Bradley J. Erickson, MD, PhD, FSIIM
Chair

The American Recovery and Reinvestment Act of 2009 (ARRA), also known as the ‘stimulus package’, promises to spend a significant amount of money promoting Electronic Health Records (EHRs) through an incentive system. Those physicians who make “Meaningful Use” of an EHR will receive incremental payments from CMS starting in 2011. That key phrase, ‘Meaningful Use” has been the subject of much discussion. Several groups have already proposed definitions. While those definitions have included many valid points, none has even mentioned imaging, including the initial recommendations of the HIT Policy Committee. That, despite the fact that imaging is a large part of the cost of healthcare in America, and is one of the most rapidly increasing components.

It is also apparent that imaging is a critical component of modern healthcare—blindly decreasing imaging across the board is not a viable option unless we are willing to accept a decline in quality. Imaging encompasses not only radiology images, but also pathology, ophthalmology and the rapidly growing field of telemedicine. Imaging-specific criteria should be included in the definition of meaningful use because imaging is a large part of the cost of healthcare in America, and is one of the most rapidly increasing components. It is also widely recognized that, when measured by data volume, the largest part of any patient’s longitudinal medical record is comprised of images and related data. Images are also significant facilitators and enablers of improved communication among the inter-disciplinary care-team.

What is required is information to help guide the use of imaging to maximize quality and safety while reducing cost. We will have to do more with less. We will have to become more productive. Imaging Informatics is at the crux of this issue—we are focused on leveraging information to achieve these goals. For that reason, we wish to advance the following as important components of meaningful use of EHRs for imaging physicians:

1. Electronic medical records must enable the sharing of images and associated data between health care organizations.  Images should be available anywhere the patient might need them. This requires sharing of reports and annotated images between health care organizations. There are now formal standards and best practices (e.g., Integrating the Healthcare Enterprise) for accomplishing this task.  But despite the proven successful use of these standards by some institutions, adoption remains minimal.   Effectively sharing images and reports could significantly reduce unnecessary imaging examinations, which will reduce costs while increasing quality, improving timeliness of treatment, and enhancing patient safety.

2. Electronic medical records must provide decision support for the selection of the right imaging examination.  For example, currently available decision support systems can help the requesting provider determine whether an intravenous contrast agent should be administered, and can suggest more appropriate and less costly alternative tests.  Evidence now shows that order entry decision support reduces imaging costs and unnecessary examinations.  This scientific evidence is strong enough that some third-party payers have already accepted the use of these systems in lieu of pre-authorization.

3. There must be recognition that physicians do not all do the same thing. One of the listed elements of ‘meaningful use’ is focused on e-prescribing. While this is useful to some physicians, a substantial number of physicians do not prescribe medications outside of the immediate delivery of medications during a procedure. As such, e-prescribing should NOT be a required component of meaningful use for some physicians. At the same time, imaging physicians should make use of decision support tools where appropriate, including 3D and 4D visualization tools, computer-aided detection and diagnosis tools, and other image enhancement methods.

Certainly, there are more elements that some will wish to propose. Indeed, my original list was longer, but some of those were more ‘stretch goals’ than items that could realistically be in place for most practices in the next 2-4 years. It is worthwhile discussing some of those pieces (e.g. structured reporting is certainly something that would increase efficiency, value, and quality) but I would like to have this blog post focused on near-term practical targets.

Please share your comments below.

Dr. Erickson is a Professor in the Department of Radiology at the Mayo Clinic, Rochester.