1. The Impact of CDs and Image Sharing on Radiology
Kang Wang Ph.D, CEO, HealthFortis
Amy Vreeland, SVP Strategic Accounts, lifeIMAGE
9/24/2013

2. Agenda
Value of Clinical Decision Support Value of Image Exchange Power of the two systems working together

3. It’s also a Patient Safety issue
“… just from overuse of CT, will result in 12 preventable radiation-induced cancer deaths a day”*
"A 20-year old woman who gets an abdominal-pelvic CT scan (i.e., just about any young woman coming to the ED with belly pain) has a 1 in 250 chance of getting cancer from that single scan.“**
*Robert Stern, Patient-centered imaging, Am J Med 2012; 125:115
**Dr. Rebecca Smith-Bindman - professor of Radiology, Epidemiology, and OB/GYN at UCSF in

4. Current solutions and their problems
Speed bumps
RBMs
Referral pre-authorization
Claim analysis and provider profiling
Problems
Human intensive
Trying to change decisions that are made
Little physician involvements
No consistent evidence based decision making
No financial incentives for physicians

5. Decision Support at the point of Decision
A better solution
A better solution
Decision Support at the point of Decision
Clinical Decision Support (CDS) Order Entry System
Integrated with EHRs

6. Proactive vs. Passive CDS
Proactive Decision Support
Decision support BEFORE the decision is made
Symptom/Diagnosis driven decision support
Change of the current CPOE order workflow
More effective: the right exam is the easiest to order
Passive Decision Support
Judgment AFTER the decision is made
Procedure driven decision support
Keep the current CPOE order flow, add a CDS step after order submission
Less effective: physicians don’t like to be judged

7. CDS: What to look for EHR integration vs. stand along CDS order entry
Comprehensive rule sets with option to customize
American College of Radiology,
ACC
ODG
Ability to set institution specific rule set
Reporting Module: provides actionable information
KB Editing Tool: can you publish your own guidelines?
Cloud hosting vs. local installation

8. Integrated with physician workflow
Tight integration with EHRs
Single sign-on
Patient context sharing
Patient chart information passed to CDS
Real time submission of the CDS result

9. Data Mining

10. Knowledge base editing

11. Cloud-based deployment model
Centrally managed content
Regular updates from content providers
Multi-tenant system
Each customer can subscribe to its preferred content or create customized content
Centrally managed system
Minimal client side IT requirements
Frequent system updates

12. Trend of Order Distribution by Appropriateness Score
System Adoption
Trend of Order Distribution by Appropriateness Score

13. 98% orders follow guidelines (up to 67%)
System Adoption
98% orders follow guidelines (up to 67%)
March 18th

14. CDS: demo

16. The Network of Networks
Highest Ranking Providers
16 of 20 best Cancer
10 of 20 best Gastroenterology
10 of 20 best Gynecology
10 of 20 best Cardiology
10 of 20 best Neurosurgery
10 of 20 best Rheumatology
9 of 20 best Geriatrics
9 of 20 best Urology
7 of 20 best Pulmonary
7 of 20 best Orthopedics
No.1 ranked hospitals in 18 out of 27 states & D.C.
561 M Images / 2.64 M Exams
205 hospitals
- Connect to another 410 hospitals
35,000 users
- 12,000 monthly active users
Our customers represent
54.9 M outpatient visits/year
7.4 M ER visits/year
32.0 M radiology exams/year
85,000 physicians (12% of total)

17. A future proof platform for image sharing5
Cross community sharing 4
Image enabled community & CDS 3
Managing connections 2
Referral workflow & publishing results 1
Outside exam ingestion
Baseline: PACS and EMR is already in use with an existing enterprise viewer

18. Image-Enabled HIE Demo

19. Imaging Service Provider Site
Health Information Exchange (HIE)
Physicians access to priors, and relevant priors alert during an order
Physician Office 1
HIE Portal
Imaging Orders
Imaging Results
Community
Patient ID
Member ID (Patient IDs)
& local MRN
lifeIMAGE
Imaging Results
Physician Office 2
Imaging Orders
Patient ID
Registry
Imaging Results
Metadata
Repository
While most hospitals have mastered the exchange of images within their system, they still have issues with exchanging both with importing images from the outside and transferring images to referring physicians outside of the system. These issues are particularly acute for image intensive specialties.
Most hospitals still lack efficient and effective solutions for importing images into their system. For hospitals that receive referrals from outside of the system, most images are received via CD. Outside CD studies can present significant issues across three key areas: workflow to import the image, image visualization, and data normalization for both use as well as importation into the PACS system.
These issues can create clinical issues– for example with trauma transfers, where every second counts. It can also create administrative burdens for specialties that receive high volumes of CDs such as cardiology and neurology.
Transferring results out of the system is similarly difficult. Most hospitals still utilize CDs given to patients to bring to their specialists. The issues that health systems face in getting these CDs into their system are also experienced by the referring physicians that receive these CDs– with the added complication of needed to rely on the patients to bring the CD to the physicians.
These issues are most acutely felt by imaging intensive specialties. These physicians rely on imaging for their livelihood and are forced to resort to relying on patients or use of phones/faxes/mail and couriers to receive images. lifeIMAGE was founded on the premise that there needs to be a better way to exchange images. A way that is simple, effective and efficient to support the physician-patient relationship. As we have developed and refined our vision, we’ve expanded it.
Reports &
Thumbnails
Imaging Service Provider Site
HL7 Report
RIS
LILA
C: Find
PACS
Image Metadata 19

20. CDS & Image Sharing Integration: demo

21. Thank You
CDS can help to increase guideline compliance and reduce utilization
Imaging sharing facilitates coordinated care delivery, reduces duplicated radiology orders, and provides meaningful Return on Investment
An integrated CDS and Image sharing platform helps to improve patient and care giver experience with their radiology services