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For some providers, HIE implementation cannot wait

Radiologists and other medical specialists are increasingly finding that waiting for state health information exchanges to come online is a bad business decision.

Patrick Ward, CIO of Central Illinois Radiological Associates (CIRA), a 64-radiologist practice that serves 15 hospitals, is in the process of setting up what looks, on paper, like a tiny radiology-specific health information exchange (HIE) implementation. Ward, of course, doesn't call it that, but CIRA's network pushes images and reports to three large health systems and a handful of smaller hospitals and clinics in its region.

More HIE implementation resources

From HIMSS 2012: "Beleaguered" public health agencies get HIE connectivity help

From RSNA 2011: Radiologists explore role in HIE initiatives

Maine HIE implementation sets national example for patient, provider participation

For CIRA, the complexities of maintaining multiple virtual private networks (VPNs) for each facility led to a rebuilt high-speed network infrastructure to accommodate a new single-sign on portal through which hospitals can access the records they need.

Right now, CIRA is participating in the design of its state-funded, public regional HIE -- health IT leaders divided Illinois into five or potentially six regions -- and, at the same time, resolving connectivity issues with hospital EHR systems and the tiny radiology HIE-like entity it has built itself. (CIRA and Ward also advised the state of Illinois when it composed its proposal for its federal HIE grant.)

Endure HIE implementation now, avoid red tape later

Whether dealing with customer data or theorizing how the regional HIE will work, CIRA wrestles with many of the same questions.

  • How do you standardize data across disparate networks?
  • How will patient data be kept private?
  • How will the business needs of competing hospitals be resolved?
  • Will the HIE use a federated or centralized structure?

The difference is that CIRA is paying for its own exchange and understands the economics of HIE. Why would CIRA take on building its own private exchange infrastructure knowing that publicly funded state HIEs are coming down the pike? Like the Beth Israel Medical Center HIE implementation, business reasons motivated the decision -- CIRA couldn't afford to wait for the political and technical wrinkles to be ironed out at the state level. (At the federal level, radiology image sharing has been added as an optional measure in the proposed meaningful use stage 2 criteria.)

"We realized that, as a private practice radiology group, we sat between three competing health systems -- two of them literally across the street from each other in Peoria -- and we were aware that they did not like to integrate, they did not like to share data," Ward said. "We needed to build something that would integrate our own radiologists."

When it happens, widespread HIE implementation will be boon for teleradiology

Next up for CIRA is connecting to other HIEs as they are built. One would think, Ward said, looking at service providers such as NightHawk Radiology Inc., which provides hospitals with preliminary image reads and delivers them internationally via the Web, that HIE implementation would be a simple matter of applying their methods and topology to the health care system.

That's what HIEs are trying to do -- basically, manage utilization and eliminate unnecessary studies.

Patrick Ward, CIO, Central Illinois Radiological Associates

It's harder than that. Nighthawk and its competitors only do preliminary reads and cannot do final reads, Ward said, because they can't access the whole patient record and notice the progression of a condition or, perhaps, pick up something on an earlier image that might have been missed.

"Teleradiology companies just provide that preliminary interpretation [and] don't take into account that patient's historical or comparative data," Ward said. Integrating radiology reports into the patient record would enable final reads of radiology images -- but, because it involves such complicated data exchange, doing final reads remotely remains "the holy grail" for his specialty.

If HIEs can get up and running, Ward sees benefits to radiology patients, especially those with cancer. These patients get many scans during the course of treatment, sometimes from multiple providers. If oncologists could share images -- or just be able to access images for the same patient from multiple providers at once -- it would probably result in fewer imaging studies ordered, Ward said, or cheaper modalities when they're appropriate. That would result in less cost for treatment, not to mention lower radiation exposure for patients.

"That's what HIEs are trying to do -- basically, manage utilization and eliminate unnecessary studies," he said.

Let us know what you think about the story; email Don Fluckinger, Features Writer or contact @DonFluckinger on Twitter.

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