How to make VNA lemonade from stage 2 MU's lemons

2014 01 23 14 51 33 773 Data Stream 200

For many healthcare organizations, the stage 2 meaningful use (MU) criteria will mean some heavy lifting for the folks tasked with managing diagnostic images and integrating them with electronic health records (EHRs). But the upside is that with careful planning, the work you do now will pay off in the future, as new healthcare models such as accountable care organizations (ACOs) and value-based payment models become more prevalent.

To accomplish the task, you will need a vendor-neutral archive (VNA), integration of your medical images with EHRs, and a collaboration portal for easy access by physicians and patients. The amount of planning and work needed has put a sour look on the faces of many IT managers. But there is lemonade to be made from what feels like a lemon to many chief information officers.

Mitchell Goldburgh from Dell Healthcare and Life Sciences.Mitchell Goldburgh from Dell Healthcare and Life Sciences.

Whether you take a do-it-yourself strategy or a managed archive approach, you can gain additional value from your investment in stage 2 MU compliance by looking beyond your own in-house imaging departments. Many of the specialists in your community are wrestling with the need to manage and share image data files, just as you are. You could provide a valuable benefit to those physician practices -- and your own hospital -- by acting as the image data center for your physician community.

Serving the broader community

Physician practices that generate their own images on in-house equipment or use freestanding facilities often wrestle with the storage dilemma. They need ready access to the images, but the complexities and cost of maintaining storage infrastructure can be daunting.

Plus, they have the same issue with data silos that hospitals have. Many use a variety of modalities, including x-ray, MRI, ultrasound, CT, and other specialized imaging systems. They don't have the technology or resources to integrate those images with their EHRs, but they need the integration every bit as much as you do.

By creating an image archiving service for your physicians, you can solve these dilemmas for them, creating an enormous amount of goodwill. You can offer the service at a small profit and still give them far better value than they can get on their own.

By uploading their image data to your archive, they would also have access to patient-centric records that include all of their patients' diagnostic images and reports -- from cardiologists, orthopedists, ophthalmologists, gastroenterologists, neurologists, etc. -- something they don't have access to at present. And because you are required to enable integration with EHRs, these physicians could also meet the stage 2 MU goal by archiving their image data with you. Also, every physician who treats these patients would have access to the record. You could simplify life for your entire physician community through this offering.

Creating a bond with patients

For patients, this community-wide image archive would offer several valuable benefits. First, there would be the security of knowing that if their diagnostic images are needed, access is relatively simple. If you've ever had to gather a set of diagnostic images from multiple providers, you know what a pain that can be -- trying to remember where the study was done, driving around town collecting CDs, hoping that the files are still available. Think of the goodwill you can earn by creating a unified record for them.

Second, patients could avoid the hassle and expense of duplicated tests. Often, the difficulty of accessing test results is just too much, and they agree to duplicate tests to avoid the hassle.

These benefits would create a psychological attachment to your hospital. With all of their image data stored at your facility, patients may come to think of your hospital as their home hospital -- the place where they are known and respected. Hospitals spend millions of dollars annually trying to create that sense of ownership in the community!

Reducing cost, improving care, earning points

Creating a community image archive can also help you succeed with ACOs and other value-based payment models. All of these models focus on better care coordination and reducing duplication. With a consolidated archive, you'll have more knowledge of what imaging tests a patient has had and can alert physicians when a duplicate test is ordered. That will help you be identified as a cost-effective healthcare provider, meaning that your organizations will be included in more health plan networks.

Also, you'll have more data available for understanding and stratifying health risks in your patient population, giving you an advantage in contract negotiations.

Consider the liability -- and how to mitigate it

What are the downsides to this idea? First, you'll be taking on additional responsibility and liability for security and access to the images. The same security measures you need for these additional images should already be in place for your own archive. However, you'll have to ensure that your business associates understand and follow HIPAA privacy and security rules to prevent you from being liable for their mistakes.

One way to mitigate this additional risk is to use a third-party archive and act as a group purchasing agent for your community, rather than as the archive manager. A managed solution that offers both on-premise and cloud storage would allow you to offer archiving to your physicians economically without taking on additional risk or work. And you won't have to worry about forecasting storage needs or provisioning storage. You shift all of that work and responsibility on to the archiving service.

A hybrid on-premise and cloud infrastructure would greatly facilitate this process and offer the additional security of a disaster recovery mechanism. Plus, a managed service often comes with additional options, such as dose monitoring and reporting, analytics, and benchmarking of quality measures. These are all valuable add-ons that are difficult for smaller organizations to acquire on their own. So you would be giving your physicians (and your own organization) access to useful resources.

A fee-per-study payment model also makes sense for this arrangement because it limits your upfront costs and aligns your costs with your income from the service. Whether you offer the service at your cost or earn a profit, this approach could add enormous value to a task that you must undertake anyway. You could transform a big expense for your organization into a profit center that builds lasting relationships with physicians and patients.

For imaging centers that are worried about becoming a cost center under ACO and capitated contracts, this service could help soften the blow. So it could take two lemons -- the expense of image integration and the change from being a profit center to a cost center -- and make a nice glass of lemonade for your organization.

Mitchell Goldburgh is global solutions manager, clinical archive services, at Dell Healthcare and Life Sciences.

The comments and observations expressed herein are those of the author and do not necessarily reflect the opinions of

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