MEDICAL DEVICE INNOVATION - Medical Device Daily

MEDICAL DEVICE INNOVATION 2010
HealthPartners integrates X-rays,
radiology reports into EHRs
By LYNN YOFFEE
Medical Device Daily Staff Report
While some organizations are still struggling to implement
electronic health records (EHR) or even computerized
physician order entry (CPOE) HealthPartners (St. Paul,
Minnesota) is way ahead of the curve, now one of the first
organizations in the country to integrate electronic X-rays,
MRIs, CT scans and radiology reports into patients’ EHRs.
In addition to reducing radiology report turnaround
times from two days to four hours, the organization’s overall
efforts to eliminate paper and film and evolve into a
complete electronic reporting environment have yielded an
estimated $14 million in savings for the health plan since
2007. But that’s a drop in the bucket compared to the
resulting everyday efficiencies and patient satisfaction.
“We’ve had a radiology information system – PACS (picture
archiving and communication system) – in place for
quite some time that was standalone and separate from our
EHR,” Kim LaReau, VP and chief information officer at
HealthPartners’ Regions Hospital told Medical Device
Daily. “In 2006 we put the radiology report in the EHR with
a link to images. The final phase was replacing the radiology
information system and looking at whether or not there
was value in having an integrated system. We chose to
move forward with Radiant Radiology Information System
from Epic (Verona, Wisconsin). As part of that process, we
looked at what efficiencies and economies we could get.”
Although LaReau works at Regions, this step to digitize
radiology records is part of a massive ongoing effort by
HealthPartners, which is both an insurance plan and a group
of healthcare facilities, including Regions and 25 clinics.
The time savings produced by integrating X-rays and
radiology reports into EHRs is especially significant given
the fact that HealthPartners Clinics and Regions perform
about 34,000 radiology exams every month.
Part of the solution was to also install, PowerScribe, a
web-based speech recognition reporting solution from
Nuance Healthcare (Burlington, Massachusetts) that
eliminates the need for transcription, producing a savings
of $130,000 per year on expenses to transcribe radiologists
reports.
LaReau explained that radiology services were still
very paper-oriented. A piece of paper flowed through the
department and that’s what drove the workflow for a radiology
image.
“We wanted to eliminate the paper process,” she said.
“We also looked at the radiologists; they had a need to look
at the clinical record, to be able to work off a radiology
work list and to dictate and transcribe.”
The process to move HealthPartners wholly from paper
to screen started in 1997. The big EHR rollout came in 2003.
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CPOE was implemented in 2006.
But the clinics didn’t have PACS and that was implemented
in 2008, bringing all parts of the organization into
one central system.
“We’ve been in the process of optimization since then,”
she said.
Although every HealthPartners location still does not
have every element of all of the systems implemented, the
process is moving forward.
“Whenever you have to connect disparate technologies
it’s always a challenge in getting them to work appropriately,”
she said. “It’s easy to have multiple versions of the
truth out there when sending information back and forth.”
To make the connection between all of the different
facilities, a software program was created from scratch,
built by a vendor.
Other challenges involved changing the workflow
within departments.
“Technologists and radiologists were learning a new
work flow; it was a big cultural challenge that involved lots
of training. People were very involved in the development
of the new workflow and design sessions,” she said.
And when it came time to go live, the IT department
provided what LaReau calls “at-the-elbow support 24/7. We
also ran a large command center to take challenges and
questions by phone. Certain people get in the groove fast,
but for others it took months.”
Now, instead of being cued to read a film or act on an
order by paper, the prompts come electronically.
“An order is placed and they go into cues,” she said.
“Technologists look at those and they are prioritized
depending on the urgency of exams. They constantly monitor
those cues. Once an exam is completed it goes to a
radiologist’s cue. As they pull an item off their PACS read
list, it simultaneously launches the EHR for them. It also
pulls up images and then they hit the button for dictation.
At that point they can send their report to a transcriptionist
or they can self-edit and complete the document. It also
files a copy in medical record.”
The team at Regions affectionally calls these multifunctional
radiology workstations “Star Wars.”
She said that having access to imaging reports sooner
has been a “patient satisfier” and has allowed the organization
to handle more patients.
They’ve also eliminated the cost of film storage – a
$300,000 per year savings.
“The health plan recently implemented decision support
for diagnostic imaging so volume levels have been
greatly impacted by high-tech imaging,” she said. “If you
look at national statistics on things such as MRI, volumes
for MRIs have exploded. The question is, are all of them
necessary The American College of Radiology has developed
guidelines on necessity for images. So decision support
was built into the system. Based on that, our volumes
of MRIs have decreased.”
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