Achieving Enterprise Imaging Maturity Dawn Cram Kim Garriott - - PowerPoint PPT Presentation

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Achieving Enterprise Imaging Maturity

Kim Garriott Principal Consultant Logicalis, U.S. DIAM-EI development team chair; HIMSS-SIIM Enterprise Imaging Community co-founder and co-chair

Dawn Cram

IS Director, Enterprise Imaging Ochsner Health System DIAM-EI development team co-chair; HIMSS-SIIM Enterprise Imaging Community; SIIM Board of Directors; JDI Editorial Board

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Session Objectives

• Understand the purpose of the Digital Imaging Adoption Maturity

Model and how it relates to the EMRAM

• Analyze the 8 stages of maturity
• Determine organizational needs to achieve maturity
• Understand the vendor R&D still needed in the industry to assist
• rganizations with achieving maturity

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HIMSS Analytics Maturity Models

ELECTRONIC MEDICAL RECORD ADOPTION MODEL (EMRAM) ADOPTION MODEL FOR ANALYTICS MATURITY (AMAM) OUTPATIENT ELECTRONIC MEDICAL RECORD ADOPTION MODEL (O-EMRAM) CONTINUITY OF CARE ADOPTION MODEL (CCMM)

DIGITAL IMAGING ADOPTION MODEL (DIAM & DIAM-EI)

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EMRAM Update Promotes Imaging to Stage 1 Requirement

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W hat is the Digital I m aging Adoption Model ( DI AM) ?

 Collaboration with international, cause-based, professional societies and very enthusiastic imaging experts from Europe, North America, Asia, Middle East and Latin America  8 Stage (0-7) maturity model; measures and benchmarks IT adoption in medical imaging  Launched in 2016  Globally applicable

Roadmap-based assessment to master digital transformation in medical imaging

Key Contributors

 Provides guidance for digital transformation of medical imaging, including best-practice sharing and public recognition opportunities

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How did w e get here?

A brief history of the DIAM

2015 Launched HIMSS-ESR workgroup (in Europe) to develop the DIAM 2016 (March) DIAM launched at European Congress of Radiology - focused on Radiology 2016–2017

• DIAM rollout in various European countries with some interest in Middle East
• First discussions with HIMSS-SIIM Enterprise Imaging workgroup in North America

2017 (June) Launched global DIAM workgroup (ESR, SIIM, EUSOMII); build on previous work Workgroup goals:

• Expand DIAM into an Enterprise Imaging roadmap
• Update / refine existing DIAM criteria for Enterprise Imaging applicability
• Develop new DIAM assessment methodology for enterprise imaging assessments
• Retain existing Radiology assessment survey
• Set stage for developing DIAM assessment methodology for other imaging areas

2018 (March) First DIAM update; now meets Enterprise Imaging challenges and requirements

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Many thanks to the following workgroup members for their valuable contribution

HI MSS Analytics DI AM w orkgroup participants

Workgroup Function Name Country Representing Organisation Job Title / Position Chair Kim Garriott USA SIIM Principal Consultant, Logicalis / Co-founder HIMSS-SIIM Enterprise Imaging workgroup Co-chairs Dawn Cram USA SIIM IS Director, Enterprise Imaging, Ochsner Health System / HIMSS-SIIM Enterprise Imaging workgroup member / SIIM Board of Directors / JDI Editorial Board Monief Eid Saudi Arabia None PACS Program Director at the MoH / HIMSS-SIIM Enterprise Imaging workgroup member Cheryl Petersilge USA SIIM MD, Cleveland Clinic / Gerald Tan Singapore none Deputy CMIO and Consultant Radiologist, Tan Tock Seng Hospital, Singapore John Daniels USA HIMSS Analytics Global Vice President Healthcare Advisory Services, HIMSS Analytics Jörg Studzinski Germany HIMSS Analytics Director Research and Advisory Services, HIMSS Analytics Lluís Donoso-Bach Spain ESR MD, PhD, Director Diagnostic Imaging Department Hospital Clínic of Barcelona / ESR President 2015/16 Luc Bidaut UK EUSOMII MD, PhD, Professor of Medical Imaging, University of Lincoln Neelam Dugar UK ESR MD, Consultant Radiologist, Doncaster & Bassetlaw Hospitals NHS Trust / Informatics Advisor for the Royal College of Radiologists Paul van Diest Netherlands none MD, PhD, Professor and Head of Pathology Department, University Medical Center Utrecht, Netherlands / Professor of Oncology at Johns Hopkins Oncology Center, USA Peter Mildenberger Germany ESR MD, PhD, Professor for Radiology and IT-Leader at the Dept. of Radiology, University of Mainz / Chair

• f ESR subcommittee for Professional Issues and Economics in Radiology

Yulia Shevchuk Austria ESR MD, PhD, Manager at Dept. of European and International Affairs, ESR Office, Vienna

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HI MSS Analytics DI AM key contributors

Thank You!

