It could be said that U.S. healthcare – and healthcare providers around the world, for that matter – are set up for volume-based care: more scans, more volume, and more business.
Now, payers, patient advocates and industry organizations such as the American College of Radiology are calling for a change to something they call "value-based imaging," radiology ranks fourth. It's part of a wider U.S. government program of healthcare reform that incentivizes better patient outcomes, reduced costs, improved safety and reduced radiation exposure – all made possible through health imaging interoperability.
Up to now, health data interoperability had some but few incentives to drive it forward. In a recent CHIME survey (sponsored by lifeIMAGE) of 100 U.S. health IT leaders, it's clear that both public and private payers are beginning to reward organizations that have interoperable systems with value-based contracts, and are denying claims when an imaging scan looks like it was unneeded or a duplicate in the claims documentation.
Moreover, interoperability is only going to get more financial backing. New MACRA rules from the Centers for Medicare and Medicaid Services (CMS) that compute care-quality scores include compliance choices for providers to search for previous CT studies, and to make CT scans available to patients and providers for 12 months.
Much bigger than radiology
So it's clear what value-based imaging is. But how do we get there, turning around the ship of volume-based care with technology? With enterprise imaging strategy that promotes liquidity of imaging information throughout the enterprise to physicians outside the firewall performing consults and second opinions. Interoperability improves patient care by avoiding duplicate, unnecessary tests and exposing patients to unneeded radiation. That is how Imaging 3.0 at once has the potential to create value, patient safety, patient satisfaction and better care quality.
More than just radiology needs imaging interoperability, too: By our count, more than 50 specialties use imaging. In a recent usage audit– comprising health systems of all sizes, skewed to large academic medical centers – broken down by specialty, radiology ranks fourth, behind neurology, surgery and internal medicine. This might be surprising, because when many healthcare professionals think of "clinical imaging," they assume it is "radiology." And why not?
Since the 1990s, picture archiving and communications systems (PACS) and vendor-neutral archives (VNAs) have been the repositories for most imaging. But those technologies are starting to show their age, especially in an era where health systems have accumulated disparate systems through mergers and acquisitions and the purchase of local independent practices. They need more flexibility and agility.
An enterprise imaging strategy covers the needs of all the specialties using imaging, once IT staff has taken an inventory of who uses imaging for what – for interpretation, treatment or reference – and what features each imaging consumer in the workflow needs.
Inside the firewall, enterprise viewers can help all the clinicians who use imaging to get their work done. But what happens outside of the firewall? This is the interoperability that creates true value for patients and the health system – it enables patients to:
• Get CT or MRI scans at a standalone imaging center
• Seek second opinions at an outside provider
• Send hospital images to primary care or specialist provider
• Secure referrals at specialists outside their usual network
• And, in the future, demand better access to their personal health information
The cloud: Key to true interoperability for MACRA
This is why in the proposed MACRA rule, we believe, there was very specific wording [in italics] one quality measure that requires practices to search for Digital Imaging and Communications in Medicine (DICOM) format images of prior patient CT imaging studies at non-affiliated external healthcare facilities or entities within the past 12-months and are available through a secure, authorized, media free, shared archive prior to an imaging study being performed.
The wording, of course, is ambiguous. It accommodates evolving technology over the life of the MACRA program. But it's clear to us the most obvious way to make that archive shareable with non-affiliated entities is via a secure cloud.
Enterprise imaging takes a center stage with MACRA and other new payer trends. Do you have a strategy in place that will help your clinicians work more efficiently, with state-of-the-art tools within your firewall and a secure cloud to exchange images with non-affiliated providers – a new requirement baked into a claims process coming soon to your finance department?
Healthcare organizations that don't have an enterprise imaging strategy in place should be drawing one up now. Payers are expecting it, and patients are counting on you to make their care more cost-efficient, safer and more convenient – because they won't have to go through as many scans after your IT department breaks down the data silos and creates value from imaging interoperability. There's still time, but it's running short.
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