Meaningful Use Does Matter To Radiologists

Edited by Ken Congdon, Editor In Chief, Health IT Outcomes

Many radiologists believe Meaningful Use (MU) requirements don’t apply to them, but RMI (Regional Medical Imaging) is proving that MU will be instrumental in moving the radiology industry forward.

While the vast majority of radiologists are eligible for the federal Meaningful Use (MU) incentives, many contend that the provisions in MU are directed at primary care and not at specialists like radiologists. As a result, many radiologists have been slow to adopt new health IT solutions or apply new processes in line with MU. However, RMI (Regional Medical Imaging), an outpatient radiology practice based in Flint, MI, is not one of these cynics. Instead, RMI has embraced MU and successfully attested for its first round of incentive funds totaling $216,000 in March of this year. More importantly, however, the practice is realizing the positive impact the MU movement will have on the field of radiology and the future of patient care. In this Q&A, Dr. Randy Hicks, CEO of RMI, shares his insights and experiences on MU.

Q: What is your take on the perception that MU doesn’t pertain to radiologists?
Dr. Hicks: I think this perception was formed early on when the Stage 1 requirements were initially announced. Radiologists started to read through the rules and discovered that most of the core measures didn’t apply to them. For example, most radiologists write few prescriptions, so e-prescribing requirements are something we would be unable to meet. We don’t generally interact with patients in this manner. As a result of the primary care slant of many of the measures, many radiologists weren’t compelled to invest in expensive IT technology that they didn’t think they were going to use.

We chose to look at MU in an entirely different way. For us, MU wasn’t about the core requirements or the menu set. It was about developing a technology foundation that would allow us to communicate with the primary care physicians who are our referral base and provide better care to patients. In order to truly care for patients, we need data. We need the patient’s medical history. We need to know what medications the patient is on. We may need to know other specifics, such as the patient’s BUN (blood urea nitrogen)-to-creatinine levels or whether or not they have hypertension or a contrast allergy. As doctors, radiologists need this data. However, most radiologists don’t currently have access to this information on a real-time basis. MU provides a blueprint that will enable doctors to easily access and share this type of health data by recording it in a standard format.

Q: How did RMI start down the path to MU?
Dr. Hicks: We kind of fumbled into it. We had a strong working relationship with AMICAS, a provider of imaging IT solutions, through our investment in many of their mammography products. They were acquired by Merge Healthcare in 2010. Merge’s CEO invited me to their headquarters in Chicago and asked what I was doing about MU. At the time, I didn’t have a game plan for MU but was intrigued by the way Merge was looking at radiology as more than just PACS (picture archiving and communication system). We started working together to build our MU workflow strategy.

Q: What are some of the key components of your technology infrastructure that are going to enable a seamless transfer of patient data?
Dr. Hicks: The world I envision is not here yet. I envision a day where I can open up a medical image and along with it comes a wealth of knowledge about that patient (e.g. medical history, allergies, family history, etc.). This information will allow radiologists to be viewed as more than mere picture interpreters, but as true doctors. This information will allow me to become more informed and engaged in the care of my patients.

For example, as part of an outpatient imaging center, I look at patient images all the time. I can tell a patient that she has a mass on her pancreas, but I have no supporting data on that patient. I can’t tell if cancer is prevalent in her family history. I can’t tell if she has chronic conditions that could complicate her treatment. This information is meaningful to me as a doctor.

Our current MU technology infrastructure is laying the groundwork for the world I envision. As part of its RIS (radiology information system) platform, the radiology-specific EHR Merge allows us to collect patient data and store it in the software in an organized fashion. It is collecting this health data in a similar format that everyone will soon be able to share. We are currently capturing and storing data, but we aren’t yet at a place where we can share this data. This is frustrating because the data capture process does very little for radiologists today. It’s the data exchange that will offer true value to our field.

Q: What data did you provide CMS to successfully attest for MU?
Dr. Hicks: Obviously, we did exempt many of the measures that didn’t pertain to radiology. We focused on collecting smoking histories, maintaining active medication lists, and setting up patient portals. We successfully reported on these measures to receive our first installment of MU incentive payments.

Q: How integral is the medical image itself to EHR MU?
Dr. Hicks: It depends on whom you ask. If you ask primary care physicians, they aren’t often that interested in looking at a medical image and diagnosing a condition. However, if you ask specialists, the image is integral to what they do. Many refuse to read reports from radiologists unless the images are attached in some fashion. In fact, in many specialties such as oncology, viewing sequential images is crucial. For example, a stand-alone radiological report can’t tell you if a tumor has grown, shrunk, or remained the same size over time. The only way to visualize this is through the images. For this reason, medical images are an extremely important component to the EHR. I think CMS recognizes this, as it is beginning to incorporate image exchange requirements in its proposed rules for Stage 2 MU.

Much of the preparation involved in sharing these images will fall upon radiologists, and RMI is currently in the process of installing a vendor neutral archive (VNA) to enable us to import and store images in any format and make them usable. Furthermore, we are currently developing a strategy along with our imaging vendors to make medical images available to physicians via smartphones and tablets.

Q: What advice would you give other radiology practices interested in achieving MU?
Dr. Hicks: Choosing a good vendor partner is essential. A vendor with expertise in radiology is important because that company will understand your unique challenges and needs from a MU perspective. Effective leadership is also key. You need someone at the top of the organization to drive home the message and rally the resources necessary to implement the basic IT framework. Lastly, try to keep the implementation simple. Don’t get caught up in the minutiae. Stay focused on the ultimate goal and objective — which is to enable the continuity of care and provide a seamless transfer of patient information — and take incremental steps to get there.