EMR, EHR, PACS & VNA: Looking Beyond the Acronyms [Part Two of Two]

These Letters Have a Lot to Say about the Past, Present and Future of Healthcare IT

Per leggere la storia in italiano, clicca qui

Dario Arfelli, Carestream Health

Last week, Part I of this series looked at the motivations, challenges and standards involved in developing EMR / EHRs to support more efficient and effective patient-centered care. We also looked into the history of the PACS concept for acquiring, archiving, managing and accessing radiology images.

In Part II, we look at the evolution of PACS technology to serve diagnostic departments beyond radiology. And we introduce another acronym, the VNA (Vendor Neutral Archive), which points the way to a fully interconnected platform for sharing clinical images from every department across the enterprise. Thereby supporting the imaging requirements of the acronyms we began with in Part I: the EMR / EHR.  Carestream-clinical-collaboration-platform
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EMR, EHR, PACS & VNA: Looking Beyond the Acronyms [Part One of Two]

These Letters Have a Lot to Say about the Past, Present and Future of HealthIT

Per leggere la storia in italiano, clicca qui

Dario Arfelli, Carestream Health

Sometimes talking about health information technologies can feel like trying to read alphabet soup. More than most industries, ours can seem like a simmering stew of acronyms.2016-02-17 09_44_20-_ 2

Even if you’ve mastered the letters and what they mean, you may find yourself challenged by the need to converse with others who haven’t. And technologies can intersect in various ways, adding to the confusion.

Here’s a quick overview of a few important acronyms – what they mean, how they relate to each other and what they say about the past, present and future of healthcare IT – along with links to more information.

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Diagnostic Reading #8: Five Must-Read Articles From the Past Week

This week’s articles include: a study examining healthcare IT technology adoption in rural areas; the need for additional training on correct interpretation of digital breast tomosynthesis scans; a study showing remote patient monitoring does not reduce readmissions or mortality for patients with heart failure; a Q&A with radiologist Stamatia Destounis, Healthcare ITMD; and news that more than 100 health industry stakeholder organizations have agreed to push the industry and policymakers to take six steps—many supported by information technology—which they say can immediately improve the nation’s healthcare system.

A study entitled “Variation In Rural Health Information Technology Adoption and Use,” recently published in Health Affairs, noted that while initial health IT adoption and meaningful use achievement were higher among rural providers and hospitals than those in urban areas, these populations were less likely to return in Continue reading

Top Five Health IT Blogs of 2015 from Everything Rad

As we near the end of 2015, it is a popular time of year to take a look back at the blogs that generated the highest interest throughout the year. In this summary, we look at some of the most popular Everything Rad healthcare IT blogs of 2015 covering value based healthcare, radiology reporting, meaningful use and clinical collaboration.

  1. Four Reasons Multimedia is the Future of Radiology Reporting – We have been touting the power of multimedia-enhanced radiology reporting for some time. We have shown the history of reporting in our industry, as well as showcased the important business cases multimedia reporting provides to departments via referrals from physicians. In brief—multimedia-enhanced radiology reporting is the future.
  1. What Does Clinical Collaboration Really Mean? – Clinical collaboration was born out the use of our vendor-neutral archive (VNA). The VNA served as a housing mechanism for medical images across a variety of –ologies, not just limited to DICOM images. With the VNA, the images remain safe and accessible when necessary, however, to enable intelligent, user-based sharing, more than just storage is needed.
  1. Imaging’s Place in Value-Based Healthcare – The answer to a question asked in a SIIM 2015 Friday morning session was clear–medical imaging needs to make further progress to be in a position to provide value-based care.
  1. White Paper: Metadata – Creating Meaningful Access to Clinical Images & Data – Metadata is explored in greater depth in an effort to truly uncover its value and importance not only medical imaging, but also in all patient clinical data.
  1. Video: The Value of Imaging Sharing in Clinical Collaboration – See how image sharing on the Clinical Collaboration Platform is able to give clinicians real time, on-demand access to imaging results, as well as how it can empower patients to share their images between facilities, physicians, and specialists. 

eBook: Radiology as an Enterprise Model for Collaboration

Julia Weidman, Carestream Health

Collaboration has become a key component of today’s healthcare system. Department silos are breaking down and fading away, and from the rubble is born multidisciplinary teams with a focus on interoperability across departments.

Meaningful Use (MU) has served as a great incentive to make patient information universally available to clinicians through the EHR, but too often the collaborative benefits of the technology fail to become available to the “-ologies” in the health system.

