Saturday, March 3, 2012

Integrating radiology into electronic health records promises cost and care benefits - SDM Pulse Spring 2012

By Palani Perumal, SDM ’11

Case for action
Spending in the US for diagnostic imaging is growing at twice the rate of total healthcare costs. This comes at a time when there are number of issues facing radiology:
• Lack of communication between physicians and radiologists
• Lack of awareness of American College of Radiology (ACR) guidelines among ordering physicians
• Absence of clinical decision support systems
• IT issues (data standards, interoperability)
• Higher costs from the fee-for-service reimbursement model
Under the Health Information Technology for Economic and Clinical Health (HITECH) Act, healthcare providers have incentives for the “meaningful use” of electronic health record technologies. However, the Stage 1 meaningful use regulations do not explicitly include radiologists or medical imaging information, and radiologists are in the dark about what the regulations offer and require.
The approach
For his SDM thesis project, Palani Perumal, SDM ’11, worked with Beth Israel Deaconess Medical Center in Boston to assess the impact of integrating radiology into electronic health records (EHRs).
Palani used system dynamics modeling to analyze the technology, business, and policy forces that shape the radiology field, and answer the question of whether radiologists should be considered part of the care team.

Figure 1. This chart shows the radiology ordering cycle.
The green arrow is the missing feedback loop. The radiology system
is less efficient without communication between physician and radiologist.
The radiology system is composed of the following:
• Radiologists
• Image capturing devices
• Radiology Information Systems (RIS)
• Picture Archiving and Communication Systems (PACS)
• Digital Imaging and Communications in Medicine (DICOM) standards
• Billing systems
The radiology system interfaces with several other systems, notably ordering physicians, hospital information systems (HIS), and payers.
Benefits and impacts
Acknowledging and fostering radiology’s role in core care has important benefits:
• Physicians can leverage the value of radiologists in ordering the right study at the right time.
• Radiologists can continually learn from the impact their diagnostic findings have on physicians’ treatment decisions.
• Radiologists can review and discuss patient medical history and contribute to improving diagnoses and recommendations.
An analysis of the likely impacts of including radiologists in the HITECH meaningful use requirements indicates the following benefits:
• More meaningful use of imaging data by referring physicians.
• Seamless image sharing, cumulative dose information tracking, and contribution to patient health records and population data.
• Improved physician ordering behavior as awareness of clinical guidelines and on-demand access to data improve.
Radiologists should be included in the meaningful use requirements as part of the care team. This modification will allow for the addition of standardized imaging data to EHRs and use of Clinical Decision Support systems in the radiology ordering workflow.

Figure 2. This chart shows the impact of including radiology in the HITECH
meaningful use requirements. The red text describes the changes the
meaningful use requirements would introduce in the radiology system.
The green text describes the resulting changes in the image ordering process.
About the Author
Palani Perumal is a Senior Program Manager at Microsoft who recently earned an MS in Engineering and Management through MIT’s System Design and Management (SDM) Program.
Palani Perumal was advised on his thesis by Dr. John D. Halamka, MD, MS, professor and CIO, Harvard Medical School, CIO, Beth Israel Deaconess Medical Center, and Dr. Max P. Rosen, MD, MPH, associate professor of radiology, Harvard Medical School, vice chairman of radiology, Beth Israel Deaconess Medical Center.
Facts and Figures
Spending on imaging in the US more than doubled (105% growth) from $6.9B in 2000 to $14.11B in 2008.
US Government Accountability Office, 2008 – Medicare Part B Total healthcare spending per capita grew 60% in the same time period.
OECD Health Data, 2010

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