Medical Imaging and HIE: Beyond the Mandate

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By Ifetayo Freeman, EdM

February 2013—The 2009 Health Information Technology for Clinical and Economic Health (HITECH) Act mandated legislative and incentive-based cost control measures to allow physicians and patients access to patients’ medical information anywhere, anytime via an infrastructure of secure electronic paths, creating Health Information Exchange (HIE).  Many large independent health delivery networks, critical access hospitals, and eligible healthcare providers have qualified to participate in the Medicare and Medicaid incentive program which is divided into three Meaningful Use (MU) stages: (1) capture data electronically and provide patients with electronic copies of health information; (2) increase patient engagement by giving patients secure access to their information online; and (3) continue to expand MU to improve health outcomes.

An evolved and sustainable HIE is a necessary layer of survival and growth for radiologists who can use their local HIE(s) to push reports to patients quickly, as required by MU stages 2 and 3. The federal government, members of the national and international scientific and legal communities, and private industry delivered digital imaging archives two decades before the HITECH Act of 2009 using the technology we now refer to as PACS. While they were not accessible or discoverable by other facilities, the adoption of PACS was an important medium to connect physicians to paperless healthcare data.

Not surprisingly, the most common exchanges currently include only radiology results delivery. Although comprehensive exchange of clinical information beyond report data is still a long way off, for most clinicians across the United States, there are promising models in several different regions. Rochester Regional Health Information Organization (RHIO) announced ImageExchange in the fall of 2012, giving thousands of healthcare providers access to diagnostic images on any internet connected computer with the click of an icon. HealthInfoNet in Maine was the first in the nation to support the statewide sharing of x-rays, CT scans, MRIs, mammograms, and other medical imaging related data. According to the 2012 Report on Health Information Exchange, advanced initiatives are growing and beginning to evolve where relevant patient data, beyond textual reports, is being secured and shared outside of the individually participating healthcare networks.

Radiology department based image management, enterprise-wide centralized archives housing radiology and non-radiology imaging datasets, and enterprise and community health information organizations (HIOs) are relying on participant agreements to develop an environment of trust and ultimately enable an effective HIE. These agreements are defined under the HITECH Act of 2009 and the Health Insurance Portability and Accountability Act (HIPAA) of 1996, which required the US Department of Health and Human Services to establish rules to protect the privacy of health information. The California Office of Health Information Integrity (CalOHII) is reconciling state laws, consent, liability, and data sharing agreements in a template called the Model Modular Participant Agreement (MMPA).

In a perfect world, the “end game” influences day to day decisions, not profit or fear. HIE is fundamentally about people.  When properly implemented, the HIE paradigm ensures that the information about people is private, secure, and shared among all verified providers regardless of organizational affiliation. On a global level, the end game is innovation. On both fronts, America’s electronic health data sharing will be remembered as a major driver of renaissance architecture within the computer world to improve the health and well being of people.

Medical imaging continues to play a critical role in the integrated healthcare delivery system and is consequently an important player at the table of HIE progress, which has the potential to transform the lives of people who no longer suffer from chronic and severe health problems because of improved physician assessment, diagnosis and treatment, and better self care. An HIEs output will build communication agility and seamless access to data which will, in the end, drown out the current din of barriers related to security breaches, legislative budget cuts, interoperability, and medical IT standards incongruity.


Ifetayo Freeman is an analyst at Ascendian Healthcare Consulting. If you have questions you can contact Ifetayo via email ifreeman@ascendian.com.

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