Building the Business Case for a Medical Image Archive Chris Meenan University of Maryland School of Medicine
Disclosures • Co-Founder Analytical Informatics • Faculty, Department of Diagnostic Radiology and Nuclear Medicine University of Maryland School of Medicine • Board of Trustees, American Board of Imaging Informatics (ABII) • Program Committee, Society for Imaging Informatics in Medicine (SIIM) • Grant Funding - RSNA / NIBIB Patient Image Sharing Project
What's the challenge? • You’ve been to SIIM and would like to pursue a VNA project. • How to champion that idea back home? • An opportunity to show the value of the CIIP to the C suite!
The paradox of IT / informatics excellence • Many of us come from technical or clinical background • Vast knowledge of technical architecture, standards, data exchange, interoperability methods. • This expertise has brought you to where you are in your career.
http://www.slideshare.net/gaspardbos/bff-open-mic-at-the-disruptive-innovation-festival
Time to meet the Executive team
Know your audience. • Incredibly busy • Multiple priorities, many stakeholders, different Departments. • In current health systems, even more complexity. • Many more capital requests than budget dollars. • Goal is help organization survive and thrive ( while minimizing risk ).
Your mission - Clear Communication Step #1 - Start with “Why”- What forces are at work? Step #2 - Describe the business problem and impact. Step #3 - Describe technical solution (high level) Step #4 - Describe Return on Investment (ROI) and ongoing costs Step #5 - Why us? Can we execute on this vision?
Step #1 - Start with “Why”
What forces are at work? • Unquestioned value of clinical imaging to help provide and improve patient care. • “Image enabling” the EMR and Patient Portals a CMS “Meaningful Use” criteria. Goal to improve / reduce costs of care by better data sharing. • ACR’s Imaging 3.0 – Transforming radiology to a more visible, consultative role. • Bigger data : Increase of data volumes (even with flat study volumes) • Rapid expansion of clinical imaging outside of Radiology (Derm., Endoscopy, Periop., point of care, visible light.)
Step #2 - Define the (Business) Problem
What is a PACS? • Medical Image viewing • Target for modalities (CT, MRI, US, etc) Picture • Tools to manipulate images (measure, area, angle) • Technologist and Physician intelligent work-lists • Report archive linked to images Communication • Links to other Hospital Information Systems • Patient medical imaging record • Safe backups, multiple locations Archive • Legal archive. System
Challenges with “traditional” PACS • Can’t display or store every image type (e.g. NucMed, thin-slice CT, others) • Migrations very difficult, long, expensive (vendor tie-in) • Data “locked” in PACS – images often not accessible to clinicians or patients. • Physician “work product” not portable. • Annotations, measurements, markups locked in DB • Forced to follow a radiology-like workflow to achieve high data quality - typically can’t scale beyond single specialty.
Current state: Silos of imaging data – not integrated • Many “local” PACS systems • No shared data storage • PACS systems don’t talk to each other • Little awareness of existing medical imaging across sites. • No EMR integration • External image management labor intensive. • CD’s In (mostly) “Can you put this on the PACS?” • Some semi-automated - Anonymous resident
UMMC Radiology Data Storage Increases Annual Data Utilization Cumulative Radiology PACS Storage (TB) Radiology PACS (TB) 140 30 120 25 100 20 80 15 Storage Volume TB 60 Cumulative Storage 10 40 5 20 0 0 2007 2008 2009 2010 2011 2012 2013 2014 2007 2008 2009 2010 2011 2012 2013 2014
John Halamka,MD - CIO Beth Isreal Deaconess As a CIO I can no longer let 1000 wildflowers bloom in the world of image management. Why? 1. Each department would use its own image viewing software 2. Each department needs it own disaster recovery strategy. 3. Each department needs it own records management / image retention rules. 4. Each department needs it’s own capital budget for disk storage. 5. Clinicians would not be able to have a unified list of imaging studies or consolidate images across multiple institutions using different medical record numbers. Answer: “Long Term Archiving that is standards compatible and supports all the ologies. Each department can purchase the applications which interface to its imaging devices and support its workflow. The Departments own the "front end"” Source: http://geekdoctor.blogspot.com/2008/03/cool-technology-of-week_27.html
Step #3 - “High-Level” Technical Solution
Current Problem: Imaging data locked in silos Problem 1: Problem 5: Multi-EMR interface integration How to view images across silos? Hospital #1 EMR (Demographics, Orders, Results) Cardiology PACS Radiology PACS Vascular PACS Other specialties PACS Picture Picture Picture Picture Communication Communication Communication Communication Archive Archive Archive Archive Problem 2,3,4: Expanding data islands • Multiple data archives that grow forever • Expensive, difficult migrations and vendor tie-in •
How to scale a multi-site health system (like UMMS)? Hospital #5 Hospital #2 Hospital #1 System EMR Hospital #3 Hospital #4 Hospital #6
Milestone #1: Implement common storage platform across imaging specialties • “Vendor Neutral Archive” - VNA • Becomes the “A” in PACS for all Picture Picture Picture systems. Communication Communication Communication • Allows for improved workflows • Predictable and lower cost System System System expansion and migrations. VNA • Stop multiple copies – store once, integrate everywhere! • ILM: Delete studies as needed. Disk Storage
Milestone #2 – Standardize on an EMR viewer • Multi-specialty viewer. • Integrates directly into EMR. • Tools for collaboration. • Multi-device (PC, Mac, Tablet). • Reduced cost for deployment - “zero footprint” system.
Milestone #3: Implement Enterprise Imaging Governance Committee • Multi-site, multi-specialty • Provide clinical, financial, legal and technical governance • Define workflows to maximize value of resources. • Monitor usage and ensure compliance. • Financial monitoring and planning
Milestone #4: Implement Image Exchange System for outside images • Minimize the CD problem for outside images. • Reduce repeat scans and import effort. • Increase referral / consult base for specialties • Future: integrate with EMR
Step #4 - Sweat the Numbers - Financial
Describe Financials and include ROI • Start with largest system / department • Calculate costs to run annually over time (Capital and Operating) • Expand model to additional Departments • Add miscellaneous costs (interfaces, testing, system management)
Build a financial reputation • Estimate savings with project • Consider cost avoidance • Streamline staffing models for better support. • Estimate timeline and commit to regular updates. • Return project savings – positive variance!
Experience at CHOP – Chris Tomlinson, Radiology Administrator Project: Implemented multi-department VNA Results / Outcomes 1. $3,000,000 cost avoidance vs. typical PACS install (5 year period) 2. Enterprise strategy to leverage enterprise scale for storage 3. Provide all clinicians will access to all imaging modalities (radiology, cardiology, urology, pulmonology, gynecology, gastrology etc) from one point. 4. One unified imaging link to the imaging layer for the EMR; not an interface per system Source: http://www.childrenshospitals.net/AM/Template.cfm?Section=t&template=/CM/ContentDisplay.cfm&Con tentID=50783
Step #5 - Why you (or what’s the risk)?
Who’s on the team? • Clinical Champion. • Business / Executive champion. • Technical champion • Other organizational resources / team members. • Helps to have: • History of successful projects. • History of positive financial management.
Questions and thanks! Chris Meenan Department of Diagnostic Radiology and Nuclear Medicine University of Maryland School of Medicine @cmeenan
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