But there are examples of successful collaboration delivering real benefits to the medical community and patients.  One of the best is the University of Virginia (UVA), where the EHR-driven radiology workflow not only provides full clinical information to radiologists, but the collaborative workflow adopted by UVA has also helped the UVA Physicians’ Group attest to MU Stage 1 and receive nearly $1.5 million.

Cree Gaskin, MD, Vice Chair, Informatics at UVA outlines their process in a recent chapter of our CIO eBook. The key to this EHR-driven radiology workflow was the life-cycle of the PACS. Specifically, the fact that it has reached a maturity level that is the third and final phase of the evolution, as seen in Dr. Gaskin’s graphic below.

EHR-driven radiology workflow

This third stage involves the PACS becoming integrated and interoperable with the EHR. This allows workflow to become optimized, and images and reports to become accessible via the EHR. From this, collaboration among clinicians and other stakeholders is supported in full and information can be accessed immediately. This ongoing gathering of data informs clinical decision support and big data analysis.

From within the EHR, the radiologist can identify what would be useful, depending on the case. That information can then be served up to radiologists so they do not have to spend time searching for it. If the information is identified in advance, then it can be made accessible, as almost all of the necessary data is housed in UVA’s EHR.

The key is to establish an EHR-driven workflow, as demonstrated here in Dr. Gaskin’s graphic.

EHR-driven workflow

How it works at UVA is that one central login at a workstation allows access to:

  • Protocoling
  • Reading Studies
  • Chart reviews/search
  • MU
  • Teaching file
  • Tech work lists
  • Manager referrals
  • Audit trail
  • Report creation and signing
  • MD performance metrics
  • Administrative reports
  • Peer review (prior while reading)
  • Charting—orders, notes
  • “Watch patients; results tracking
  • Communication with providers

The interoperability between UVA’s Epic EHR and Carestream PACS permits the EHR-driven workflow or the EHR-enslaved workflow which is PACS-driven. In the PACS-driven workflow, the doctor selects a study from the PACS integrated worklist, and the corresponding patient record will be opened in Epic.

UVA reports that the results of such capability have included improved report turnaround time (RTAT), and more important, with stratification by level of priority, and nearly $1.5 million MU Stage 1 incentives for the UVA Physicians’ Group.

For a more detailed look at UVA’s story, you can read the interactive eBook, “Clinical Workflow in an Era of Interoperability,” which contains interviews and soundbites from Dr. Gaskin, as well as Dan O’Malley, MS, UVA’s director, informatics and business services.

Julia, Weidman, Marketing Manager, Healthcare Information Solutions, CarestreamJulia Weidman is the Healthcare Information Solutions Marketing Manager for the US and Canada at Carestream.


Diagnostic Reading #31: Five Must-Read Articles from the Past Week

Carestream LogoAnother week and another issue of Diagnostic Reading. This week’s topics are focused on population health, Meaningful Use and the “Digital Divide,” clinical and claims data, radiology decision support, and radiology’s role in enterprise imaging.

1) Population Health: The Path Forward – Healthcare Informatics

Mixed sentiments were on display among the industry leaders participating in the 15th annual Population Health Colloquium, held on March 23 at the Jefferson School of Population Health at Thomas Jefferson University in Philadelphia, and chaired by David Nash, M.D., dean of the Jefferson School of Population Health.

2) Did Meaningful Use Create a ‘Digital Divide’? – Healthcare IT News

A new study from Weill Cornell Medical College, published this week inHealth Affairs, points to the emergence of “systematic differences” between physicians who participated in the Medicare and Medicaid EHR Incentive Programs and those who didn’t. Docs’ participation in the Medicaid incentive program rose from 6.1 percent to 8.5 percent between those two years, researchers say, while participation in the Medicare incentive program rose from 8.1 percent to 23.9 percent.

3) Infographic: Clinical and Claims Data – What Lies Beneath? – Healthcare IT News

“This infographic draws upon the unified clinical and claims data warehouse of Arcadia Healthcare Solutions to show the quantity of data available for 500 patients. Claims records are represented by the “above-ground” green bars – but they’re dwarfed by the vast amount underlying electronic health record data, represented by the brown bars underneath.”

4) Radiologist Decision Support May Cut Unnecessary Studies – AuntMinnie

According to researchers at NYU Langone Medical Center, a decision-support tool that is readily available to radiologists when reading medical images can help them order more-appropriate follow-up exams. After adopting the tool the research team found that radiologists’ adherence to clinical guidelines improved from 50% to 80%.

