While recent news has publicized concerns from the Federal Trade Commission (FTC) that interoperability standards recommended by the Office of the National Coordinator (ONC) could stifle competition in healthcare, the ONC’s Interoperability Roadmap continues to drive providers to make real interoperability a central priority that touches every aspect of healthcare.
It is clear that the industry focus on interoperability is not waning, in spite of the FTC’s concerns. And in the medical imaging market, interoperability is particularly important. Medical imaging, which some estimates say drives upwards of $300 billion of downstream healthcare spend each year, is a key component of true interoperability. Not one surgery is performed without an image being taken somewhere along the way. That fact positions imaging at a critical juncture on the front end of a patient care plan and helps determine whether that plan is successful on the back end. Having the right imaging strategy in place is essential not just to providers’ bottom lines, but also to the effective care of patients as the industry implements more interconnected healthcare processes.
While imaging will continue to be a mainstay of care delivery, payment reform and the rise of quality outcome measures raise the question of imaging appropriateness. Payers have already begun to mitigate the risk that unnecessary images will be taken through measures such as prior authorization requirements, but that hasn’t completely resolved the issue. For example, many studies estimate that around one-third of all images are unnecessary, either because doctors are practicing defensive medicine or studies are being duplicated because patients are bouncing between health systems that aren’t intrinsically connected or effectively communicating. Investing in imaging interoperability is the first step toward increasing efficient and appropriate utilization of imaging as a whole.
An interoperability strategy that takes stock of imaging comes down to three key parts: connecting with community physicians, optimizing the electronic health record (EHR) system, and managing internal imaging.
Connecting with a community of physicians
Connecting with a community of physicians can be a real challenge because not all doctors work in the same way; some providers deliver more economic value to a system than others because they send the system more patients, or they’re specialists as opposed to general practitioners. Nevertheless, most every physician eventually sends patients to get scanned, and healthcare systems need ways to connect their infrastructure with physicians to ensure they can effectively manage the volume of imaging being ordered and performed.
Infrastructure will become especially relevant as health information exchanges and accountable care organizations become more pervasive. When a health system (as providers take on greater risk) becomes responsible for managing a patient’s total cost of care for eight or nine years — a realistic length of time for a patient to stay on the same provider (vs. employer) plan, for example — that organization must be able to track imaging orders effectively so they have an all-encompassing view of the patient and can intervene before he or she becomes gravely ill or his or her care becomes financially unsustainable.
A health system’s ability to connect a community of physicians and radiologists, for example, also enables better referral management. Managing referrals and eliminating referral loss have major revenue implications for hospitals today. Interoperability, with respect to a stronger imaging infrastructure, can improve referral operations and strengthen physician loyalty in the long run.
Optimizing the EHR system
Optimizing the EHR system around a universal viewer is another important step to achieving genuine interoperability. Health system administrators need to ask themselves: What’s our “single pane of glass” strategy for the decision making that’s going to ultimately drive costs out of our system? How are we making sure that our doctors can get data into their EHR and then stay in the EHR for the work they have to do?
Deep EHR optimization is the “single pane of glass” strategy whereby physicians can remain within a workflow tool without having to jump through multiple windows or software solutions to accomplish their patient care and management goals. From an imaging perspective, a universal viewer creates this capability for providers.
Managing internal imaging
Healthcare system leaders should think about how any one doctor in their system looks at an image, regardless of whether it’s a DICOM image or a .pdf or a .jpeg. Images must be stored in one place, tightly linked to the EHR. For example, capabilities allowing providers to access a consolidated patient view of current and historical images at the point of care and across specialties and sites, such as vendor neutral archives, are critical tools for clinical and financial alignment.
Is imaging part of your interoperability plan?
When it comes to getting the most out of interoperability in the context of medical imaging, a wide-ranging infrastructure that starts within but extends far beyond an organization’s four walls is a core strategy healthcare system leaders should consider. As we move toward an environment of value-based purchasing and outcome-driven care, the time is now for organizations to see the significance of imaging as a part of their interoperability strategies.