The Impact of CDs and Image Sharing on

RadiologyKang Wang Ph.D, CEO, HealthFortis

Amy Vreeland, SVP Strategic Accounts, lifeIMAGE

9/24/2013

Value of Clinical Decision Support

Value of Image Exchange

Power of the two systems working together

Agenda

It’s also a Patient Safety issue

“… just from overuse of CT, will result in 12 preventable radiation-induced cancer deaths a day”*

"A 20-year old woman who gets an abdominal-pelvic CT scan (i.e., just about any young woman coming to the ED with belly pain) has a 1 in 250 chance of getting cancer from that single scan.“**

*Robert Stern, Patient-centered imaging, Am J Med 2012; 125:115

**Dr. Rebecca Smith-Bindman - professor of Radiology, Epidemiology, and OB/GYN at UCSF in http://community.the-hospitalist.org/2011/02/11/a-game-changing-statistic-1-in-250

 

Solutions

•Speed bumps

• RBMs

• Referral pre-authorization

•Claim analysis and provider profiling

Current solutions and their problemsProblems•Human intensive

•Trying to change decisions that are made

•Little physician involvements

•No consistent evidence based decision making

•No financial incentives for physicians

Current solutions and their problems

Clinical Decision Support (CDS) Order Entry System

Integrated with EHRs

A better solution

Decision Support at the point of Decision

A better solution

Proactive Decision Support—Decision support BEFORE the decision is made—Symptom/Diagnosis driven decision support—Change of the current CPOE order workflow—More effective: the right exam is the easiest to order

Passive Decision Support—Judgment AFTER the decision is made—Procedure driven decision support—Keep the current CPOE order flow, add a CDS step

after order submission—Less effective: physicians don’t like to be judged

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Proactive vs. Passive CDS

EHR integration vs. stand along CDS order entry

Comprehensive rule sets with option to customize—American College of Radiology, —ACC—ODG—Ability to set institution specific rule set

Reporting Module: provides actionable information

KB Editing Tool: can you publish your own guidelines?

Cloud hosting vs. local installation

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CDS: What to look for

Tight integration with EHRs— Single sign-on— Patient context sharing— Patient chart information passed to CDS— Real time submission of the CDS result

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Integrated with physician workflow

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Data Mining

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Knowledge base editing

Centrally managed content—Regular updates from content providers—Multi-tenant system

• Each customer can subscribe to its preferred content or create customized content

Centrally managed system—Minimal client side IT requirements—Frequent system updates

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Cloud-based deployment model

Trend of Order Distribution by Appropriateness Score

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System Adoption

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March 18th

System Adoption98% orders follow guidelines (up to 67%)

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CDS: demo

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The Network of NetworksHighest Ranking Providers

• 16 of 20 best Cancer• 10 of 20 best Gastroenterology• 10 of 20 best Gynecology• 10 of 20 best Cardiology• 10 of 20 best Neurosurgery • 10 of 20 best Rheumatology• 9 of 20 best Geriatrics• 9 of 20 best Urology• 7 of 20 best Pulmonary• 7 of 20 best Orthopedics

561 M Images / 2.64 M Exams

• 205 hospitals - Connect to another 410 hospitals • 35,000 users - 12,000 monthly active users

Our customers represent• 54.9 M outpatient visits/year• 7.4 M ER visits/year• 32.0 M radiology exams/year• 85,000 physicians (12% of total)

No.1 ranked hospitals in 18 out of 27 states & D.C.

A future proof platform for image sharing

1 Outside exam ingestion

Referral workflow & publishing results

Managing connections

Image enabled community & CDS

Cross community sharing

Baseline: PACS and EMR is already in use with an existing enterprise viewer

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Image-Enabled HIE Demo

Health Information Exchange (HIE)Physicians access to priors, and relevant priors alert during an order

CommunityPatient ID

Physician Office 1HIE Portal

Physician Office 2

Imaging Orders

Imaging Orders

lifeIMAGE

Image MetadataPACS

C: Find

Imaging Service Provider Site

HL7 ReportRIS

Repository

Registry

LILA

Metadata

Reports &Thumbnails

Member ID (Patient IDs)& local MRN

Patient ID

Imaging Results

Imaging Results

Imaging Results

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CDS & Image Sharing Integration: demo

CDS can help to increase guideline compliance and reduce

utilization

Imaging sharing facilitates coordinated care delivery,

reduces duplicated radiology orders, and provides

meaningful Return on Investment

An integrated CDS and Image sharing platform helps to

improve patient and care giver experience with their

radiology services

Thank You