By Tom Watson and Cris Bennett, clinical analysts, MD Buyline

Interoperability is a huge buzz word at HIMSS17, and although the concept touches many different areas of the health care IT spectrum, what does it mean for the EMR?

EMR entry into the clinical area is far from complete, and continues to expand and integrate into the daily workflow throughout the health care ecosystem. According to discussions with a number of prominent vendors at HIMSS, one of the common themes is a greater integration of imaging data into the EMR. This goes beyond just providing a link to a radiographic image or video. It includes imaging of all kinds, including endoscopic images, laboratory images, ophthalmology images, dermatology images among others.



X-ray-based images that are generated by the hundreds of thousands in hospitals, as well as imaging centers, primary care, and specialty physician offices, make up the largest sector of images in a patient’s medical journey. These images might come from surgery, infection control, ED and trauma areas, to name a few.

We need to make sure that patient records and images across all of the “-ologies” are available on demand. Picture Archive and Communications Systems (PACS) and Enterprise Imaging (EI) vendors across this space have made large strides to make this happen, but still face challenges in interoperability with every piece of equipment in the radiology space.

Interoperability has improved with the use of a vendor-neutral archive and integration engines to route the patient’s imaging across the health care landscape. To a degree, these integration engines are beginning to create a seamless flow of imaging files across the network to multiple work stations. They are growing, and will eventually appear on point-of-care devices, which will then allow the physician and/or radiologist to make better informed and more meaningful decisions at the point of care.

The associated reporting and data that go with the images are becoming key as well. The goal is a comprehensive record of every patient’s history, test results, diagnoses, treatment regimens, and medication history, along with images, data and reports.

There continues to be work in both the EMR camp as well as the imaging camp to move toward this common goal. Imaging solutions still have a number of silos within their sector that need to be further consolidated into a single database or centralized storage with associated quantitative and standardized report structures. Many image solutions have not yet fully embraced the need to create not only an image repository for non-radiographic images (lab, ophthalmology, surgery, etc.) but also to combine that with the clinically necessary quantitative and diagnostic tools required for each respective specialty.

From the EMR perspective, the challenge of incorporating diagnostic images and video clips needed for ultrasound and angiographic studies creates a sizeable task both for bandwidth and for storage within the solution. It also requires minimizing access time, to keep the physicians willing to access and use the data in their medical assessments and decision-making.

The road has been bumpy to date. A number of cardiovascular information system (CVIS) vendors were concerned that EMR records were insufficient to provide data that could be used in a meaningful way by physicians that need a much deeper level of information. There may have been an early learning curve for the EMR vendors, as well as the IT input for the minimally acceptable image and data required to be a beneficial data summary.

Also, the consumer (hospital) focus was on the extremely challenging and expensive task of choosing, implementing and integrating even the basic functionality of an EMR into their environment. To a degree this is still ongoing, but they have gained early experience and are now beginning to step back and realize there is still more work to be done for this concept to become fully functional.

This will continue to be a focus for imaging and EHR vendors for the future. Based on our discussions with EMR and imaging vendors at HIMSS, both sides now have common visions and those visions are coming into focus. It will be critical to see both segments working in a more collaborative manner to ultimately achieve the desired goal, or at least the necessary foundation to make the desired goal achievable.


ABOUT THE AUTHORS: Tom Watson joined MD Buyline in 1986 and has over 40 years of experience in the field of cardiovascular medicine. He started his career as a staff technologist at West Jefferson Medical Center. He spent two of those years as a staff technologist and the remainder as administrative and technical director of cardiology. His clinical experience and training include all diagnostic noninvasive cardiac modalities, including echocardiography, stress-testing Holter and ECG. His invasive experience encompasses diagnostic cardiac catheterization, PTCA and electrophysiology. He also has experience with critical care and intensive care monitoring, as well as cardiac rehabilitation applications. As a senior clinical analyst at MD Buyline, he is the primary analyst for cardiology, which includes interventional angiography (cardiac, vascular and neurological), electrophysiology imaging and monitoring, and cardiology PACS and information systems. He provides secondary support for noninvasive cardiology. He also provides cross-coverage to related areas of radiology.

Cris Bennett joined MD Buyline in 2015 with over 19 years of experience in medical imaging. He has a diverse background in general radiography, CT, MRI and radiology IT. Before joining MD Buyline, he served in multiple positions at Dallas Regional Medical Center as lead MRI technologist and PACS administrator. These duties provided valuable experience in coordinating the radiology department’s Quality Assurance program. He has also worked as a dedicated pediatric MRI technologist at Children’s Hospital of Dallas, where he gained experience in pediatric MRI and DTI research. As an MRI field service engineer, he helped develop new T1 Fast Spin Echo scans that had not previously been available on low-field MRI systems.

At MD Buyline, Mr. Bennett serves as the primary analyst for CT and MRI systems and provides insight, along with other analysts, on radiology IT solutions.