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How Will the HITECH Act Impact Radiology?

The HITECH Act, part of the American Recovery and Reinvestment Act (ARRA), and its impact on radiology is foremost on the minds of everyone in healthcare. Critical questions surrounding the language of the Act remain unanswered. To gain better insight on the matter, Imaging Technology News spoke with healthcare IT research and development expert Don Woodlock, vice president and global GM of GE Healthcare Integrated IT Solutions. Imaging Technology News (ITN): Will PACS and RIS qualify for reimbursement under the ARRA? Don Woodlock (DW): The centerpiece of and the spirit of the HITECH Act is about adoption of general purpose EMR that go across the hospital or physician office EMRs for multi-specialty groups. The definition of meaningful use does mention images; all of the patient’s test results have to be in the EMR, including images and imaging reports. Images need to be part of the electronic health record; [there is] mention of RIS/PACS, but it’s not clearly spelled out that the stimulus will pay for RIS/PACS. I think the area where we need most clarity is in the outpatient- imaging environment. They are physicians, they see patients, and RIS and PACS is all they have, and they don’t have another electronic medical record in that environment. It’s my feeling that stimulus funds should be provided for physicians [who] use technology even though it isn’t a traditional EMR. ITN: On June 16th, the definition of “Meaningful use” was released and included reimbursement for imaging described as “multimedia (e.g. X-rays).” A public comment period followed to assist Congress in clarifying this definition. What is the industry doing to represent radiology and convince Congress to include radiology’s needs under the stimulus package? DW: We are part of several groups that will provide feedback on helping Congress clarify this definition. We are part of Access to Medical Imaging Coalition, which is a group of imaging vendors. I talked to the chair of SIIM, Dr. Erickson from the Mayo Clinic and SIIM was going to get involved in defining meaningful use. ITN: How will growing volumes of patient data impact radiology? DW: There will be a big indirect effect on radiology. Radiology has been well automated for many years with RIS and PACS installed over the last decade. But they are basically working with physicians that have not automated at all, and I think the main impact that this Act will have is that there will be EMRs everywhere – hospitals and referring physicians will have EMRs as well. The way radiology interoperates and the workflow of the community will be a lot better when everybody has an EMR. A couple of examples are the radiologists [who] need the complete patient record to do a good job reading the patient exam. That includes patient history, problems, information about the order; patient allergies will be accessible to the radiologists in the click of the button. The orders will come in, in a cleaner fashion; right now they come in on paper, and radiology can help provide decision support in the ordering process, so that the right test is ordered for the right patient and the report will come in with all of the information that the radiologist needs. Then, inside radiology they will still use RIS and PACS to read and report on the exam, but then on the way back, the images and the reports will be embedded in the EMR so they will be widely available to every ordering physician that should have access. So the work of the radiologist will be more widely available to physicians that need it and the communication between the radiologists and the rest of the care team will be more effective once everyone is well-automated with IT systems. ITN: Will the referring physicians be viewing all of the images on the EMR? DW: That’s right. [For] All the physicians outside of the radiology, their view of the world will be through the EMR. They will go through the EMR to see the full patient record including the imaging tests, the reports and will probably launch a browser to the images. So, we don’t see the EMR becoming a PACS; the images will still be in the PACS, but there will be links to those images and Web browsers embedded in the EMR, so it will be easy for physicians to have access to this information. ITN: Will the viewer in the EMR also have diagnostic capabilities? DW: Probably not. In terms of a 6 mega pixel workstation, that will still exist in radiology. But these other physicians will have Web based tools and they may have access to diagnostic workstations and Web viewers, but that’s not really what they are after. They want to see the images, and sometimes use 3-D tools, but they are not using it for primary diagnosis. ITN: How will interfacing radiology PACS and EMRs impact workflow? DW: The workflow will be much more streamlined. So, on the inbound side with the orders and the EMR information, we can eliminate paper with electronic order, we can make sure the right test is ordered.