mgh/phs has licensed technology to, receives royalties from and/or has financial interests in:...

IMAGE SHARING, RADIOLOGY AND MEANINGFUL USE

IHE NORTH AMERICANCONNECTATHON CONFERENCE 2011

JANUARY 18, 2011CHICAGO

Dr. Keith J. DreyerVice Chairman of Radiology - Massachusetts General Hospital

Assistant Professor of Radiology - Harvard Medical SchoolCo-Chairman Informatics Committee - American College of Radiology

• MGH/PHS has licensed technology to, receives royalties from and/or has financial interests in:• LifeImage, Inc.

• Nuance, Inc.

Conflicts of Interest

• Societies and Organizations • ACR

• Chairman, IT Government Relations Cmte• Co-Chairman, Informatics Cmte• Co-Chairman, Clinical Decision Support

Cmte• Meaningful Use Presenter

• RSNA• Chairman, IT Government Relations Cmte• Member, Informatics Cmte• Meaningful Use Presenter

• ABR

• Member, ABR IT Advisory Committee

• RBMA

• Meaningful Use Presenter

• RadiologyMU.org• Meaningful Use Advisor• Meaningful Use Presenter

Volunteer Positions

Overview

MGH Experience EMR Imaging Integration IMR – Imaging Medical Record Meaningful Use for Radiology

ACR Message to Federal Agencies

Use EMR as a context platform for communication 1995 - Hospital Distribution of Images

EMR Imaging Integration

EMR Image Distribution

PACS

EMR

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Use EMR as a context platform for communication 1995 - Hospital Distribution of Images 2000 - Enterprise Distribution of Images

Multiple PACS to Enterprise EHR


Enterprise Image Distribution

PACS

EMR


Enterprise EMR with MPI

PACS PACS



Multiple PACS to Enterprise EHR 2001 - CPOE for Radiology 2003 - CDS for Radiology Ordering


Radiology CPOE and CDS

RIS

EMR


Medical ImagingClinical Decision

Support

ORDER IMAGING…

PACS

RADIOLOGY CPOE AND CDS

MGPO actual imaging tests per 1000 members (MRIs, CT Scans, Nuclear Cardiology)

310.0

315.0

320.0

325.0

330.0

335.0

340.0

345.0

350.0

355.0

360.0

365.0

370.0

375.0

380.0

385.0

390.0

395.0

2004 2005 2006 2007 2008

actu

al t

ests

per

100

0 m

emb

ers

19% Decrease(2005 – 2008)

RADIOLOGY CPOE AND CDS


Multiple PACS to Enterprise EHR 2001 - CPOE for Radiology 2003 - CDS for Radiology Ordering 2010 -Foreign Image Import – Physical Media 2011 - Extra-Enterprise Image Sharing


Physician

Desktop

The Image Sharing EvolutionPhysical Media Based Exchange• Category I • Radiology image CD of patient with an

MRN• Category II• Non-Radiology image CD of patient with

an MRN• Category III• Any image CD of patient without an

MRN

LifeIMAGE

PACS

EMR LI

I

II III

RSNA-NIBIBImage

SharingProject

Hosp 1

Hosp 2

Hosp n

PHRs

Standards Based Exchange• To Other Providers• To Patients

Overview

MGH Experience EMR Imaging Integration IMR – Imaging Medical Record

Standalone Platform Radiology manages entire system

Authentication, HIPAA, group privileges Session level security Browser and mobile device based

External Access to Imaging Services Exam Ordering, Scheduling, CDS, Authorization Critical Communication System Report and Image Distribution

Imaging Medical Record


PACS

HospitalDept

ImagingCenter

ImagingCenter

ImagingCenter

ImagingCenter

ImagingCenter

External

EMR 1

External

EMR n

RIS

MGHEMR

Medical ImagingClinical Decision

Support


Overview


Meaningful Use for Radiology


Information Technology MGH Developed

Complete EHR Certification Process

Q42009

Q12010

Q22010

July 2010

Aug2010

Sept2010

Notice of proposed rule making

60 day comment

period

Review Gap analysis based on proposed rule Completed Final

LMR Gap Analysis

LMR Certification Timeline and Milestones

Version 2.0 August 2010LMR Spring 2011 ReleaseLMR Fall 2010 Release

We are here

LMR Exec. Approval for Cert. projects

Define reasonable approaches to all LMR MU gaps

Oct 2010

Nov2010

Dec2010

Jan2011

Feb2011

Mar2011

Apr2011

May2011

Final Rules Published

Insight into ONC-Authorized Testing and Certification Body

LMR Certification Best case scenario Worst case scenario



Complete EHR Certification Process Vendor Components

Modular EHR Certified Internal Support for EP Meaningful Use

A Formula for Meaningful UseStage 1 Eligible Providers MU = 15 Core Measures and 5 of 10 Menu Measures

