Industry Watch – November/December 2015

By James Jay, Global Vice President, Imaging IT Solutions, Agfa HealthCare

Not too long ago, experts across health IT questioned whether the cost and productivity benefits of the electronic health record would ever be realized in the real-world medical setting. Today, EHRs are ubiquitous within healthcare, as common as stethoscopes and syringes.

Enterprise imaging – a centralized system that integrates images from any clinical specialty into a patient’s EHR and securely renders that information to any clinician – has been in a limbo similar to what EHRs experienced several years ago. Many hospital CIOs and CMOs have clearly understood the value potential that an “any image, any time, from any location” strategy might deliver if offered to their healthcare community. However, just as with EHRs, industry inertia – due to combinations of budgetary, skillset, and bandwidth limitations – slowed the widespread adoption of such systems.

But that is about to change, as 2016 is poised to be the year of enterprise imaging.

What has led me and others in the industry to make this prognostication? Today, the conversation surrounding enterprise imaging has crystalized around three key factors that, in my opinion, have become the catalysts for what is expected to be a wide-scale adoption of enterprise imaging systems in 2016 and beyond. CIOs and healthcare IT specialists who are not yet in the know should take note.

1. Consolidation: Until recently, some hospitals attempted to create enterprise imaging capabilities by repurposing or extending their PACS (picture archiving and communication system) and VNAs (vendor-neutral archives). However, what at the time seemed like a logical – and cost-effective – solution has proven largely unworkable due to the immense and ever-increasing amount of image data that is generated across all specialties within a hospital. This same realization previously occurred across the enterprise with the EHR, leading to the collapse of what was a series of departmental systems into the consolidated platforms that today are delivered by Epic, Cerner, Allscripts, etc. This paradigm shift is now occurring within image management where an integrated, enterprise-wide strategy is eclipsing the “piecemeal PACS” approach.
2. Convergence: In lock step with consolidation, advances have been made with the convergence of imaging access and storage systems with sophisticated technologies that enable department-specific image acquisition, ordering, clinical metadata creation, and billing automation all in one place. The result is a solution that can serve the diagnostic departments while seamlessly managing the ingestion, transfer, routing, and review of images across the enterprise.
3. Workflow: In today’s modern hospital, nearly every department generates clinical images. Radiology and cardiology remain the most prolific, but departments as disparate as obstetrics and gastroenterology also produce diagnostically important images and are doing so on a more frequent basis. True enterprise imaging strategies offer the ability to synchronize thousands of potential workflows securely, which can encompass everything from creating a worklist on a modality to order generation and notification to the EHR that a study exists.

For modern hospitals, the ability to maximize image-usage efficiency can become a competitive advantage. Not only does the opportunity exist to improve the operational and fiscal performance of a hospital, but ubiquitous access to patient images can also help foster an environment of informed patient management, supporting today’s value-based care model.

So here’s to 2016 – The Year of Enterprise Imaging.

EHR Incentive Programs

Meaningful Use modifications, final rule lauded by CHIME

The College of Healthcare Information Management Executives (CHIME) Board of Trustees Chair Charles E. Christian released a statement Oct. 6 welcoming the Centers for Medicare & Medicaid Services’ (CMS) updated policies on Meaningful Use, particularly a drastically reduced reporting period. The Department of Health & Human Services (HHS) released details of the policy changes in a press release on that day.

“We are pleased that the Centers for Medicare & Medicaid Services today finalized modifications to the current stages of the Meaningful Use program and agreed to extend the comment period on Stage 3. CHIME and its 1,700-plus members agree with CMS that it is time to focus the Meaningful Use program on adoption of information technology systems that improve both the quality and safety of patient care,” Christian wrote.

“The 752-page rule grants flexibility for providers who are doing their best to not only meet the intent of the federal program, but also ensure the adoption of health information technology that improves patient care.

“Importantly, the rule adopts a 90-day reporting period for the current stages of the program, down from 365 days. CHIME has long called for a 90-day reporting period and applauds CMS for adopting this new standard. While several members are positioned to take advantage of this shorter period, others will be challenged to meet it since there are fewer than 90 days remaining in the year. We urge CMS to implement a hardship exemption for those unable to meet this timeframe.

“CHIME also applauds the agency for modifying requirements surrounding patient access to electronic records. The rule stipulates that for 2015 and 2016, [only] one patient discharged from a hospital [must] view, download, or transmit their electronic record.

“With regard to Stage 3, the extra comment period will enable providers, CMS, and other stakeholders to ensure that the next stage of Meaningful Use advances interoperability and takes into account new payment models being advanced by Medicare.

“Also today, the Office of the National Coordinator for Health Information Technology finalized a rule on certification of electronic health records. CHIME supports key provisions in the rule that should lead to greater transparency regarding vendor products, improved testing and surveillance of health IT, and an improved focus on user-centered design.

