Image Sharing, Radiology and Meaningful Use IHE North American Connectathon Conference 2011 January 18, 2011 chicago

1. Image Sharing, Radiology and Meaningful UseIHE North AmericanConnectathonConference 2011January 18, 2011chicago Dr. Keith J. Dreyer Vice Chairman of Radiology - Massachusetts General Hospital Assistant Professor of Radiology - Harvard Medical School Co-Chairman Informatics Committee - American College of Radiology

2. Conflicts of Interest • MGH/PHS has licensed technology to, receives royalties from and/or has financial interests in: • LifeImage, Inc. • Nuance, Inc.

3. Volunteer Positions • Societies and Organizations • ACR • Chairman, IT Government Relations Cmte • Co-Chairman, Informatics Cmte • Co-Chairman, Clinical Decision Support Cmte • Meaningful Use Presenter • RSNA • Chairman, IT Government Relations Cmte • Member, Informatics Cmte • Meaningful Use Presenter • ABR • Member, ABR IT Advisory Committee • RBMA • Meaningful Use Presenter • RadiologyMU.org • Meaningful Use Advisor • Meaningful Use Presenter

4. Overview • MGH Experience • EMR  Imaging Integration • IMR – Imaging Medical Record • Meaningful Use for Radiology • ACR Message to Federal Agencies

5. EMR  Imaging Integration Use EMR as a context platform for communication • 1995 - Hospital Distribution of Images

6. EMR Image Distribution Adsdfaldfsfff Adfasfafasdfdf Thrie his son wo Jswherwihsosfn Thwi neo whos m Haffueowhoehw Hwernienroeon New inwripwpw Nffjskdoer o erj EMR PACS

7. EMR  Imaging Integration Use EMR as a context platform for communication • 1995 - Hospital Distribution of Images • 2000 - Enterprise Distribution of Images • Multiple PACS to Enterprise EHR

8. Enterprise Image Distribution Adsdfaldfsfff Adfasfafasdfdf Thrie his son wo Jswherwihsosfn Thwi neo whos m Haffueowhoehw Hwernienroeon New inwripwpw Nffjskdoer o erj Adsdfaldfsfff Adfasfafasdfdf Thrie his son wo Jswherwihsosfn Thwi neo whos m Haffueowhoehw Hwernienroeon New inwripwpw Nffjskdoer o erj Enterprise EMR with MPI EMR PACS PACS PACS

9. EMR  Imaging Integration Use EMR as a context platform for communication • 1995 - Hospital Distribution of Images • 2000 - Enterprise Distribution of Images • Multiple PACS to Enterprise EHR • 2001 - CPOE for Radiology • 2003 - CDS for Radiology Ordering

10. Radiology CPOE and CDS Adsdfaldfsfff Adfasfafasdfdf Thrie his son wo Jswherwihsosfn Thwi neo whos m Haffueowhoehw Hwernienroeon New inwripwpw Nffjskdoer o erj ORDER IMAGING… EMR Medical Imaging Clinical Decision Support RIS PACS

11. Radiology CPOE and CDS

12. Radiology CPOE and CDS 19% Decrease (2005 – 2008)

13. EMR  Imaging Integration Use EMR as a context platform for communication • 1995 - Hospital Distribution of Images • 2000 - Enterprise Distribution of Images • Multiple PACS to Enterprise EHR • 2001 - CPOE for Radiology • 2003 - CDS for Radiology Ordering • 2010 -Foreign Image Import – Physical Media • 2011 - Extra-Enterprise Image Sharing

14. The Image Sharing Evolution • Standards Based Exchange • To Other Providers • To Patients • Physical Media Based Exchange • Category I • Radiology image CD of patient with an MRN • Category II • Non-Radiology image CD of patient with an MRN • Category III • Any image CD of patient without an MRN Physician Desktop Hosp 1 EMR LI RSNA-NIBIB Image Sharing Project PACS Hosp 2 III II Hosp n I LifeIMAGE PHRs

15. Overview • MGH Experience • EMR  Imaging Integration • IMR – Imaging Medical Record

16. Imaging Medical Record • Standalone Platform • Radiology manages entire system • Authentication, HIPAA, group privileges • Session level security • Browser and mobile device based • External Access to Imaging Services • Exam Ordering, Scheduling, CDS, Authorization • Critical Communication System • Report and Image Distribution

17. Imaging Medical Record External EMR 1 External EMR n MGH EMR Imaging Medical Record Medical Imaging Clinical Decision Support PACS RIS Imaging Center Imaging Center Imaging Center Imaging Center Imaging Center Hospital Dept

