Readers Write: Advanced Interoperability: Leveraging Technology to Improve Patient Lives and Provider Workflows

Advanced Interoperability: Leveraging Technology to Improve Patient Lives and Provider Workflows
By Justin Dearborn

There’s an increasing need for all of healthcare to be integrated in its approach to accessing, sharing, and storing information. It’s not just patients who could stand to benefit from more advanced interoperability. It’s also healthcare providers who want to meet legislative requirements such as Meaningful Use Stage 2 and Stage 3, as well as reduce costs and improve care quality.

Consider what typically happens in today’s medical imaging environment—often partway between a traditional manual environment and a fully interoperable one—when a patient presents to his primary care physician (PCP) complaining of shoulder pain, for example:

After receiving a comprehensive clinical exam, a patient named Dave heads home with a hand-scribbled order for a shoulder MRI. Before the exam can take place, however, the imaging center must get the order pre-certified by Dave’s health insurer. After receiving the insurer’s faxed approval days later, the imaging center schedules the patient for his exam. Days after that, the radiologist faxes his report to the PCP, who then calls Dave to set another appointment to discuss his torn rotator cuff. Once the decision to seek surgical treatment is made, Dave is asked to bring a CD of his radiology images to the orthopedic specialist.

If this process sounds cumbersome, time consuming, and inefficient, that’s because it is. It’s also the rule with respect to today’s medical imaging processes.

While it’s true that anywhere between 10 to 20 percent of imaging orders issued today are processed electronically, that still means the vast majority are processed manually via paper and/or fax. According to the Centers for the Disease Controls and Prevention (CDC), approximately 12 percent of all PCP visits alone result in a referral for diagnostic imaging—some 44 million imaging exams each year—which equates to a lot of wasted time and paper, not to mention money.

The payer-approval process only adds to that burden. Roughly 122 million imaging exams are processed manually by radiology benefits management companies each year, at a cost of about $75 per exam. That adds up to nearly $8 billion of waste a year.

So the question is this: What would happen in an environment of advanced interoperability, where existing electronic health records (EHR) and other technologies are fully leveraged? Take Dave’s scenario again:

After receiving a comprehensive clinical exam, Dave’s PCP electronically orders a shoulder MRI and schedules an imaging appointment for later in the day. Before the exam takes place, the imaging center receives electronic pre-certification. Once the MRI is complete, the PCP automatically is alerted that an image-enabled report is available. Before he leaves his office for the evening, the PCP calls Dave to discuss his torn rotator cuff and to electronically refer him to an orthopedic specialist who already has secure automated access to the image-enabled radiology report.

As this simple scenario illustrates, the entire patient-imaging process can be streamlined by enabling five key services: 1) electronic referrals and ordering; 2) automated pre-certification and approval using clinical decision support; 3) electronic patient navigation and scheduling; 4) image-enabled reporting; and 5) analytics.

Such advanced interoperability provides Dave, his PCP, and his orthopedic specialist with near-instantaneous exam ordering, approval, and scheduling. Ease of access to reports, results, and images is dramatically increased.

By creatively leveraging EHRs and other technologies, healthcare organizations can maximize their interoperability with internal and external providers. All these services, moreover, can be provided without costly point-to-point HL7 interfaces.

With payment reform, it is clear that the days of disjointed, manual image processing are numbered. Indeed, advanced interoperability like that described here not only addresses the challenges that impact physicians, but also pays handsome dividends for patient care.

Justin Dearborn is CEO of Merge Healthcare of Chicago, IL