5) Big Picture: Radiology’s Role in Enterprise Imaging – Radiology Today

“As medical imaging has risen from a radiology-specific concern to an enterprisewide need, hospitals and medical centers have responded to the increasing and broadening demand for images. Making that adjustment is no easy feat, however. Clinicians desire image availability and accessibility wherever they work; making it happen requires scrupulous planning and plenty of hard work.”

Diagnostic Reading #30: Five Must Read Articles from the Past Week

Carestream LogoAnother week means another edition of Diagnostic Reading where we highlight five must-read articles published in the last seven days. This week’s articles focus on Stage 3 Meaningful Use, dense breast tissue, VNAs, breast cancer screening, and mobile app adoption among radiologists.

1) Proposed Rules for Stage 3 Meaningful Use – Imaging Technology News (ITN)

Dave Fornell of ITN goes into details for each of the eight objectives for Stage 3 Meaningful Use set in place by the Centers for Medicare and Medicaid Services (CMS). The eight objectives include: 1. Protect Patient Electronic Health Information; 2. Electronic Prescribing; 3. Clinical Decision Support (CDS); 4. Computerized Provider Order Entry (CPOE); 5. Patient Electronic Access to Health Information; 6. Coordination of Care Through Patient Engagement; 7. Health Information Exchange (HIE); and, 8. Public Health Reporting.

2) Making Sense of Dense Breasts – Imaging Technology News (ITN)

Jeff Zagoudis of ITN discusses how as states continue to mandate patient notification of dense breast tissue, the technology for analyzing and reporting continues to evolve. A big issue today is how almost all in the medical community know about the impact of breast density, but that knowledge has not been passed down to patients. The article dives into the how many states in the U.S. are working to notify patients about dense breast tissue, and other modalities to get a second read of the exam.

3) NEJM: Breast Cancer Screening Reduces Mortality by 40% – AuntMinnie

“Researchers from the World Health Organization’s International Agency for Research on Cancer (IARC) found that women ages 50 to 69 who regularly receive mammography screening reduce their risk of dying from breast cancer by 40%, compared with women who are not screened. This translates into about eight deaths prevented per 1,000 women regularly screened, according to the group.”

4) SIIM 2015: VNA Adoption Yields Workflow, Cost Benefits – AuntMinnie

In this session from SIIM 2015, Wake Radiology was able to realize the benefits of a vendor-neutral archive (VNA) such as improved workflow, better management of digital breast tomosynthesis (DBT) images, and reduced storage costs.

5) Q&A: Radiologists at the Forefront of Mobile App Use – Diagnostic Imaging

The Q&A is with David Hirschorn, MD, director of radiology informatics at Staten Island University Hospital, in which he discusses a panel he participated on at ACR 2015 called, “Reshaping Radiology Through Mobile: Apps, Technologies, and FDA Regulations.”

Diagnostic Reading #21: Five Must Read Articles from the Past Week

Carestream logoIt’s Friday, which means it is time for a new Diagnostic Reading. This weeks edition includes cybersecurity, ethics in radiology, patient safety, Meaningful Use and EHRs and tips on reading ultrasounds.

1) 6 Steps Healthcare Groups Must Take in Response to a Security Hack– Fierce Health

This article discusses the importance of security when it comes to big data. The author gives tips on how to handle a security breach if it does happen. The steps are to establish a response team, investigate the event, stop the harm, know if it’s a breach, notify those impacted and go back to risk analysis.

2) The Ethical Radiologist– Diagnostic Imaging

In the evolving field of radiology, ethical practice is becoming a higher priority. The author of this article talks about the importance of ethics and how to implement ethical behavior in your practice, touching on establishing a code of ethics, what to do when facing challenges, and how ethics are policed in radiology.

3) Patients Want Information About Radiation Risk– Aunt Minnie

A study conducted by Radiology indicated that patients would like information on the health risks of radiation. The study found that these patients would rather hear this information from physicians than radiologists. This article talks about the importance of communicating with physicians about these risks in order to insure better patient care.

4) Stage 3 Proposal Embraces Open API Movement– Healthcare Informatics

This article touches on the new standards of Meaningful Use Stage 3. In the proposal, the CMS stated that application programming interfaces (API) would be an effective gateway to interoperability. These APIs can be third party applications and may be seen as more accessible than typical patient portals.

