Recently I have received a number of inquiries regarding the stimulus funding that will become available under the newly enacted American Recovery & Reinvestment Act. “What image management technologies will qualify? More specifically, “Would a PACS-Neutral Archive qualify for stimulus dollars?” I thought it would be useful to post my opinions on this subject, here on my web site.
In my opinion, yes. I believe a PACS-Neutral Archive would qualify under two scenarios. The most obvious scenario is as the multi-object content manager for the Electronic Medical Record system. This assumes of course that the PACS-Neutral Archive “package” includes the appropriate Display software. This scenario is applicable to organizations that have an EMR. Since most (if not all) current EMR solutions do not include their own image display application, the PACS-Neutral Archive “package” would be expected to include an “integrated” display application.
The second scenario is as the self-contained multi-object content manager and simple display application (zero foot print / server-side rendering) that could be accessed directly over the internet (not through a Portal). The display application should have HIPAA-compliant security and logging capabilities to handle direct access. This would meet ARRA requirements for simple and inexpensive internet access. This second scenario would be applicable to organizations large or small that do not have an EMR, so this solution would support image access and display via direct access over a LAN or directly across the internet.
“What aspects of ‘meaningful use’ would the PACS-Neutral Archive fulfill?”
I believe that the intent of “meaningful use” is providing the physicians with the ability to quickly and easily access imaging reports and associated images. The keys are quickly and easily, because anything less will not be used by the physicians. Another key feature would be the ability to assemble images from multiple disciplines (Radiology, Cardiology, Pathology, etc.) in the same viewing session. This is something that cannot be done today in an environment where each imaging department PACS has its own URL interface to the EMR Portal and its own separate display application for its own images. In my opinion, this approach would discourage use, because learning different viewers would be tedious and flipping back and forth between viewers would be time consuming.
The built-in audit logs could be used to create reports that would indicate the level of physician usage: how often they used the system, what they were viewing, and the length of the session. This method of reporting would meet the government’s requirement for a simple usage report that would not overly burden the organization.
In this context, it is interesting to point out that the most meaningful usage would probably be skewed towards the attending physicians, who are primarily report users. The significance being that this user profile would most likely be satisfied with the J-PEG lossy version of the image that could easily be server-side rendered and delivered to almost any kind of computer platform because the display application would be very small if not zero. In contrast, the specialists/surgeons are already using some kind of image access, probably directly to the Radiology or Cardiology PACS, because they have to work with the images. It is the attending physicians who actually make clinical decisions that affect patient care that would benefit the most from a multi-modality image delivery system that was easy to use and fast. I think this is what the government wants to stimulate, as timely clinical decisions are directly related to length of stay and therefore cost!
“Would a departmental PACS system qualify for stimulus finding?”
In a my opinion, no! A department PACS can provide physician access to that department’s reports and images, but it typically does not support access to all of the clinical information and images from those other departments. It is widely known that most Radiology PACS have failed miserably to meet the needs of the referring physicians. The display applications intended for use by the referring physician are frequently difficult to use and time consuming.
I suppose an argument could be made on the behalf of the department PACS, IF the referring physician display application were improved, but in a situation where a referring physician had a choice between using a department PACS display application or a multi-modality display application, my money would be on the later, and I think the usage logs would bear that out.
It is also important to point out that the department PACS are unlikely to be able to aggregate clinical information from other information systems (lab, medication, and care summaries) anytime soon. It is also highly unlikely that a department PACS would be able to aggregate image data from other departmental PACS. The absence of these capabilities would further decrease the usefulness of the department PACS in the context of “meaningful use”.