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How does it look from inside?

A short walk through The DIAM Stages

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No or lim ited Electronic I m age Managem ent

DI AM Stage 0 ( Enterprise I m aging)

• Less than 2 service areas have/use an enterprise or specialized

information system for image acquisition and reports/notes management  A service area = image producing unit / department, such as:

• Radiology
• Cardiology
• Pathology
• Opthalmology
• Dentistry
• Obstetrics, etc.

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Electronic I m age Managem ent covering service area( s)

DI AM Stage 1 ( Enterprise I m aging)

• Information systems to…

− manage image acquisition (order- or encounter-driven) − manage reports/clinical notes related to medical images − image archiving − may have: supply and inventory management (where appropriate, e.g. Radiology/Cardiology)

Potential Software Solutions  RIS, CVIS, LIS, Dental IS etc.  RIS, CVIS, LIS, Dental IS etc.  PACS, VNA etc.  Typically part of other systems, such as RIS, CVIS, EMR etc.  A service area = image producing unit / department, such as Radiology, Cardiology, Pathology, Opthalmology, Dentistry, Obstetrics, etc.

+

• At least 2 service areas need to have electronic

image management (no matter which):

• Modalities/devices to produce images in

digital format

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Electronic I m age Managem ent covering a variety of im ages across the enterprise

DI AM Stage 2 ( Enterprise I m aging)

+

• At least 3 service areas (or 70% of all

medical images/videos) need to have electronic image management (no matter which)

+

• Additional requirements:
• Third party image management systems need to be integrated with the EMR (or similar solution)
• Images should be directly accessible, e.g. by single or multiple links, via the EMR (or similar

solution)

• Images must have metadata assigned (e.g. MRN, name, description etc.)
• External images can be imported for clinician access (if policy allows)

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I m aging Governance and Strategy; W orkflow and Process Safety

DI AM Stage 3 ( Enterprise I m aging)

• Governance & Strategy (incl. governing body / oversight) for

− Type of imaging solutions/technology, security etc. − Information/data management (e.g. use of standards to ensure consistency) − Formalized strategy (addressing the enterprise) and regular vetting − Purchases/procurements

• Workflow and Process Safety

− Quality, safety and operational parameters across multiple imaging services are measured and under control − Image acquisition workflows accross multiple imaging services are formalized, standardized and implemented − Status management for imaging studies, reports/notes across multiple imaging services − Processes to ensure right is associated with right image (and vice versa)

• Image Sharing and Accessibility

− Clinicians can access all types of images/multimedia through a consolidated („universal“) viewer; specialists can use specialty viewers on top − External referrers can access and view images „online“ (through the organization‘s network/repository)

Technology Program Information Financials

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Fully integrated im age m anagem ent w ith efficient enterprise-w ide im age sharing across different service areas

DI AM Stage 4 ( Enterprise I m aging)

• Enterprise-wide image repository
• Enterprise-wide standardized workflows for image/multimedia/metadata

capture, storage and sharing

• Use of internationally recognized standards, protocols and/or profiles to

support system integration and clinical workflows

• Secure acquisition and easy viewing capabilities for mobile images (mobile

platforms, handheld devices)

• Capability to directly ingest external images (incl. associated reports/notes,

metadata etc.)

• Remote access to images and reports/notes

Source: Roth CJ, Lannum LM, Persons KR. A Foundation for Enterprise Imaging: HIMSS-SIIM collaborative

• whitepaper. J Digit Imag 2016)

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Advanced I m aging Analytics

DI AM Stage 5 A ( Enterprise I m aging)

• Imaging platform provides infrastructure that

enables enterprise data warehouses to use information from images and asscociated metadata

• Clinical and operational parameters are

systematically tracked, benchmarked and can be presented in real-time

• Organisations use and incorporate external data

sources

• Examples of using predictive and prescriptive

analytics can be presented

• Capability to correlate genetic information from

patients with imaging biomarkers

• Technology use is captured and analyzed to

influence user behavior

Imaging biomarker: Determination of the HER-2 status of paraffin embedded xenograft tumours by immunohistochemistry of HER-2 (Source: Wikipedia, Author: Mumssygris) Source: https://www.governanceanalytics.org/knowledge-base/Main_Tools/Data_classification_and_analysis

