Building the Business Case for a Medical Image Archive Chris Meenan - - PowerPoint PPT Presentation

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?

Picture Communication Archive

• Medical Image viewing
• Target for modalities (CT, MRI, US, etc)
• Tools to manipulate images (measure, area, angle)
• Technologist and Physician intelligent work-lists
• Report archive linked to images
• Links to other Hospital Information Systems
• Patient medical imaging record
• Safe backups, multiple locations
• 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)
• Some semi-automated

“Can you put this on the PACS?”

• Anonymous resident

UMMC Radiology Data Storage Increases

5 10 15 20 25 30 2007 2008 2009 2010 2011 2012 2013 2014

Annual Data Utilization Radiology PACS (TB)

Storage Volume TB 20 40 60 80 100 120 140 2007 2008 2009 2010 2011 2012 2013 2014

Cumulative Radiology PACS Storage (TB)

Cumulative Storage

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

• logies. 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

Picture Communication Archive Picture Communication Archive Picture Communication Archive Picture Communication Archive

Hospital #1 EMR Cardiology PACS Radiology PACS Vascular PACS Other specialties PACS Problem 1: Multi-EMR interface integration (Demographics, Orders, Results) Problem 2,3,4:

• Expanding data islands
• Multiple data archives that grow forever
• Expensive, difficult migrations and vendor tie-in

Problem 5: How to view images across silos?

How to scale a multi-site health system (like UMMS)?

System EMR Hospital #1 Hospital #2 Hospital #3 Hospital #4 Hospital #5 Hospital #6

Milestone #1: Implement common storage platform across imaging specialties

• “Vendor Neutral Archive” - VNA
• Becomes the “A” in PACS for all

systems.

• Allows for improved workflows
• Predictable and lower cost

expansion and migrations.

• Stop multiple copies – store
• nce, integrate everywhere!
• ILM: Delete studies as needed.

Picture Communication System Picture Communication System Picture Communication System

VNA 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
• utside 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

• ne 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