A great place to begin improving the interoperability of health care informatics is where the radiology practice and the hospital intersect
The importance of IT already has been established; it is key to the success of an imaging practice. Organizations with this vision have made major investments in the right kind of IT management and in the infrastructure required to run an efficient practice. Most imaging practices and hospitals will invest in clinical technology with the premise of giving referring physicians exceptional service to enhance patient care. The same organizations, however, do not necessarily invest in IT management or infrastructure, thus leaving patient care somewhat compromised in terms of timely reporting and electronic access.
If we are to achieve any measure of interoperability, it is imperative for IT departments in hospitals to be trained to support requests from physician practices in a timely fashion. When physicians are on-site at a hospital doing rounds, and they need access to image information, they frequently are unable to get a response from the IT department when help is needed. By the time they hear back from IT staff, they have finished their rounds and left the hospital.
Likewise, there is great potential for frustration on the radiology-practice side when the practice’s viewer, which has been working perfectly for months in the hospital, suddenly stops working. There is much back-and-forth discussion about where the problem lies, and even if the viewer works everywhere else (including at other hospitals), it is still difficult to get the hospital to acknowledge that, for instance, an internal update of the software might have broken the interface.
As an imaging practice, we take our referring community very seriously. Even with limited staff, we treat a call for help as our utmost priority because we understand that the referring physician is ultimately trying to provide the best patient care. Some hospitals have limited budgets and have tenured staff members who are still maintaining loosely coupled legacy systems. The process of deciding to change is thwarted by an ingrained internal bureaucracy. In my experience, no matter which IT arm one works with in a hospital environment, getting to the person who can start the process is a challenge.
The Path to Communications
How does one succeed in exchanging information with the hospital, or simply in giving access to diagnostic reports and images (acquired at your practice) to referring physicians while they are doing their hospital rounds? The answer is not simple. It requires a lot of time and effort to convince the IT staff at the hospital of the reason that the application that works very reliably anywhere, except on the hospital computers, is not working within the facility’s walls. I understand that security and HIPAA regulations warrant locking down the workstations like Fort Knox. Sometimes, however, this impairs service.
We have tried first going to the IT staff through a help desk. After failing, we then escalate to the CIO. We have also tried the reverse. Sadly, no matter which way one goes, the final resolution takes months for something simple, and years if the problem is an interface exchanging data. I have a little sign in my office that says, “Bang head here.”
Relationships are very important, and understanding hospital IT is even more important. A private imaging practice does not face the same challenges that a hospital radiology department does. Radiology is one part of large system, and understandably, it is easy for things to get lost in the shuffle. If you want to succeed, you have to take the time to include everyone involved in information exchange, including the referring physicians, clinical support, and the IT support staff. Make the necessary telephone call, follow up with e-mail, and know that the more you do this, the quicker the resolution will be. Don’t be surprised, though, if some problems are never resolved, as experience also has taught us.
We are now in an era in which most physician practices, both within and outside radiology, are beginning to invest in practice-management systems that are capable of exchanging patient data. Hospitals will need to adapt by providing information exchange, and by doing so sooner rather than later, we hope. The challenge, for hospitals, will be getting off their legacy systems and starting to adopt newer systems. The dilemma is that health care IT systems are still in development; unlike systems common in finance, entertainment, and delivery, most have not reached a state where they can be trusted. There are best-of-breed application vendors for PACS, hospital information system/RIS, and HL7 interfacing, and bringing them in as partners will definitely give the organization an edge over the competition. Spend your dollars well and wisely. Don’t be penny wise and pound foolish.
No matter what, it is important for both sides to have open minds about each others’ systems and to work with a sense of urgency. Ultimately, the goal is to provide good patient care in a timely fashion.
This article was written by:
Duleep L. Wikramanayake is CIO for Advanced Radiology Consultants (ARC), Trumbull, Connecticut. Before joining ARC in 2001, he accumulated 20 years of IT experience in a variety of industries, ranging from e-commerce to publishing to insurance.