18. Overview • MGH Experience • EMR  Imaging Integration • IMR – Imaging Medical Record • Meaningful Use for Radiology

19. Meaningful Use for Radiology • Information Technology • MGH Developed • Complete EHR Certification Process

20. LMR Certification Timeline and Milestones Notice of proposed rule making Insight into ONC-Authorized Testing and Certification Body Final Rules Published LMR Exec. Approval for Cert. projects 60 day comment period LMR Certification Best case scenario Worst case scenario Q4 2009 Q1 2010 Q2 2010 July 2010 Aug 2010 Sept 2010 Oct 2010 Nov 2010 Dec 2010 Jan 2011 Feb 2011 Mar 2011 Apr 2011 May 2011 Review Gap analysis based on proposed rule We are here Define reasonable approaches to all LMR MU gaps Completed Final LMR Gap Analysis LMR Fall 2010 Release Version 2.0 August 2010 LMR Spring 2011 Release

21. Meaningful Use for Radiology • Information Technology • MGH Developed • Complete EHR Certification Process • Vendor Components • Modular EHR Certified • Internal Support for EP Meaningful Use

22. A Formula for Meaningful UseStage 1 Eligible Providers MU = 15 Core Measures and 5 of 10 Menu Measures Core 1 1 1 1 Menu 1 1. Master e-prescribing (eRx) • CPOE (30% medication orders) • Transmit prescriptions electronically (40%) • Implement drug-drug / drug-allergy (attest) • Maintain active medication list (80%) • Implement drug Formulary (attest) Practice Staff 2. Leverage Care Team • Record demographics (50%) • Record vital signs (50%) • Record smoking status (50%) • Provide patients with an electronic copy of health info. (50%) • Provide clinical summaries for each office visit (50%) 1 1 1 1 1 Eligible Providers 3. Leverage Enterprise Application • Implement 1 clinical decision support rule (attest) • 1 - test of EHR capability to exchange key clinical information (attest) • Capability to submit immunization to immunization registries (attest) • Capability to submit electronic syndromic surv. data (attest) • Incorporate clinical lab test results unto EHR / structured data (40%) • Generate Lists of patients by specific conditions (attest) 1 1 1 1 1 1 IS and MGH/MGPO 4. Focus on Structured Data Elements • Maintain problem list (80%) • Maintain active medication allergy list (80%) • Quality Reporting (report measures) 1 1 1 5. Practice Assessment Work • Conduct security risk analysis (attest) 1 15 5

23. Meaningful Use for Radiology • Information Technology • MGH Developed • Complete EHR Certification Process • <Show the MGH MU pathway slide> • Vendor Components • Modular EHR Certified • Internal Support for EP Meaningful Use • Radiologists don’t directly input data to the EMR • Voice => Reporting System => RIS => EMR • Need to create a parallel system for radiologists to be seen as other EPs by the EMR

24. Radiology MU MGH EPs /Other Care Providers MU Reporting to CMS MU EP Dashboard MU Data Aggregation EMR RIS Interpretations = Patient Encounters Reporting System (Voice Recognition) Rad 1 Rad 2 Rad n

25. Overview • MGH Experience • EMR  Imaging Integration • IMR – Imaging Medical Record • Meaningful Use for Radiology • Messages to Federal Agencies

26. Message to Federal Agencies • Include Medical Imaging into HITECH care goals • Quality, Safety, Cost, Outcomes • Use Meaningful Use constructs when possible • Create a distinction between: • Medical Imaging Creators • Medical Imaging Consumers

27. Message to Federal AgenciesONC • For Medical Image Consumers • Images included in MU definition for ‘exam results’ • EMR, PHR, PHI Sharing • Require electronic ordering of Imaging • Require ‘electronic’ not paper to imaging department • Clinical decision support of Imaging • Separate from disease centric, order sets, drug-drug

28. Message to Federal AgenciesONC • For Medical Image Creators Create CQM specific to these EPs • Critical communication management • Urgent Notification, Recommendation Follow up • Require Report and Image Connectivity • To EHR and PHR • Provide Imaging CPOE and CDS • Radiation Dose Registry Compliance • Archival, Display, Access requirements • Relax the requirement to purchase systems that measure what EPs are excluded from.

29. Message to Federal AgenciesCMS • Embrace Clinical Decision Support for Imaging • Demonstration Project for Imaging CDS • Support Initiatives for CDS Rule Sets • National, Transparent, Standard, Medical Societies • Consider payment reform based on CDS

30. Message to Federal AgenciesFDA • Radiation Dose Registry • Patient Centric Exposure Monitoring • Image Storage and Access Requirements • Consumer based mobile visualization • iPhone, iPad

31. Message to Federal AgenciesNIBIB • Demonstrate value of existing technologies • CDS, Image Sharing, Critical Comm, Consumer Access • Promote standardization of existing technologies • Foster a common understanding of Imaging • Throughout various governmental agencies • Throughout Congressional oversight committees • Throughout the White House and OMB

32. Image Sharing, Radiology and Meaningful UseIHE North AmericanConnectathonConference 2011January 18, 2011chicago Dr. Keith J. Dreyer Vice Chairman of Radiology - Massachusetts General Hospital Assistant Professor of Radiology - Harvard Medical School Co-Chairman Informatics Committee - American College of Radiology