Radiology imaging is most effective when interpreted in the context of the patient?s clinical condition and any prior studies. However, the fragmented U.S. healthcare system and lack of shared electronic health records (EHRs) limit access to prior results, impairing both physicians? ability to appropriately order imaging studies as well as radiologists? ability to best interpret results. Patients are consequently frequently exposed to duplicate imaging and suboptimal image interpretation. These factors in turn increase costs and may cause patient harm. Health information exchanges (HIEs) are intended to overcome these barriers and improve appropriate utilization. Yet, HIEs have not been effectively implemented on a wide-scale basis in the U.S. In addition, a lack of integration of such systems into facilities? existing IT infrastructures and associated inconvenience for providers leads to low clinical use and low patient impact for existing HIEs. Moreover, existing HIEs generally do not provide the ability to view radiology images from other centers. To address these challenges, we propose a novel collaboration among an academic medical center (NYU Langone Medical Center [NYULMC]), a large regional health information exchange (Healthix), a major electronic health record vendor (Epic), an image sharing company (eHealth Technologies), and other academic medical centers in the New York City region to make both images and reports available in real time within the native EHR for ED clinicians and within the native PACS for radiologists. Once this image share system is implemented, we will compare four contemporaneous patient groups of ED patients: (1) those with relevant outside imaging for whom reports are available but segregated in a separate section of the EHR; (2) those with relevant outside imaging reports available and integrated into the radiology section of the EHR; (3) those with both outside reports and images available and integrated; and (4) those with relevant prior imaging performed at NYULMC. This unique arrangement will provide sufficient data to allow us to determine the impact of fully-integrated image sharing on key clinical outcomes of repeat image ordering and recommendations for follow-up testing, as well as to determine the incremental effects of partial sharing (reports only) and workflow integration. The findings will not only establish the impact of effective image sharing on patient outcomes, but also help direct the ongoing and future development of image share networks across the U.S.
In this project, we will implement a regional image share network among major New York City medical centers, tightly integrating outside imaging reports and images into existing IT infrastructure and clinical workflow. We will evaluate the incremental impact of outside report and image availability on rates of repeat imaging as well as rates of recommended follow-up imaging, thereby potentially reducing overtesting and improving patient care.
