital infrastructure.

Just five years ago, providing central access to imaging from within the patient record was near impossible. Fast-forward to today, and the solutions are in reach for every provider, large and small. The intersection of cloud innovation, healthcare reforms, and standards is pro-pelling the medical world into a new era of information technology.

In this guide, we’ll tackle one of the most talked about integrations: image enabling the EMR. Throughout the following pages, we will discuss the various ways DICOM Grid can offer imaging support. After reading through the topics covered in this eBook, I invite healthcare leaders and professionals, as well as EMR vendors, to contact DICOM Grid to learn more about our integrations and offerings.

A Note From Morris PannerCEO DICOM Grid

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OverviewImaging is a key component of the patient health record and accessing all information in one comprehensive view is often critical to diagnosis and treatment. For that reason, physicians are demanding access to imaging within the EMR.

Care providers aren’t the only ones advocating for this technology. The Department of Health Services is offering financial incentives to organizations that can demonstrate the “meaningful use” of electronic records. Now, the pressure is on for organizations needing to meet certain requirements, including one that calls for access to radiology images and reports via a certi-fied electronic health record.

So, if physicians are asking for it, and through Meaningful Use incentives, the Federal gov-ernment is suggesting you give it to them, the big question becomes how? This document holds the answer. In this guide, we’ll first address the functionality you should expect from an image-enabled EMR. We’ll also make recommendations on different workflows that will help you put the concept into practice. In the last chapter, we’ll cover three tips to ensure your de-ployment runs smoothly. Let’s get started!

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What is an Image-Enabled EMR?As a term that is frequently tossed around, you probably have an idea of what image-enablement means. At the most basic level, it’s an integration that gives access to imaging from within the EMR. In fact, below is an example of what this integration can look like.

Tip: Make sure to click on the guest link in the patient jacket to launch DICOM Grid’s zero footprint viewer.

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Browser-based viewing: DICOM Grid’s zero footprint viewer is browser-based, requiring no installations or plugins. It’s the perfect solution for immediately launching images directly from the patient record.

Tip: Want to learn about browser-based viewers? Download DICOM Grid’s whitepaper on universal medical image viewers.

Single sign-on: A seamless login authenticates users into DICOM Grid and launches a feature rich, zero-footprint medical image viewer.

One-click access: Provide access to images and results within the patient jacket of the EMR.

Login to EMR Find Patient Click Image Link Launch Viewer

Functionality You Can Count OnNow that you’ve seen a quick preview of how you can access imaging through the EMR, let’s run through the specific functionality you can expect with this integration. If you choose to use DICOM Grid as your imaging partner (which we hope you do), the following capabilities will be made available to your users.

Who can access imaging? Both physicians and health-care staff as well as patients, via a patient portal, if that is enabled in your EMR.

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No plugins: Allow referring physicians to view images without downloading any additional software.

Mobile Accessibility: Take advantage of quick access to studies on tablet devices.

The Benefits of Image-EnablementA seamless EMR imaging integration gives medical staff access to diagnostic studies without installing any viewer or other imaging software on their computers. This is a key benefit and enables a healthcare provider to rely on just one integrated system. In some cases, if an orga-nization already distributes reports to referring facilities, image links can be embedded right into those reports. This means that even users outside of your organization can access studies without any downloads or specialized software.

View related studies and reports: From within the viewer, users can access related health information including prior imaging and reports.

Report Distribution: Distribute reports with contextually imbedded links.

Image sharing: Electronically share studies to preset physician groups or DICOM destinations (PACS).

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Understanding the WorkflowThe EMRs dominating the current marketplace offer little in the way of imaging. In fact, most EMRs can only display text-based radiology reports, not the actual diagnostic studies. The EMRs that do support imaging have limited capabilities, and typically display low-res versions in the form of screenshots or attachments. Any image intensive care provider working primar-ily within the EMR will tell you it’s not enough. These providers need access to the original DICOM in all its richness. Some organizations have addressed the issue with complex work-arounds and HL7 interfaces to connect their PACS/RIS/and EMR. These solutions are far from ideal. It is safe to say that until now, technological limitations forced the majority of practices to keep the imaging data separate from the EMR.