5) Ultrasound Exams Present Interpretation Challenges– Aunt Minnie

Sonography is rapidly growing due to its versatility and real-time imaging. With the growth of the ultrasound field, it is important to accurately read images, as well as learn how to read difficult images.

Addressing Concerns Behind Meaningful Use

Doug Rufer

Doug Rufer, Director Technical Marketing and Clinical Sales Engineering, Carestream

By now, you have probably been feverishly working to meet compliance with Stage 1 Meaningful Use and right around the corner, Stage 2 is set to begin in 2014.  If you have been keeping up with the latest news on Stage 2, you are surely aware the requirements have suddenly become more difficult and are continuing to increase in complexity.

Stage 2 Meaningful Use requires higher thresholds than Stage 1 (for example, requiring that more than 80% of unique patients have their vital signs recorded as opposed to 50% from Stage 1).  Additionally, two very important changes take center stage that will drive future stages of this program: 1) patient engagement by providing them access to their medical records (allowing access, download, and transmission of that data) within 4 business days of their care and; 2) EHR system interoperability (i.e. data exchange).  But are these requirements being enacted too quickly and is our healthcare system ready for the change?

Chart via. http://cms.gov

Chart via. http://cms.gov

Patient Record Access

At a recent healthcare IT conference, many attendees expressed their concerns over providing patients access to their information, not that they shouldn’t have access but will providers be overwhelmed by questions from their patients?  An interesting outcome, in a few pilot programs, was patients actually do prefer to have access to their information. As a general rule, most providers have found that their patient’s are not continually calling and asking them questions at all hours of the day and the questions they do ask are more focused on allowing the provider to advise them on how to improve their outcomes.

Another concern that surfaced was meeting the objective requirements that the patient actually access their information.  Not only is it important that a tool be provided for patient access (portal solutions are now required by certified EHR vendors for patient record access), but to meet the measure, the site has to verify that 5% of their patients actually do access their information.  The good news is the CMS reduced this threshold so obtaining the 5% measure requirement should be much more attainable during this stage.

The bottom line is this: providing patients with better access to their health information allows them to ask better questions to their providers.  No longer are we in an era where the patient takes the word of the provider as “gospel” but they are truly, actively engaged in their care maintenance and delivery and can now collaborate with their provider for the best possible outcomes.  This is a key goal of the program and one which, over time, will help bridge the gap that has historically existed between patients and providers.

Data Exchange and System Interoperability

Another area of concern was with vendors being properly prepared for data exchange.  Although there are well established standards today, data exchange is costly and time consuming for many facilities.  Data exchange needs to become more fluid and simplified to allow patient data to be exchanged from one IT system to another.  This is critical for providing better patient care and lowering the cost of healthcare.  Health Information Exchanges (HIEs) are being established throughout the country to accommodate the exchange of patient information.  The HIEs purpose is to facilitate the exchange of key information which grants providers in other locations access to important patient information. This allows them to make better decisions on patient care and eliminate costly repeat procedures.

Finally, imaging of all types (radiology, cardiology, etc.) needs to focus on access as well.  These imaging systems have traditionally been silos of information.  Now that patient data will be accessible through HIEs nationally, imaging needs to be taken into consideration on how to share patient images when their imaging record may span across multiple organizations and PACS systems, yet be readily available with their patient health data.

Accountability and Making Sense of Meaningful Use

At the end of the day, the goals driving Meaningful Use were made simply to lower the cost of healthcare, provide better communication and collaboration among healthcare facilities and practitioners, and improve patient outcomes.  The program set three initial stages to accomplish this goal: 1) Stage 1 was meant to capture data; 2) Stage 2 is meant for use and data sharing in a meaningful way and; 3) Stage 3 plans to focus on data analysis and using the data to improve clinical outcomes (Stage 3 has not yet been finalized, however).

To accomplish the goals of Stage 3, a new model must emerge in the delivery of care and this is taking place with the rise of ACOs and Population Health Management.  ACOs are meant to establish, through a group of providers and physicians, an accountability for the care they provide.  In other words, there’s a shift from “fee for service” to a model where the caregiver is encouraged to deliver higher outcomes and is incentivized to provide this level of care.  Population Health Management is health outcomes by a group of individuals that aims to improve the outcomes of an entire population, not just the individual.  Population Health is getting a lot of attentioimage_myvue_laptop_3n because concentrating on an entire population creates a model to impact costs of care delivery over time.

When factors beyond a single patient are taken into consideration (such as socioeconomic status, environment, and resource distribution of care), and programs can be put into place to improve certain diseases or conditions within that population by equalizing access to the care, the long-term effects will be lower healthcare costs.

