What Interoperability Means For Radiology

CHICAGO - When it comes to health care information technology (HIT), the latest buzzword is interoperability.

Up to this point, the vast majority of HIT implementation has centered on merely introducing hospitals, ambulatory clinics, and private practices to the tools that will drive health care delivery in the future. But, according to industry experts at this year’s Radiological Society of North America annual meeting, the federal government now says it’s time for everyone to start talking to each other.

“From the frontload, our conversations were about incentives – more incentives drove HIT adoptions,” said Doug Fridsma, MD, PhD, president and chief executive officer of the American Medical Informatics Association. “Now, the last thing, and the most important point is interoperability.”

And, likely the biggest impetus toward interoperability in the coming years will be the Protecting Access to Medicare Act (PAMA). This legislation, which goes into effect on Jan. 1, 2017, requires every radiology claim for outpatient, non-emergent services to include a code that proves the referring physician consulted a clinical decision support (CDS) tool before ordering a study. If the code is absent, the radiologist will not be reimbursed.

After two years of this widespread, mandated CDS use, the Department of Health & Human Services will identify 5% of referring providers who are outliers – those who don’t follow appropriateness guidelines for ordering advanced diagnostic imaging studies. These providers will be required to use a pre-authorization process for all imaging procedures.

The main motivation to-date behind adopting HIT solutions has been money, but that’s soon to change, as well, said Curtis Langlotz, MD, medicine and radiology professor at Stanford University Medical Center.

“Legislative activity over the past decade has focused on health quality and IT policy with multiple incentives for its adoption ahead of the curve in radiology,” Langlotz said. “But, as some of these quality initiatives converge, the financial incentives are going to disappear.”

The sticking point now will be whether and to what degree patients become involved. The way patients want to access and consume their health care information will fundamentally determine the tools hospitals and providers will use.

Two tools – personal health records and patient portals that allow patients to view their medical records online – are already in use at larger health care facilities nationwide. These are novel engagement strategies for radiology, said David Mendelson, MD, radiology professor at Mt. Sinai Hospital, and it’s pushing radiologists into more direct communication with patients.

But it’s unlikely the federal government will be able to design the additional technological solutions that will lead to both interoperability and portability, Fridsma said. Much of that onus will fall to the private sector, he said.

“There may be ways that we can leverage federal and government resources to ensure the markets work the way they’re supposed to,” he said. “But the key to success is going to be the private sector.”

Any entity involved in creating interoperability tools must focus on five points: working around a core standard and function, meeting certification criteria, protecting privacy and security, supporting the associated business and regulatory environment, and establishing trust between all partners who will trade information.

When it comes to creating the right tools, the biggest interoperability challenge for radiology, Mendelson said, will be finding a way to make DICOM a communicable language.

“DICOM is fundamental to what we do – it makes everything work in radiology,” he said. “But it’s not something other physicians understand, and we need to be able to communicate to the rest of providers and to patients in ways that go beyond DICOM.”

One significant change would be enabling referring physicians to see only the images they find most useful for patient care rather than having to download the full complement of studies. A product moving DICOM in this direction is DICOMWeb™. It safely brings together images from a variety of databases throughout the Internet to create a single view of desired data. Then, radiologists and other providers can search it, as well as download and store what they need.

Ultimately, Mendelson said, representatives from all aspects of health care must come together to create a shared vision for HIT interoperability. They must collaboratively identify an end goal and design the tactics for reaching it.

“Progress toward interoperability will be incremental. I’ve yet to hear anyone disagree with this,” he said. “The reality is that we won’t wake up tomorrow and, with the flip of a switch, have interoperability across our ecosystem. It will take time, and we’ll have to work together to progressively build upon the foundation we’ve laid.”