Cloud-based solutions for image management, like DICOM Grid’s, solve a critical challenge by giving healthcare organizations an agile framework to transmit studies over the Internet. In terms of accessibility, they give physicians the option to view studies from any computer or tablet. This is hugely valuable for a number of day-to-day clinical activities. However, under-standably, for physicians working primarily within the EMR, it would be more efficient to have

Want to know more about Meaningful Use? Download DICOM Grid’s eBook to learn about the imaging component of Meaningful Use Stage 2.

Having centralized access to imaging within the EMR is not only an operational convenience, but it can also have a compelling impact on patient care and safety. Seamless access to diagnostic studies can help to minimize repeat tests. This is important because unnecessary and duplicate exposure to radiation always carries some level of over exposure risks, and can increase patient care costs and lengthen time to care delivery.

For organizations attesting to Meaningful Use, image-enablement comes with an additional perk. An integration between your image management system and electronic health record can help to address a new Stage 2 menu objective aimed towards making imaging results and reports electronically accessible. We have spent a fair amount of time studying this and have set out a comprehensive analysis in a separate guide.

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the imaging data centrally accessible directly from the patient record. Without integrating the imaging with the patient record, EMR users are required to open a new browser, log into a separate system, and search to find a patient’s image exam. Consolidating imaging within the EMR eliminates the need to login into two systems and toggle between browsers. The question we hear time and time again, from both healthcare professionals and EMR ven-dors is, “How can it be done?” So, let’s dive into some of the nuts and bolts of how it works.

DICOM Grid offers a simple and seamless way to add imaging capabilities to your EMR. There are no complex steps and very quickly your team will be able to securely access imaging in the EMR and with no extra clicks. Nirvana, right?

We use a system of encrypted links. In essence, it is a very secure version of embedding a URL on a web site. All EMRs have the ability to create custom URLs or links within the patient record. DICOM Grid has a simple specification for the custom links, which enables the EMR to create and embed an encrypted image link using native EMR tools. When a user clicks the link within the patient record, the appropriate study (or studies) is opened in a zero footprint viewer. The links can have a wide variety of security mechanisms applied to them, includ-ing passwords, IP white listing, expiration times and a full SAML2.0 (single-sign on) authentication workflow. We developed this specif-ically so that healthcare institutions could have a one-click secure system.

Additionally, DICOM Grid’s technology can provide or enrich HL7 messages to embed the links directly into the patient record via an HL7 feed. This is particularly relevant for institutions, which seek to query and retrieve from multiple EMRs. In DICOM Grid’s case, we have a number of Health Informa-tion Exchanges (HIE) that are doing this. For customers requiring a deeper inte-gration, such as the need to custom-ize the user experience with specific approval workflows, DICOM Grid has a full REST API. HIE partic-ipants or readers thinking about embedding higher-level workflows into the EMR viewer experience, please contact us and we can share our learning.

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Understanding Security OptionsAs we alluded to above, what makes embedding an “imaging URL” in your EMR different is that you have to manage the security and access. What is great about the DICOM Grid system is that we make managing that security safe and configurable. What this means, is there are several security options to keep these links, and the imaging data that they display, protected. Below are just a few examples of security parameters, which can define how the links can be used:

• A link expires after x clicks• A link expires after x minutes• A link requires a password • A link can be retired at any point in time

Additionally, rather than restricting the links, you can limit the functionality of the viewer ses-sion. In other words, once a user clicks on a link to launch the viewer, you can limit the fea-tures that user can access. For example, certain viewer capabilities can be stripped away, such as the ability to make annotations.

Another security option is to whitelist certain IP addresses, meaning that only users logging in from certain site domains can access studies.

