Watching medical-imaging CDs pour into and out of their academic medical center by the thousands every month, Beverly Rosipko and Jeffrey Sunshine, MD, PhD, knew there had to be a better way. CDs are unencrypted. They have to be transported by unpredictable human hands. They’re resource- and labor-intensive on the sending end and notoriously fussy to deal with on the receiving end. And how are the data they include best handled?
What’s worse, the list of potential snares increases exponentially when CDs—not to mention medical DVDs and/or USB drives—are getting shared not just within a large health system but between that system and other provider organizations.
Cross-institution CD fussing and shuttling was exactly what Rosipko and Sunshine wanted to curtail at 18-hospital University Hospitals Health System that stretches across 15 counties in Northeast Ohio. There, Rosipko is director of radiology informatics and Sunshine is CMIO and vice chair of radiology.
“We were often running into the issue where physicians would put a CD into a drive and find they couldn’t run it ‘for one technical reason or another,’” Rosipko recalls. “We came up with a workaround allowing our users to import the images into our PACS for temporary viewing.” But this was a Band-aid solution. “And these problems were even occurring in the OR during surgeries.”
While intent on reducing CD production and consumption, the UH imaging team wanted to do no harm to existing inter-organizational clinical collaborations. In fact, they wanted to increase cooperative image sharing, the aim being to help improve the health status of the more than 4 million people living in northeast Ohio. And they certainly knew the world was well into the age of broadband internet and cloud computing.
So it was about three years ago that the question all but asked itself among UH imaging stakeholders: Hadn’t anyone come up with a good way for ready, willing and like-minded provider institutions to go online and securely share digitized medical images?
Indeed someone had. It turned out to be the same technology vendor UH had selected as its PACS supplier in 2010 and for a VNA solution in 2015. The vendor is Sectra and its cloud-based Image Exchange Portal (IEP) is the solution. UH added the software in 2016. The result of the installation is image-sharing agreements with 19 area provider organizations—and counting—with UH taking a lead role driving collaborative efforts to optimize care quality and patient experience while pursuing population health and reduced costs.
The advancement in digital image-sharing “is a win-win-win,” Sunshine says. “First and foremost, it’s a win for patients and families who are trying to take care of sick loved ones. They don’t have to keep track of a CD or DVD, worrying about forgetting it or losing it or leaving it at the last doctor’s office. We’ve unburdened patients and their families.”
Second, he adds, it’s a leap forward for both the receiving and the sending provider organization. Imaging senders don’t have to burn, ship and track physical discs. Imaging receivers don’t have to deal with missing or unusable viewers, corrupted image data, potential malware exposure, digital files that just won’t open or interminable waits to see clinical images prior to the arrival of the patient bearing them.
And all three groups benefit by the avoidance of repeat imaging procedures—an unfortunately common occurrence when CDs are involved—and by the ready availability of comparison imaging for tumor staging and other critical diagnostic steps.
“It’s not often,” Sunshine says, “that we have wins across three domains.”
Collaboration on a broad scale
For UH, reducing CD handling also has had the happy side effect of increasing collegiality among Cleveland care providers.
During the tryout phase, one of the top attractions of the IEP was its capacity to facilitate image exchange between UH and organizations that have other cloud platforms or none at all, Sunshine and Rosipko agree. Since IEP processes data in the cloud, no one needs to install local hardware. Standard interfaces—DICOM, HL7 and XDS—handle the integration, while any of the popular web browsers will work as a password-protected entry point.
The limitless scalability of the cloud, combined with the flexibility of IEP’s onramps, has made it possible for UH to forge image-sharing relationships with provider organizations as dissimilar in size and means as the Cleveland Clinic, which has more than 4,400 beds system-wide, and 227-bed Firelands Regional Medical Center in Sandusky, Ohio. (See the list of UH’s digital image-sharing partners below.)
Image viewing can be done in more ways than one, but many end users stick with PACS and use viewers they’re familiar with. Regardless, for most, the process automatically launches in workflows that begin, as normal, in the EMR.
“I wouldn’t say that we now know everybody, but we’re certainly having more conversations than before” with image-sharing partners, Sunshine says. “University Hospital personnel talk to Cleveland Clinic people now much more than we used to,” he adds.
Hearing that, a careful observer of U.S. healthcare couldn’t help but notice that UH and the Cleveland Clinic are longtime competitors. In the age of patient-centered care, this is no small thing.
“Digital image sharing has helped to spur those conversations,” Sunshine says, “because we had to figure out how to carry it out in a cooperative way. We’re doing something that works really well for us but, more important, works really well for the patient.”