What’s Next?

We live in an era that has the most robust access to care and technology to help improve more lives than ever before in history.  But costs have spiraled out of control making access to care difficult for those who need it most.  Getting a jump on this trend by looking at key patient data and outcomes across a population, in time, can help bring these costs back under control.  Managing population health will help drive down costs of chronic conditions within a given population by better understanding the drivers for such a condition and developing and administering preventative programs early on.  All this can only be achieved by capturing data, having open access to the data, and the right tools to analyze it.  So the next time you are struggling with the “why” behind capturing data and the fuss of this program, know you are on the forefront of changing the delivery of patient care in the future, and that in and of itself, is a goal worth striving for.

Why Should Radiologists Be Mobile Friendly?

Cristen Bolan, Executive Editor, Applied Radiology

Cristen Bolan, MS, Executive Editor,  Applied Radiology

Radiologists should be mobile friendly. Have you heard that? As soon as someone tells you what you should be, you don’t want to be it, even when you already are. Most radiologists have already thrown out those archaic flip phones and all-thumbs Blackberrys and graduated on to the much sleeker, interactive interface of smartphones. Is it a sign of higher intelligence or just a new shiny thing in the corner? Visually, it may be eye candy, too tempting for a visual junky to pass up. But is it too personal; something you wouldn’t bring into the workplace…or would you?

The biggest reason radiologists should be mobile friendly is because their referring physicians are.

Physicians and other clinicians are using their personal devices, like iPads, iPhones, and Androids, to access patient information from anywhere, anytime. In a recent survey, primary care and internal medicine physicians indicated a strong preference for electronic health record (EHR) usability on their mobile devices.1  In the same survey, 83% of respondents reported they would immediately use mobile EHR functionalities to update patient charts, check labs, and order medications if available to them via their current EHR.1

Mobile-device medicine, ie, the use of mobile devices to deliver care, is a growing trend and the more forward-thinking radiologists are catching on.

When Siddharth Prakash, MD, DABR, Vanguard Medical Imaging P.C. (Melville, NY), was deciding on which PACS to purchase for his imaging center, he needed to make sure he could send radiological reports to the physicians at a relatively inexpensive cost. “I was looking for a PACS provider that was looking into the future and trying to incorporate other devices, such as iPads and smart phones, and a simple system for contacting referring doctors,” said Dr. Prakash. “I wanted to find a solution that was taking the next step—communication.”

For Dr. Prakash, delivering a report to a mobile device gives his imaging center a competitive edge.  “More doctors want to see reports on their mobile devices, and when we provide this, they remember that my practice was able to do that, while others were not,” said Dr. Prakash.

How quickly could mobile-device medicine become a reality?

Well, it already is among hüber techy radiologists. But even the Board of Directors of RSNA is pondering the practical application of using mobile devices in the clinical setting. This year, RSNA launched a new learning management system to make RSNA education content available on mobile devices, in response to member demand.2 And along Dr. Prakash’s line of thinking, the theme of the RSNA 2013 annual conference is Power of Partnership: Partnering with the referring physician. The theme underscores the importance of radiologists providing a service that meets the needs of their physician partners.

No doubt smartphones on some level are a distraction—and dangerous when talking, texting and driving at the same time. But they also are very useful and there is no sign of turning back. As radiologists embrace the EHR, just like moving from analog to digital, they are now moving from desktop to mobile because these systems become so much more valuable when they “talk” to one another.3

The Top EHR Mobile Applications1

  1. remotely review charts
  2. update charts
  3. assign tasks
  4. view schedules and appointments
  5. send messages to practice staff
  6. lab orders and result review
  7. permit electronic prescribing
  8. patient encounter documentation
  9. input vital signs
  10. access EHR data after office hours


1. Slabodkin G. Survey: Doctors overwhelmingly favor mobile devices and apps for EHRs – FierceMobileHealthcare http://www.fiercemobilehealthcare.com/story/survey-doctors-overwhelmingly-favor-mobile-devices-and-apps-ehrs/2013-06-03#ixzz2aeyazY5J. Updated June 3, 2013. Accessed July 31, 2013.
2. RSNA Board of Directors Report. RSNA. http://www.rsna.org/NewsDetail.aspx?id=8583. Posted March 1, 2013. Accessed July 31, 2013.
3. Shrestha R. Enterprise Imaging: Enabling true image exchange. Applied Radiology. 2013;5:20-21.