When the Rochester RHIO was established in 2006 to improve the quality and efficiency of care in the greater Rochester, NY, area, one of the requirements from a local matching grant was to enable diagnostic-image sharing among healthcare providers.
Since July 2009, the nonprofit, community-run organization has offered this service, first receiving images from a few and then expanding to include 11 participating radiology practices.
"By next year, we should have more granular details of the clinical variations that happen with access to images," said Executive Director Ted Kremer. The Rochester RHIO's studies will contribute to current literature on the value of HIEs and imaging use.
To date, the Rochester RHIO has conducted a modeling exercise to understand administrative savings.
"We're looking at in excess of a million dollars a year in administrative savings outside of reduction in duplicative imaging and radiation exposure to patients," he said. "We're just now getting the kind of volumes needed to study these aspects."
Through eHealth Technologies’ eHealth Imaging Solutions, the Rochester RHIO receives approximately 100,000 radiology results and fields about 9,500 queries each month. Of these radiology queries, 9 percent include viewing an image.
Saving lives, offering greater convenience
Although these studies are not yet completed and released, several anecdotal stories have provided powerful testaments to the value of accessing medical images.
"We've had some life-saving stories early on, which were really encouraging," Kremer said, "including the discovery and triage of a brain bleed when the treating clinician queried and accessed an imaging study for a patient who presented to a local emergency department."
Besides delivering clinical value, image access offers greater convenience for both providers and patients. Patients no longer have to ask for a CD of their images before going to their next appointment. It is not uncommon for patients to show up without their images, which then places the burden on specialists to retrieve them.
Previously, clinicians logged onto different portals maintained by the radiology groups or hospitals. Many users didn't have cross-credentialed access to some of these portals, which often meant they had to find out from the patient first if any images existed and then go through the process of getting a copy. Now they can access the images via the Rochester RHIO.
Rolling out the zero download image capability
The RHIO recently implemented eHealth Technologies' zero footprint image viewer and has enjoyed a seamless rollout without disruptions to clinicians. Previously, clinicians had to work with their internal IT departments in order to download the viewing software, whereas now they can access the image viewer via the web.
"We expect to see increased adoption from smaller groups and maybe within larger practice groups – where going through security was a difficult procedure," Kremer said.
In response to a request by one of the smaller regional hospitals for a better workflow when transferring patients from rural to urban hospitals, the Rochester RHIO has now piloted an emergent imaging capability.
Up until this rollout, images were not being released to RHIO users until the reports were read, which delays critical real-time care for patients being transported to tertiary hospitals or by helicopter service. "It [the capability] has a lot of resonance with the ED docs," Kremer said. "ED has been a place where we've shown significant savings, and we want to layer in anything more that can help them out."
Next steps: Wider deployment, connecting mobile providers
The image exchange represents a significant component of the Rochester RHIO's current 2X savings, but Kremer expects an 8X savings with expanded deployment.
"The image exchange has helped us with sustainability, as we're charging radiology practices," he said. The capability was a big part of the value proposition to them and played a significant role in recruiting radiology practices to be HIE participants.
The Rochester RHIO is in the early stages of connecting a couple of its mobile radiology providers, which work in the long-term care and home-care settings. It is also aiming to get feeds from cardiologists by the end of the year, which is important because cardiologists traditionally don't have a PACS or RIS system, and store their images in their electronic health record systems. Alongside the continued rollout, the RHIO wants to promote the collaborative feature of the image exchange.
"What we've seen is as much as we can throw technology out there, it still takes a little bit of work to promote the adoption," Kremer said. "The job will be a little bit easier given the well-developed community and communications group that was formed by the participating stakeholders."
While Kremer said the next big focus would be in communicating the value better, the upcoming results of the studies and use cases will surely be a big boost in those communication efforts.