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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