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3 Keys to SuccessPlanning for your image-enabled EMR is an exciting time! It’s about breaking down barriers and staying ahead of the technology curve. The deployment can be simple and cost-effec-tive using the technology described throughout this eBook. At DICOM Grid, we’ve worked with hospitals, practices, and EMR vendors to customize image integrations and we think it’s important to share what we’ve learned and what we know. Throughout the process of im-age-enabling your EMR, you’ll need to make some important decisions. Here are three de-ployment pearls of wisdom to consider.

Pull in your security officer earlyYour security and compliance teams should be involved early in the process to weigh functionality and security concerns. We have worked with many organi-zations to respond to security related concerns relating to audit trails, single-sign on, user privileges, etc. You’ll need to establish the right mix of settings and con-trols for your organization. In some situations, customizations may need to be developed to stay compliant with certain protocols. By bringing in your security officer early on, you can help to mitigate latent security concerns.

Create a strategy for physician adoptionDeploying an image-enabled EMR is a huge step in the right direction, but it’s not enough. In order to reap any benefits from the solution, care providers actually have to use it. You’ll need to put a plan in place to promote your EMR’s new capabilities. The best way to do this is to start early. Don’t wait until the day before your go-live date to promote the availability of imaging in the EMR. You’ll want to communicate the value to end users through various announce-ments and by including it in your EMR training documentation. Another tip is to use “beta testers” to help spread the word. Prior to launching your image-en-abled EMR, you can target a group of physicians to test the functionality. This puts the tools into practice ahead of time, and gives physicians the ability to provide feedback before the product is even live. Doing this provides a feeling of impor-tance to the beta testers, who will likely mention the capabilities to colleagues.

Think outside the EMRThere’s no better time to “think outside the EMR” than during the deployment process. It might be counter-intuitive, but while you’re laying the framework for image-enabling the EMR, you’ll also want to explore how you can leverage the technology in other facets of your institution. Two areas you may want to explore include image-enabling your patient portal and image-enabling your health in-formation exchange (HIE). The integrations necessary to image-enable a patient portal and/or an HIE are very similar to those of an EMR. As you’re crossing the hurdle with your EMR, be sure to inquire about other potential use cases.

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Who is DICOM Grid?We are a health IT company dedicated to making digital medical image exchange accessi-ble and affordable to all. By streamlining the medical image exchange process, we connect patients, care providers, and facilities worldwide. Our core product line, DG Suite, allows healthcare organizations of all sizes to manage diagnostic imaging and related health data safely in the Cloud. Additionally, through DG ImageShare, patients can store imaging data online and share with care providers.

DICOM Grid’s technology is used by leading hospital systems to share information in order to increase efficiencies, decrease costs, and improve the patient experience. New clients include Mayo Clinic, Rush University Medical Center, Memorial Hermann in Houston, Texas; Baptist Hospital of South Florida; Greater Houston Health Connect; Rush University Medical Center; and the Barrow Neurological Institute.

With over 1.2 billion images in our care, our team has a proven track record of planning and implementing successful image management strategies world-wide. Our professional services team has a deep understanding of the requirements for image-enabling the EMR and offers a range of workflows to help hospitals meet strategic image management goals and Meaningful Use objectives.

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Additional ResourcesStart your image-enablement project with a demo of DG Suite. You will be teamed up with an imaging expert who will assess your use case and walk you through the ins-and-outs of our deployment process.

A Deep Dive into Meaningful Use Stage 2Want to know more about Meaningful Use? Download DICOM Grid’s eBook to learn about the imaging component of Meaningful Use Stage 2.

The Ultimate Guide to Implementing a Medical Image Sharing PortalDiscover how easy it is to roll out a medical image sharing portal at your practice. Download this popular guide, which will walk you through the process.

Evaluating Universal Medical Image ViewersWondering what to look for in a DICOM viewer? Let this guide serve as your roadmap for navigating the vendor landscape.

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