Federate? Migrate? Capitulate? ACO Driven Workflow & Interoperability. Mike LaChance, Vital Images

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1 Federate? Migrate? Capitulate? ACO Driven Workflow & Interoperability Mike LaChance, Vital Images

2 Young Woman? Elderly Woman? The Situation: This woman is sick and we need a diagnosis, we also need to know if she is Young or Elderly An incorrect age assessment endangers her life Prior photos and descriptions exist Original 1915 by the cartoonist W.E. Hill

3 Young Woman? Elderly Woman? Bernie Balance Start $10 Diagnostic Procedure, cost $5 $5 Reimbursed $7 $12 Total Net $2 Donald Balance Start $10 Diagnostic Procedure, cost $5 $5 Diagnostic Procedure, cost $5 $0 Reimbursed $14 $14 Net $4 * Will be rewarded with future incentives Accountable Claws Backs Standard of Care, cost $7 $7 Quality of Care, cost $2 $5 HCAHPS, cost $2 $3 Total Net: $7 Loss * Will be penalized with future penalties

4 Accountable Care Do Better with Less CMS s CJR: Compressive Care for Joint Replacement 90 day episode retrospective Fee-for-Service during care Cost & Quality retrospective inc. Patient Engagement (HCAHPS) Providers Success Requires Great: Communication, Coordination, Care

5 Interoperability Standards Alphabet Soup or Very Promising Initiatives? HL7 DICOM IHE XDS SNOMED LOINC ICD The Direct Project CommonWell Health Alliance Sequoia Project Carequality HL7 FHIR the HTML of healthcare John Halamka, MD, MS CIO Harvard BIDMC Argonaut Project DICOMweb ONC Interoperability Roadmap

6 (New) Reality 2014 and 2015: Meaningful Use, ICD-10, and keeping the lights on (HISTalk survey comment) Today: Accountable Care is the new reality we have to find ways to extract more meaningful value from the results of our Meaningful Use initiatives The good news is that there is lots of very relevant potential in our systems And, a number of contemporary technologies and solutions to help us harness that potential and minimize change management

7 IT Interoperability is Important & Challenging

8 In the News

9 Somewhere along the way we forgot Departmental Workflow Today s Departments now span Multiple locations Multiple Patient ID domains Multiple EMRs, HISs, HIMs Disparate departmental applications Population Health versus Patient Health You can t change/upgrade all of your systems at once but even if you could, there would still be workflow & interoperability challenges make your current investments work for you Departments provide bulk of diagnostic care

10 Very Promising News Modern Middleware Solutions Expect more from a contemporary Workflow & Interoperability Engine: Listen to all messaging, e.g., HL7, DICOM Keep track of messages expand the temporal dimension Be able to read and act upon all messages and structured data (discrete and codified) including morphing, translating data, and triggering messages, dataflows and workflow Be an Interface Engine.. be a Routing Engine be an intelligent Rules Engine Function as a distributed service spanning the enterprise, not a box Provide aggregated access to federated and/or centralized data sources (traditional ECM/VNA) Provide, or at least facilitate, records-of-truth for workflow, analytics, population health Patient Matching (internal empi) Leverage Contemporary Technologies (FHIR, XDS, DICOMweb)

11 Simple Enterprise Viewer Example Challenge: major teaching institution rolls out an enterprise viewer on top of an existing VNA and several new caches but users complain of poor performance and IT doesn t like caches Solution: DICOMweb enable the storage and the enterprise viewer Outcome: clinical users thrilled with experience, IT happy to eliminate caches, everyone relieved to eliminate potential data synchronization issues VNA DICOMweb DICOMweb Cache DICOMweb Cache DICOMweb

12 Lessons Learned from a Existing VNA Deployments Consolidated Information In a traditional VNA PACS are pointed at the VNA Historical studies were migrated to the VNA but Enterprise viewing performance is slow Relevant priors don t display properly Information not in the VNA is not available Solution: frontend the VNA with a contemporary Workflow & Interoperability Engine Images and reports are updated and morphed based on destination Un-migrated information is effectively accessible

13 Cardiology Example Multi-facility IDN Disparate MRNs Intent to systematically sunset departmental applications Eventually rolling out IDN-wide EMR, including some departmental applications Where to start? Some of the functionality: Provide patient matching Relevant priors engine, image & report morphing Translating measurements and reports, DMWL, etc. Triggering orders and billing events Various data migration plans Benefits: Achieve IDN goals now, including Quality & Cost Sunset existing applications fearlessly and responsibly Rollout EMR and departmental applications when ready

14 Accountable Care Enterprise Imaging Platform Top 9 Recommendations 9. Develop an Enterprise Imaging Informatics Platform Strategy 8. Take the Accountable Care movement seriously 7. Enable Cross Enterprise Sharing & Collaboration 6. Demand enterprise class performance, reliability, and TCO (perhaps an SLA-based partnership*) 5. Consolidate data access, migrate for the right reasons, embrace a hybrid environment 4. Leverage Contemporary Standards and Technologies 3. Data Liquidity, Security and Integrity 2. Focus on both Population & Patient Health 1. Delighting your stakeholders, starting with the clinicians and patients

15 Thank You! Mike LaChance Vital Images Exhibit #732

16 Contribute and learn! The IHE Radiology Technical Committee! Publish new IHE Radiology Profiles: Address the interoperability use cases defined Select appropriate standards Developed the detailed implementation specifications Key Dates: (approximate annual cycle dates) December initial Tech Committee meeting February meeting to publish profiles for Public Comment April meeting to review Public Comments and publish for Trial Implementation and wiki.ihe.net