"It's hard to quantify the ROI, but we can tell you that it's created value," Yablonka says. "It's significantly improved our turnaround times and our service to patients, and it's improved our teaching program. It's allowed us to more quickly and with better accuracy report the quality of our imaging service, so it's not just return on investment. I would say the same thing to anybody else who wants a strict ROI interpretation of any IT investment. It's about creating value."
Enterprise imaging "is an opportunity both to leverage cost and infrastructure, but also to deliver integration and work flow to the EMR, and I think that's critically important," Yablonka says. "It is really critically important to have high-quality, very productive imaging groups, and whatever we can do to improve their work flow using technology, we should."
As information flows increasingly from provider to provider via health information exchanges or accountable care organizations, enterprise image management will be crucial, adds Yablonka. "You don't necessarily want patients to be imaged over and over as they move through different phases of care, but you then have to have an image sharing platform, almost like an image HIE kind of capability, and traditionally images have not been core to HIE plays. So I think that's a huge opportunity going forward on the imaging side to both save money in the industry and reduce exposure to patients of excess image radiation and to improve the quality of care. That's going to be very big."
So far, the Centers for Medicare & Medicaid Services has not made access to images through an EMR a requirement for providers. But meaningful use Stage 2, the rules for which were finalized in October 2012 and which take effect in October 2014, includes for the first time as a menu option the requirement that EMRs be able to access more than 10% of all test results of which is one or more images ordered by an authorized provider of the eligible hospital for patients admitted to inpatient or emergency department. And CMS has a track record of incorporating menu items in one stage of meaningful use into the core requirements of the next stage.
"Meaningful use says it doesn't matter if this patient had a chest x-ray from another hospital or another PACS," Chang says. "You need to be able to display it on this other EMR. That's a nontrivial issue. This is a huge issue. So the real challenge of enterprise images is not the enterprise as we know it today. The real challenge of enterprise imaging will be when the definition of the enterprise goes beyond our firewall."
At 550 beds, Chang says Chicago is not a big system. "We don't have that problem. But trust me, a lot of folks call me all the time asking for my advice on how to address that nut, because it is a really difficult problem when you get beyond a simple definition of the enterprise."