At ProMedica, a 13-hospital system serving northwestern Ohio and southeastern Michigan, the lineup of clinical departments soon to benefit from leadership’s decision to expand a long-installed radiology PACS into an enterprise VNA practically reads like a who’s who of the entire system. Cardiology, pathology and ophthalmology are on line or in line to be soon. So too are dermatology, wound care, maternal-fetal medicine, outpatient physician practices and more.

“It’s a big list, and it will take some time to get them all on board,” says Sean McClure, IT manager of enterprise image management for the not-for-profit organization. Still, he’s confident they’ll get there—and sooner than many expect. The project relies on their EMR supported by Sectra PACS for image access across the enterprise.

“We want our Epic EHR to be a single source, one-stop shop where all users can go for all things imaging,” McClure says. “We don’t want to be connecting various different links in the EHR. We want our Epic to be able to go to PACS or VNA for all the different vendors the departments are using.”

Having “grown up” with Sectra PACS over the past 15-plus years, when he returned to his original department, radiology, after spending 17 years in pathology, McClure was quick to get on board with the spring 2016 decision to stick with Sectra for the much-needed VNA expansion.

“Through the years we’ve been very happy with Sectra as a company and how they support us, along with their capabilities and where they’re going with this product, particularly with pathology and other areas,” McClure says. “We have a high degree of confidence that the Sectra system is a very good, viable system to take us into the future.”

Internal innovations for early ROI

The broadened ProMedica-Sectra partnership became official April 13, when the provider and vendor announced a six-year contract that will have Sectra providing enterprise image management—with components including capture, viewing, distribution and archiving—of one million images and multimedia files per year.

The two organizations say they foresee the Sectra VNA/Epic EHR integration giving physicians ready access to their patients’ complete imaging history, which will help improve care while increasing efficiencies.

Meanwhile ProMedica radiologists working in mammography, nuclear medicine and other areas of diagnostic imaging will tap newly released advanced visualization tools from Sectra that will improve PACS reading functionality.

McClure likes that the Sectra VNA is both storage-vendor agnostic and workflow-vendor independent—attributes that promise to facilitate efficient communication among and between user entities while also supporting patient-centered workflow.

While it’s a work in progress to get some of the clinical areas up and running on the EHR as well as the VNA, he says, some are already showing the shape of things to come.

“In the emergency department, we’re having physicians actually contact us,” McClure explains. He tells how one of ProMedica’s EDs contacted his department to say they’re performing abdomen-limited ultrasound on every trauma patient as part of their standard protocol. The ED wanted to know if they could place this protocol, including its associated image capture, in their general order set for a trauma.

“Guess what?” says McClure with unmistakable enthusiasm in his voice. “We may not be billing for procedures we are performing because there is no proof the procedure was performed, capturing the exam images provides proof of performance.”

Much the same is already happening with anesthesiologists, says McClure. “Say they’re doing a nerve block or an ultrasound for placement,” he says. “If they capture that image, proof of performance of the ultrasound, it can be billed for. We are not yet doing this. It is a potential future opportunity that has been identified.”

Intuitive and flexible 

Asked about challenges he anticipates as the clinical departments come on line with the VNA, McClure replies with one word: workflow.

As enterprise image management moves forward at ProMedica, IT-savvy staff and vendors “need to be cognizant of each entity’s existing workflow,” he says, adding that electronic image management “may be second hat to radiology, but most others have never done this.”

Citing as an example ultrasound technologists who have been working in an OB/GYN office for a long time, he points out that these individuals are probably not readily familiar with the digital world.

“They’re printing out images and sometimes even scanning them into another system for permanent storage,” McClure says. “You need to be aware that they’re going to be apprehensive and may be not be as accepting and all gung-ho as radiology may have been when they went digital. They’re cautious.”

Fortunately the Sectra VNA, like Sectra PACS, is highly intuitive, McClure suggests.

“It’s a receiver and dish-er out of information,” he says. “It takes stuff in and dishes it out when asked. There were no enhancements at all that were really necessary [upon expanding the PACS into an enterprise VNA]. It was all essentially there.”

The VNA also is proving plenty flexible when it comes to integrating with, for example, a system in maternal-fetal medicine that uses specialty-specific software.

“We’re going to store their images, but our premise is you should always be able to retrieve them back to the system that the clinician is using, the system that essentially has the toolset the clinician uses to interpret the images and produce their report,” says McClure. “We don’t expect the VNA necessarily to have each and every toolset. You’ll never get there. It would be subpar all around.”

Future expansion

Looking ahead, McClure says he believes the question about order-driven versus episode-driven image management “is going to be huge in the future.”

“How do you develop that workflow that allows you to incorporate episodic driven images? That is going to be key to this,” he says. “I don’t think anybody has a very good answer yet. The Sectra system has the ability upon image import to create an accession number which, in turn, can be incorporated into the image link sent back to the EMR which enables access to view the imported images in the VNA from the EMR.

Given his loyalties prior to returning to radiology, McClure’s excitement over seeing pathology tap into the benefits of the Sectra enterprise VNA seems understandable.

“What pathology does now is courier one or several slides trays with the paperwork to the pathologists,” he says. “It could save time and money to not have to ship slides to a pathologist. Even without FDA approval for primary diagnosis from digitized slides, there is opportunity in covering frozen section requirements at remote facilities, enabling the ability to quickly and easily consult with peers on difficult cases, and in satisfying peer review requirements.”

“As we become more [adept at] enterprise image management, that image sharing mechanism is no longer just a radiology mechanism. Through whatever the discipline is, you have to have a way of sharing your images. That’s going to be a key item in the future as well,” McClure says.

“We should be able to use existing technology such as secure email with password restrictions, or a single vendor for your image sharing requirements that connects to and shares with whatever image sharing vendor the receiver is utilizing.”

‘Easier, safer and much more controlled’

McClure wraps up his thoughts on the move from PACS to enterprise VNA with a personal anecdote.

On a recent ER visit with a relative, he was shocked to observe a physician seeking a second opinion on an ultrasound by—drum roll—using a smartphone to snap a photo of the image on the monitor. After checking off several HIPAA violations the physician may have committed, McClure points out: “Had those images been captured on a vendor neutral archive, they could have been immediately available via a device that doesn’t store the image on it. There would be no HIPAA violation whatsoever, and the image would have been of much better quality.”

“As we start looking at imaging-producing entities out there, we are starting to see that are so many people doing little things like that physician did in the ER,” McClure says. “We don’t have systems yet for these situations, but we’re going to get there soon and make image management easier, safer and much more standardized all across the enterprise. And that’s a good thing.”