1. Master e-prescribing (eRx) CPOE (30% medication orders) Transmit prescriptions electronically (40%) Implement drug-drug / drug-allergy (attest) Maintain active medication list (80%) Implement drug Formulary (attest)

Core1111

Menu

1

2. Leverage Care Team Record demographics (50%) Record vital signs (50%) Record smoking status (50%) Provide patients with an electronic copy of health info. (50%) Provide clinical summaries for each office visit (50%)

11111

3. Leverage Enterprise Application Implement 1 clinical decision support rule (attest) 1 - test of EHR capability to exchange key clinical information (attest) Capability to submit immunization to immunization registries (attest) Capability to submit electronic syndromic surv. data (attest) Incorporate clinical lab test results unto EHR / structured data (40%) Generate Lists of patients by specific conditions (attest)

11

1111

4. Focus on Structured Data Elements Maintain problem list (80%) Maintain active medication allergy list (80%) Quality Reporting (report measures)

111

5. Practice Assessment Work Conduct security risk analysis (attest) 1

15 5

IS a

nd

M

GH

/MG

PO

Pra

ctic

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Sta

ff

Elig

ible

P

rovid

ers



Complete EHR Certification Process <Show the MGH MU pathway slide>

Vendor Components Modular EHR Certified

Internal Support for EP Meaningful Use Radiologists don’t directly input data to the

EMR Voice => Reporting System => RIS => EMR

Need to create a parallel system for radiologists to be seen as other EPs by the EMR

MGH EPs /Other Care Providers

Radiology MU

Rad 1 Rad 2 Rad n

Reporting System(Voice

Recognition)

RIS

EMRMU DataAggregation

MU EPDashboard

MU Reportingto CMS

Interpretations =Patient Encounters

Overview


Meaningful Use for Radiology Messages to Federal Agencies

Message to Federal Agencies

Include Medical Imaging into HITECH care goals Quality, Safety, Cost, Outcomes

Use Meaningful Use constructs when possible

Create a distinction between: Medical Imaging Creators Medical Imaging Consumers

Message to Federal AgenciesONC

For Medical Image Consumers Images included in MU definition for ‘exam

results’ EMR, PHR, PHI Sharing

Require electronic ordering of Imaging Require ‘electronic’ not paper to imaging

department Clinical decision support of Imaging

Separate from disease centric, order sets, drug-drug

Message to Federal AgenciesONC

For Medical Image Creators Create CQM specific to these EPs Critical communication management

Urgent Notification, Recommendation Follow up Require Report and Image Connectivity

To EHR and PHR Provide Imaging CPOE and CDS Radiation Dose Registry Compliance Archival, Display, Access requirements Relax the requirement to purchase systems that

measure what EPs are excluded from.

Message to Federal AgenciesCMS

Embrace Clinical Decision Support for Imaging Demonstration Project for Imaging CDS Support Initiatives for CDS Rule Sets

National, Transparent, Standard, Medical Societies Consider payment reform based on CDS

Message to Federal AgenciesFDA

Radiation Dose Registry Patient Centric Exposure Monitoring

Image Storage and Access Requirements Consumer based mobile visualization

iPhone, iPad

Message to Federal AgenciesNIBIB

Demonstrate value of existing technologies CDS, Image Sharing, Critical Comm, Consumer

Access Promote standardization of existing

technologies Foster a common understanding of Imaging

Throughout various governmental agencies Throughout Congressional oversight committees Throughout the White House and OMB

IMAGE SHARING, RADIOLOGY AND MEANINGFUL USE

IHE NORTH AMERICANCONNECTATHON CONFERENCE 2011

JANUARY 18, 2011CHICAGO

Dr. Keith J. DreyerVice Chairman of Radiology - Massachusetts General Hospital

Assistant Professor of Radiology - Harvard Medical SchoolCo-Chairman Informatics Committee - American College of Radiology

mgh/phs has licensed technology to, receives royalties from and/or has financial interests in:...

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