Enterprise Imaging Strengthens Your Quadruple Aim:  Part 1 - Quality

*  denotes a link to article requiring a subscription

In our previous article “What is Enterprise Imaging and Why Do I Need It?”  we focused on What is Enterprise Imaging and examined the parallels between Enterprise Imaging and data management.    In this article we are going to explore the second part of the question Why Do I Need It.  In other words, what value will it bring to my organization?  A great framework for answering this question is the Quadruple Aim and the value equation.   In this article we will examine how Enterprise Imaging impacts the quality side of value equation.  We will investigate the cost side of the equation in the next article.

Quadruple Aim and the Value Equation

The  Quadruple Aim is the north star for healthcare organizations.  It highlights four aspects of healthcare for organizations to optimize as they seek to achieve excellence in healthcare:

• Improve patient experience
• Reduce costs
• Improve health of populations
• Improve provider work life

The value equation is intimately related to the Quadruple Aim.

Value = Quality/Cost

The ultimate goal is to deliver cost-effective, high quality care.  Enterprise Imaging has the rare benefit of positively impacting both sides of the value equation; quality is improved while costs are decreased.  Enterprise Imaging helps an organization enhance clinical care, improve operational efficiency, strengthen cybersecurity, enable mobile tools and support business and clinical analytics *.

Improve Patient Experience

Patient engagement is a crucial feature of value-based healthcare.  Providing patients with access to their data is a key strategy to drive patient engagement.   In today’s world patients demand access to their medical information and that information includes their images.  As with all their other data, patients want mobile access to their medical information.

Clinical Impact

Patients benefit from “seeing” their disease process.   58% of patients with chronic wounds* believed that seeing photographs of their wounds helped them better participate in their own care and 81% felt that seeing their wounds allowed them to better follow their progress.  In the RSNA Image-Share Project preliminary study greater than 95% of patients expressed a desire to access their radiology images.   In another study 86.7% of patients believed that seeing their radiology images helped them better understand their medical condition and 63.8% believed that viewing their images enhanced the doctor-patient relationship.

Sharing images with patients during an office visit is a great way to transform the computer from a barrier into a tool that enhances the patient-provider interaction.   In response to this patient interest, many providers use their smart devices to share images with patients during daily rounds.  Does your organization provide a secure and compliant process to support this image sharing between provider and patient?

Image Accessibility

Not unreasonably, patients expect their provider to have access to all of their information to support diagnosis and treatment decisions. Regardless of the source of the image, an internal department at a different geographic location or an external department, images need to be readily accessible.  Patients are unwilling to have care delayed due to a provider’s inability to access information.

Enterprise Imaging delivers the functionality organizations need to meet these challenges.   When the universal viewer is integrated with an EMR-based patient portal, organizations create a single point of images.

Patient-Directed Image Sharing

As Enterprise Imaging technology continues to evolve, universal viewers will allow patients to assume responsibility for sharing their imaging studies.  Patient-directed image sharing eliminates the need for a visit to the HIM (health information management) department to collect a CD.  In the current COVID-19 environment eliminating an unnecessary trip to the hospital or imaging center is particularly important.

Additionally, the potential for inadvertent loss of the CD or failure to bring it to a clinical appointment is eliminated.  Data about the number of incomplete medical appointments attributable to to missing imaging information is difficult to come by.  However, most providers can remember at least one recent appointment where decisions couldn’t be finalized because imaging studies were not available.

Improve the Health of Populations

The spotlight is brightly shining on population health as we move away from a transactional health system based on acute, episodic care.  Population health initiatives strive to promote health, prevent disease, and improve the quality of care.  Information sharing along the care continuum is essential to a high performing population health initiative.

Population Imaging

The role of imaging in population health is in its infancy.  For radiology, incidental findings management, disease surveillance, appropriate use of screening examinations, clinical decision support and overall imaging utilization management are front and center.  As more and more AI applications and advanced imaging analytics reach viability, medical imaging will continue to increase in importance.  Population imaging will be recognized for its role in disease prevention through its ability to detect precursors of disease.

Patient-Centric Imaging Record

In multi-hospital systems an enterprise imaging program creates a unified imaging record, even if different radiology, cardiology or ophthalmology groups are employed/contracted and several different EMRs are in use.  This unification of imaging studies establishes a single comprehensive imaging record.  A patient’s imaging record shifts from an organization-centric or department-centric model to patient-centric model.