The rules were published Oct. 16 and are on display in the Federal Register.

You can access the final rule and more detailed information from CMS at www.cms.gov/EHRIncentivePrograms.

Security

FBI: Internet of Things a serious cybercrime risk

The Internet of Things (IoT), “dumb” devices that become “smart” by connecting to the Internet automatically to send and receive data, opens the door to serious security vulnerabilities that cybercriminals could exploit, according to a published warning from the Federal Bureau of Investigation (FBI) Internet Crime Complaint Center (IC3) issued Sept. 10, 2015.

Organizational risks to medical facilities include: an exploitation of the Universal Plug-and-Play protocol (UPnP) to gain access to many IoT devices; an exploitation of default passwords to send malicious and spam emails or steal personally identifiable or credit card information; compromising the IoT device to cause physical harm; overloading devices to render them inoperable; and interfering with business transactions.

But there are things that can be done. Countermeasures recommended by the FBI include:

• Isolate IoT devices on their own protected networks;
• Disable UPnP on routers;
• Consider whether IoT devices are ideal for their intended purpose;
• Purchase IoT devices from manufacturers with a track record of providing secure devices;
• When available, update IoT devices with security patches;
• Consumers should be aware of the capabilities of the devices and appliances installed in their homes and businesses. If a device comes with a default password or an open Wi-Fi connection, consumers should change the password and only allow it to operate on a home network with a secured Wi-Fi router;
• Use current best practices when connecting IoT devices to wireless networks and when connecting remotely to an IoT device;
• Patients should be informed about the capabilities of any medical devices prescribed for at-home use. If the device is capable of remote operation or transmission of data, it could be a target for a malicious actor; and
• Ensure all default passwords are changed to strong passwords. Do not use the default password determined by the device manufacturer. Do not use common words and simple phrases or passwords containing easily obtainable personal information, such as important dates or names of children or pets. If the device does not allow the capability to change the access password, ensure the device providing wireless Internet service has a strong password and uses strong encryption.

Leadership

Top 10 strategies for building a healthy IT team

Beth Dituro, HIT Program Director, Pinnacle Center for Professional Development, gives her spin on how to build up – and keep – a strong and effective health IT crew.

1. Provide effective project management: Especially important at the beginning of projects.
2. Boost morale: Overwork should be kept to a minimum, managed tightly, and rewarded.
3. Foster teamwork: When teams work together for any length of time, it is important for members to avoid becoming like families, with associated dysfunctional roles and relationships. Leadership is required to ensure teams function on all cylinders, playing on complementary strengths and focused on a common goal – the success of the project.
4. Develop creative problem-solving skills: Allow team members to fail and learn from mistakes.
5. Cut the red tape: Too much bureaucracy can be an embarrassment to the IT organization and a source of frustration, distrust, and disrespect by end-users, customers, and vendors alike.
6. Provide transparent governance: Invisibility causes frustration both inside and outside the IT organization because no one knows the rules of the game. Good governance simply spells out the processes for identifying, prioritizing, and funding IT requirements.
7. Hire the right people: HIT organizations do themselves a disservice when they insist on hiring staff with experience in a particular vendor product. Finding the perfect person will often take longer than hiring someone with proven, related skills and providing them with training.
8. Walk the walk of both IT and healthcare: Be fair, fearless, and fault tolerant.
9. Continually show appreciation and respect: Recognize ongoing efforts, both in private and in public.
10. Empower staff: Provide ongoing continuing education. The best and most effective managers have solid backgrounds in health IT with an understanding of the “big picture” of HIT.

System Implementation Wins

UF Health Shands Hospital selects Lexmark VNA

Gainesville, FL-based University of Florida (UF) Health Shands Hospital, part of the Southeast’s most comprehensive academic health center, will deploy the Lexmark vendor-neutral archive to serve as an enterprise solution for managing medical images across its many diverse healthcare facilities and clinics. UF Health Shands will implement the Lexmark VNA as part of an enhanced technology foundation to better manage the more than 550,000 imaging studies produced each year.

“The Lexmark VNA will support our goal to provide any UF Health Shands clinician a location-independent ability to view patient information within Epic,” says Kari Cassel, Chief Information Officer, UF Health Shands. That means better access to patient information at the point of care.

Lexmark will also assist UF Health Shands in migrating nearly 7 million existing imaging studies. Lexmark VNA will integrate with UF Health Shands’ enterprise viewer and worklist applications to provide a solution for image access, management, sharing, and exchange across patient care facilities. The solution is expected to provide enhanced interoperability of patient information with the hospital’s existing electronic medical record (EMR) and other clinical information systems. UF Health Shands is currently using Lexmark Enterprise Image Connectivity solutions, including Perceptive Media Writer, PACS Scan, and PACS Scan Film to automate document and medical imaging workflow.

Source: Lexmark