Image-Enabling the EMR

A Message from Seth Koeppel.

If you haven’t already heard the phrase “Image-Enabling the EMR,” you will. Now that the Federal Government has provided incentive payments to eligible professionals, hospitals and critical access hospitals (CAHs), “Image-Enabling the EMR” is all the buzz.

Through the American Recovery and Reinvestment Act of 2009 (ARRA) and Medicare and Medicaid EHR Incentive Programs, incentives are paid out for adopting, implementing, upgrading or demonstrating Meaningful Use (MU) of certified EHR technology. Eligible professionals can receive up to $44,000 through the Medicare EHR Incentive Program and up to $63,750 through the Medicaid EHR Incentive Program.

This has driven the referring physician community, which controls the referral and ordering of diagnostic imaging procedures, to adopt Electronic Medical Records at a fevered pace. As a result, imaging providers are now inundated with requests from their referring physicians to have reports made available within their EMRs.

Interestingly, Stage 1 MU did not require medical images to be part of an EMR in order to meet meaningful use qualifications, and while the recently defined Stage 2 includes it only as a menu option, it’s hard to understand why any medical facility or healthcare provider would not want to include medical images as part of their EMR.

When we discuss medical imaging with physicians, they are nearly unanimous in their opinions that medical imaging is necessary to clinical diagnosis and treatment, not to mention prevalent in the patient care cycle. Furthermore, they tend to agree that the lack of access to imaging studies in the EMR often means that diagnostic imaging is repeated, exposing patients to unnecessary doses of radiation, increasing patient care costs and extending treatment times, and sometimes even delaying referral processes.

Most medical practitioners would be happy to add medical imaging to their EMR with their stage 2 meaningful use implementation. The benefits are obvious, and the medical practitioners can use this as one of their 3-5 menu options that are required for reimbursement.

However, many healthcare professionals and imaging providers are uncertain just how to add medical imaging to their EMRs. Often the question we hear is: “can eRAD send the medical report to this EMR?” While technically feasible using standard HL7 interfacing, is that really the best way to accomplish it? As always, the devil is in the details.

There isn’t any support for report formatting in HL7; so when they do arrive in the EMR, the reports are often not visually clear and don’t represent the sending institution very well. Besides the cost and technical challenges, sending the report to EMR via HL7 doesn’t do anything to address access to the images-a critical point that impacts both patient care and MU Stage 2 requirements. The old adage “a picture is worth a thousand words” certainly rings true in medical imaging, and clinicians want to be able to show their patients the images and discuss treatment.

This is where the term “Image-Enabling the EMR” comes into play. In the past there has been no easy way to access images or medical reports through the EMR without expensive upgrades or wholesale system replacements. Early on, the advent of Web-based systems like eRAD addressed this challenge by allowing clinicians to gain outside access.

They could simply log onto a browser from any computer or device connected to the Internet, and even receive automated notifications via emailed links or text messages that gave providers even easier access. But these all required the provider to leave the EMR, open a browser, and enter a username and password into a separate system, search for the patient and then drill down into the reports and images. Not the most efficient method.

Today there are more technically advanced methods to link the images and reports directly into the EMR within the context of the patient. This allows the provider to have seamless, one-click access to both the reports and images from within the patient’s record in the EMR. These are called Application-Programming Interfaces or APIs, which is a set of commands for accessing an application or system. A software company publishes its API so that other software developers can design products that are powered by its systems and services.

An API is a software-to-software interface, not a user interface. With APIs, applications talk to each other without any user knowledge or intervention. When you buy movie tickets online and enter your credit card information, the movie ticket Web site uses an API to send your credit card information to a remote application that verifies whether your information is correct. Once payment is confirmed, the remote application sends a response back to the movie ticket Web site saying it’s okay to issue the tickets.

As a user, you only see one interface-the movie ticket Web site-but behind the scenes, many applications are working together using APIs. This type of integration is called seamless, since the user never notices when software functions are handed from one application to another.