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Clinical Decision Support and Value-based I m aging

DI AM Stage 5 B ( Enterprise I m aging)

(Some of) the many faces CDS

• Organization uses Structured Reports and/or Natural

Language Processing to generate discrete data that can feed algorithms/rules and trigger Clincial Decision Support

• Organizations have integrated electronic workflow

support to check the appropriateness of imaging orders

• Imaging specialists have seamless access to medical

imaging knowledge databases/libraries (integrated with the primary system)

• Computer-aided detection and/or Computer-aided

diagnosis tools are in use (traditional or based on AI/Deep Learning)

• Best-practice guidelines are directly integrated into the

electronic workflow

• Advanced Visualisation software is in use

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External I m age Exchange and Patient Engagem ent

DI AM Stage 5 C ( Enterprise I m aging)

Image source: https://healthcaresecprivacy.blogspot.de/2014/03/health-information- exchange-centralized.html

Patient Engagement Framework

(HIMSS Foundation)

• Majority of image producing services shares images and

reports/notes with care organizations of all types (i.e. primary, secondary, tertiary care etc.) within local care community, region,

• r even the whole country
• Use of recognised standards (e.g. relevant IHE profiles) for

external data exchange

• Imaging applications support multidisciplinary interactive

collaboration (MDTs, Instant-image sharing etc.)

• Patients can …

 make appointments for examinations online  access their images and reports/notes online  access (targeted/context-specific) educational content online  Upload, download their images and provide access to other care providers or family members

• Patient satisfaction (about services provided) is measured and

under control

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Participate in the Survey Developm ent Feedback Process!

How Can You Get Involved?

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• Why
• Ensure the model contains criteria that are relevant, specific, measurable, actionable and globally

applicable

• Enable key stakeholders (providers, industry) to improve the model and be engaged with its

development

• How
• Online feedback form
• Public comment timeframe: May 14th – June 8th
• Who
• EI solution providers and consultants
• Professionals (clinicians, IT etc.) that (intend to) use EI solutions
• What will happen with it
• All responses will be analysed, normalized, categorized
• The DIAM-EI workgroup will discuss and prioritize them based on relevancy, importance and alignment

with the model; highly prioritized items will be included into the DIAM assessment survey and used to evaluate and score providers with regard to their EI capabilities

Collecting Feedback

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Suggested item s / criteria m ust be:  Globally applicable

• i.e. independent of a health system or country

 Vendor-agnostic

• i.e. not bound to a specific product, workflow or standard provided by one particular vendor

 Measurable and/ or possible to demonstrate

• Evaluated providers must be able to collect that information from their organisations
• If requested by HIMSS, providers must be able to demonstrate the required capability through live

demos, use cases etc.

 Achievable

• Providers must be able to achieve a certain capability by implementing and using technology that is

available on the market

 Aligned with the 8 Stages (0 – 7) of the DIAM for Enterprise Imaging

• Criteria that are out of scope will not considered, e.g.

 criteria related to very specific (rare) types of imaging services  criteria related to very specifc (rare) type of imaging providers

Guiding principles for feedback

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• Review
• The DIAM – Enterprise Imaging – Stages Description
• The feedback form
• Make comments and suggestions
• for all focus areas
• r
• for those focus areas that you are particularly interested in / knowledgeable
• Engage other colleagues in your organisation who might be able to contribute

with valuable input

• Ideally consolidate your feedback within your own organisation before you

submit it to us

• Invest at least 30min, if not a bit more…

W hat w e ask for

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Use this link to open our online feedback form: https: / / himss.co1.qualtrics.com/ jfe/ form/ S V_0VWc1ifOmn7WkBv

How it w orks

Open stages description document Progress through the feedback form

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W hat w ill be next?

• Solicit vendor feedback on survey

framework

• Complete survey
• Role out globally
• Benchmarks, learnings, &

improvements

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Com ing soon: DI AM - EI

The updated model aligns with the current Radiology- focused DIAM  one model, but separate assessments (Radiology vs. Enterprise Imaging track) The new DIAM chart, with slight text adjustments to be inclusive of the Enterprise Imaging concept Insert updated model (if available)

Next milestones Open Feedback collection (May – June) Assessment kit development (Q2-Q3 2018) Public launch and assessments (Q4/2018)

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Questions?

Kim Garriott Principal Consultant Logicalis U.S. Chair, DIAM-EI Development Team e-mail: kim.garriott@us.logicalis.com Dawn Cram I.S. Director, Enterprise Imaging Ochsner Health System Co-Chair, DIAM-EI Development Team e-mail: dawn.cram@ochsner.org