Pictures are increasingly becoming part of the healthcare story at the Cleveland Clinic, and the health system’s strategy to better integrate medical images into patient care is getting a lift from a new enterprise imaging system. Agfa HealthCare’s Enterprise Imaging Platform is helping blend images into patients’ medical records while also making pictures and images more useful and accessible for physicians and clinical staff.
Compiled by Scott Westcott, Contributing Writer
Medical images have long been an essential tool for providing optimal patient care, but accessing and tracking those images present significant challenges. Healthcare providers such as the Cleveland Clinic are turning to technology to address these issues.
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Pictures are increasingly becoming part of the healthcare story at the Cleveland Clinic, and the health system’s strategy to better integrate medical images into patient care is getting a lift from a new enterprise imaging system. Agfa HealthCare’s Enterprise Imaging Platform is helping blend images into patients’ medical records while also making pictures and images more useful and accessible for physicians and clinical staff.
The Clinic’s goal is to “create a seamless environment in which images are represented as another piece of important data in the EMR,” says Dr. Cheryl Petersilge, the information technology division medical director who led Cleveland Clinic’s imaging upgrade effort.
Physicians are embracing the system as images become more integrated into workflows and easily accessible from any location. Patient feedback has been positive as physicians can readily share images with patients, allowing a greater understanding of medical conditions. Petersilge shared her insights on how the system is bringing about positive change.
Q: How is the integrated enterprise imaging system different from what Cleveland Clinic previously had, and why was a change initiated?
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Petersilge: The system we had previously wasn’t very user friendly. It required a separate link on the desktop to access images. In other words, a user had to leave the EMR and open a separate app from the desktop to launch a window where images could be accessed and viewed. This resulted in a disjointed user experience because the text information in the EMR and the image viewing were disconnected. This led us to want to create a seamless environment in which images are represented as another piece of important data in EMR. With our new platform, there is a get-images button embedded in our EMR. The user can launch the imaging application and view X-Rays, MRIs, CT scans, and more without ever leaving the EMR. The EMR is now a comprehensive source of patient information. Not only can you access the images, but those images are presented along with other important patient information so you can get the entire patient profile, which obviously is beneficial from both a workflow and a patient care standpoint.
Q: What technology investments and process changes did Cleveland Clinic need to make to effectively leverage the new enterprise imaging system?
Petersilge: We made a commitment to invest in a system that would meet our needs. We didn’t just buy a VNA (vender neutral archive), but we also acquired associated workflow instruments and enterprise viewers that gave us the capability to view as many of the different image types as we want to display. The harder sell is getting everyone to use the system for their image archive, and that is where the process change occurs. We focused on education and increasing awareness. We found that, when the physicians and other clinical staff start seeing clear benefits from the system, there has been steady adoption. That continues to grow as we educate end users about the technology and how easy it is to use.
Q: How has the enterprise imaging system changed clinical workflow?
Petersilge: From a workflow perspective, we have a “get images” icon that automatically launches the viewer and all of the images connected to that individual exam. When you look at a radiology report, there is a getimages link that will take you directly to the images associated with that report. The clear benefit is that you don’t have to go anywhere else. You don’t have to walk down to the radiology room or open a different application on your desktop. What is really interesting is that this is not just limited to traditional radiology pictures. We have a very useful image library being built over time. So, for instance, the wound team has images of various wounds, or there are images of a digestive health procedure. Previously, images such as those, if they existed, were located in disparate systems throughout the enterprise. Now we can take images at the hospital or another location, and they become part of the integrated system and can then be seen by anyone who has access to the system, regardless of their location. So if a woman had an early pregnancy ultrasound and comes to emergency a month later with a problem with the pregnancy, emergency room personnel can access those images that were taken at a different location.
Q: How are physicians at Cleveland Clinic making use of the program?
Petersilge: We may have a patient of a primary care physician go for a sophisticated test and return to the primary care physician for the results. It is much more beneficial to then be able to actually show the patient images. For instance, “Here is the polyp, and this is why we are concerned, and here is what we can do about it.” We have done interviews with patients who have told us that seeing images of the disease or condition they are dealing with makes it more real. It took away some of the anxiety and uncertainty they had when they were not able to see images related to the challenge they were facing. It has really turned the computer from something of a barrier into a powerful tool that helps the patient-physician relationship.
Q: What benefits have Cleveland Clinic and its patients realized as a result of this initiative?
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Petersilge: More physicians are recognizing the value of what we are doing and are asking to be part of the program. That is a sign physicians are not only accepting, but also responding to pressure from others who are now realizing the value of these images and the benefit of being able to enter images from various sources, for instance, using a smartphone to take a photo and upload it into the EMR. The trauma team is starting to take photos of traumatic wounds to document the wound and the progression of that wound as the patient receives treatment. They now would like these images to be stored in the library and viewable in the EMR — something we hope to achieve moving forward. We had an EMT surgeon say, “If I can take one picture of a lesion on the vocal cord, it’s much more valuable than three written paragraphs describing it.”
Q: What was the most challenging aspect of implementing the program?
Petersilge: Working through all the various workflows that exist in the organization. We took a long time to determine our image descriptions to make sure they were well thought out. We wanted to make sure when you go into the image library, everything is organized and you can easily find what you’re looking for. That was a big challenge, to make sure it was done right. You don’t want to have to go back and restructure the system after the image library expands. If you can get organized from the start, it helps ensure future success. We also wanted to make sure we had a governing body serving as a team that is driving strategy but also representing groups of physicians across the entire organization so we have a range of perspectives.
Q: What would your advice be for other organizations trying to do this?
Petersilge: Set up a governing body that includes image producers and consumers, and be sure to understand what their specific needs are. Every organization is different, so you have to understand what works best and will be the most beneficial for your organization. Finally, start with the low-hanging fruit and figure out how you can get the most benefit and some quick wins that will start building greater awareness and adoption. Approach a partner in every department and find out what their needs are. This helps build a better system and develops relationships that are essential to the project’s long-term success.
Pictures are increasingly becoming part of the healthcare story at the Cleveland Clinic, and the health system’s strategy to better integrate medical images into patient care is getting a lift from a new enterprise imaging system. Agfa HealthCare’s Enterprise Imaging Platform is helping blend images into patients’ medical records while also making pictures and images more useful and accessible for physicians and clinical staff.
Petersilge: The system we had previously wasn’t very user friendly. It required a separate link on the desktop to access images. In other words, a user had to leave the EMR and open a separate app from the desktop to launch a window where images could be accessed and viewed. This resulted in a disjointed user experience because the text information in the EMR and the image viewing were disconnected. This led us to want to create a seamless environment in which images are represented as another piece of important data in EMR. With our new platform, there is a get-images button embedded in our EMR. The user can launch the imaging application and view X-Rays, MRIs, CT scans, and more without ever leaving the EMR. The EMR is now a comprehensive source of patient information. Not only can you access the images, but those images are presented along with other important patient information so you can get the entire patient profile, which obviously is beneficial from both a workflow and a patient care standpoint.
Petersilge: More physicians are recognizing the value of what we are doing and are asking to be part of the program. That is a sign physicians are not only accepting, but also responding to pressure from others who are now realizing the value of these images and the benefit of being able to enter images from various sources, for instance, using a smartphone to take a photo and upload it into the EMR. The trauma team is starting to take photos of traumatic wounds to document the wound and the progression of that wound as the patient receives treatment. They now would like these images to be stored in the library and viewable in the EMR — something we hope to achieve moving forward. We had an EMT surgeon say, “If I can take one picture of a lesion on the vocal cord, it’s much more valuable than three written paragraphs describing it.”