This patient-centric imaging record can be exploited to verify screening and follow-up imaging and to deliver access to all relevant comparison studies.  As health care systems vertically integrate, the imaging record electronically travels with the patients as they seek higher levels of sub-specialized care.  Clinical decision support tools are a valuable tool in the population health management armamentarium.  When a single imaging record exists, these tools can interrogate the entire health system imaging record to reduce redundant examinations.

Improve Provider Work Life

Today’s healthcare providers are being crushed by the burden of ever-increasing demands of healthcare delivery.  Poorly constructed workflows and gaps in information are known factors contributing to provider burnout.  Strategies to help reduce this burden include improving health IT, establishing standards and implementing automation.

Provider Access to Imaging Information

Easing access to patient information is essential to reducing burnout.  Integrating the universal viewer with the EMR will provide the right information at the right time in the right workflow.   Information is available right at the providers fingertips in the EMR-based workflow.   Capitalizing on metadata standardization, the universal viewer can deliver relevant, curated imaging data.  Less time is spent tracking down patient images.  The universal viewer delivers a consistent user experience without the frustration associated with CD-based viewers which often fail to open.  Mobile tools deliver imaging information to providers at any time, in any location.  Robust image exchange will deliver all the imaging data needed to care for patients and eliminate the burden of tracking down missing external information.

Final Thoughts

Enterprise Imaging delivers undeniable value to an organization.  From radiology studies for cancer diagnosis and follow up, to photographs to document dermatologic conditions and wound care, images are tightly woven into the fabric of healthcare.  Is it realistic to think we can achieve quality outcomes without managing these critical pieces of information?  In the next article we will examine the impact of Enterprise Imaging on the cost side of the value equation.

References

1. Rishi Sikka, Julianne M Morath, Lucian Leape.  The Quadruple Aim: care, health, cost and meaning in work. BMJ Qual Saf 24: 608-610, 2015. https://qualitysafety.bmj.com/content/qhc/24/10/608.full.pdf
2. Petersilge CA. The Enterprise Imaging Value Proposition. J Digit Imaging. 33:37-48, 2019. https://link.springer.com/article/10.1007/s10278-019-00293-1 *
3. The 3 Building Blocks Supporting Patient Engagement Strategies. Patient Engagement HIT.  https://patientengagementhit.com/features/the-3-building-blocks-supporting-patient-engagement-strategies. Accessed Sept 7, 2019.
4. Wang SC, Anderson JA, Jones DV, Evans R.  Patient perception of wound photography.  Int Wound J.  13:326-30, 2016.  https://onlinelibrary.wiley.com/doi/abs/10.1111/iwj.12293 *
5. Hiremath A, Awan O, Mendelson D, Siegel EL. Patient perceptions of participating in the RSNA image share project:  a preliminary study.  J Digit Imaging 29:189-194, 2016.   https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4788609/
6. Vetter SY, Schuler S, Hackbusch M, Muller M, Swartman B, Schnetzke M, Grutzner PA, Franke J. Tablets for image review and communication in daily routine of orthopedic surgeons – an evaluation study.  J Digit Imaging 31:74-83, 2018.  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5788817/
7. Mollura DJ, Carrino JA, Matuszak DL, et al. Bridging radiology and public health: the emerging field of radiologic public health informatics. J Am Coll Radiol. 5:174-181, 2008. https://www.jacr.org/article/S1546-1440(07)00490-5/fulltext*
8. Kauffman L. The radiologist and population health management.  Radiology Business.  https://www.radiologybusiness.com/topics/care-delivery/radiologist-and-population-health-management. Accessed August 11, 2020
9. Gourevitch MN, Thorpe LE. Advancing Population Health at Academic Medical Centers: A Case Study and Framework for an Emerging Field. Acad Med. 94:813-818. 2019. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6553514/
10. Rouger M. Population imaging:  Big data will boost disease prediction.  https://healthcare-in-europe.com/en/news/population-imaging-big-data-will-boost-disease-prediction.html. Accessed August 11, 2020
11. Shannon DW. Reducing burnout tops the to-do list of health care orgs.  https://betsylehmancenterma.gov/news/reducing-burnout-tops-the-to-do-list-of-health-care-orgs. Accessed August 11, 2020
12. Donovan F. Improving health IT infrastructure key to reducing clinician burnout.  https://hitinfrastructure.com/news/improving-health-it-infrastructure-key-to-reducing-clinician-burnout. Accessed August 11, 2020
13. Monica K. 5 ways to prevent physician burnout in the age of the EHR system.  https://ehrintelligence.com/news/5-ways-to-prevent-physician-burnout-in-the-age-of-the-ehr-system.  Accessed August 10, 2020