Medical imaging informatics is the next data step forward


Challenges of integrating an EHR with medical imaging storage

The healthcare industry is still sorting out how to handle storing medical images in general. However, one issue is integrating that storage with the EHR.

Among the challenges that face medical imaging storage today -- including dealing with massive amounts of data...

and ensuring reliable and efficient access to images -- is integrating the various storage options with EHRs.

Rasu Shrestha, chief innovation officer at the University of Pittsburgh Medical Center in Pennsylvania, told SearchHealthIT that, within the healthcare industry, much chaos has surrounded the problem of integrating medical imaging storage with EHRs.

Shrestha discusses the challenges, how some are trying to overcome these challenges, as well as the best practices and standards he thinks are needed in order to successfully integrate EHRs and medical imaging storage.

How do EHRs integrate with medical imaging storage options?

Rasu Shrestha: To be quite honest, in the last several years, there was a lot of chaos around this. There were [EHR] vendors who had their only repositories and still have their own repositories and capabilities in terms of how you integrate to ... the vast array of multimedia content that gets generated. Because when you think about things ... we've gone from divisional to departmental to enterprise. When you think about things from an enterprise imaging perspective, it's not just DICOM content that's coming at you from a CT scanner or an ultrasound machine, it's also non-DICOM content, it's also moving images. It's visible light images that you're capturing from your cellphones and from digital cameras around wound images, or you're looking at melanomas and other skin lesions, and then scenes and scopes that you're capturing from your endoscopes. So managing all of this content in a very cohesive way has continued to be a challenge, especially as it relates to how you then integrate it back into the [EHR].

Rasu Shrestha, chief innovation officer, University of Pittsburgh Medical CenterRasu Shrestha

What approaches are healthcare organizations taking to achieve this integration, and how are they overcoming these challenges?

Shrestha: I do think that ... these strategies [are coming together] around more of a hybrid model, that there are now best practices that are emerging on how you might want to plug some of this content back into the [EHR]. What we're seeing, and I think what's optimal and what most CIOs need to be thinking about, is how do you really optimize the workflow across the board?

[One goal is] you capture once, you store once and you are able to then access and reuse the multimedia content multiple times through multiple different applications and use cases. So to be able to do that and then hence decrease costs and improve outcomes -- which is really the goal that CIOs also have -- ... you need a tighter level of integration back into that [EHR]. So you're capturing it once, you're storing it once in that repository that we described earlier, that you need to be able to create the right level of access points directly into the [EHR] or directly into that [health information exchange] HIE viewer. And so you're propagating, essentially or ideally you're propagating ... standardized ways to capture and store and to access this content.

[One goal is] you capture once, you store once and you are able to then access and reuse the multimedia content multiple times through multiple different applications and use cases.
Rasu Shresthachief innovation officer, UPMC

What are those standards or best practices that need to be adopted in the industry in order to enable successful medical imaging and EHR integration?
Shrestha: So what's interesting is, with that need that I just articulated, and sort of the best practices and the blueprints that are being created around those best practices, what's emerging right now is a need for [EHR] vendors to really adhere to more of a standards-based approach to access and plug in to these repositories. So whether it's directly through HL7 and DICOM, which have made a lot of progress in the last several years, to emerging standards like HL7's [fast healthcare interoperability resources] FHIR ... that allows for tighter levels of integration back into the [EHR], these are the sort of the best practices that I think we need to be propagating more of in the industry.

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