Leading health system achieves 'One Patient, One Chart' vision with enterprise imaging

UNC Health had medical images stored in picture archiving and communications system (PACS) at multiple facilities. Even with an integrated electronic health (EHR), providers needed to burn images from a departmental PACS to a CD or DVD to share the images with a clinician in another department or location.

The tedious processes created significant challenges for a not-for-profit health system with 15 hospitals, 19 campuses, 900 clinics and 26,000 users. To address the imaging silos and provide a more consistent patient experience, UNC Health implemented a single clinical image repository with Hyland Acuo, a vender neutral archive (VNA) solution. NilRead, Hyland's universal diagnostic viewer, provides access to the health system's medical images, and Hyland PACSgear expedites the indexing of the images via automation.

The enterprise imaging initiatives have simplified UNC Health's portfolio, with 21 PACS and reporting systems eliminated, and generated enterprise-wide benefits.

Here's how the health system achieved its "One Patient, One Chart" vision.

UNC Health's enterprise imaging strategy

The health system focused on a few key areas:

• Improve image accessibility: By integrating Acuo, NilRead and PACSgear with the EHR, UNC Health has "one link within Epic where it doesn't matter what hospital that you're at, you can see those images from anywhere," Applications Developer Jameke Edwards said.

• Reduce complexity and total cost of ownership: With Acuo as the long-term repository, UNC doesn't need to store images in other systems, which frees space and lower costs.

• Image life cycle management: "Having that governance and framework to kind of be the sheriff of the house to make sure things are clean is awesome," Edwards said.

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Almost a decade after launching its enterprise imaging vision, UNC Health has accomplished the following:

• 26 million exams are accessible via the VNA

• Via NilRead, there are an average of 600 users per hour viewing exams

• 300,000 patients have viewed their images via Epic's MyChart

• More than 100 point-of-care (POC) departments and functional areas have POC imaging devices integrated with the VNA

• 244,000-plus images are exchanged with external health systems annually

• 21 distinct systems have been eliminated

The latter figure, which is still growing, creates portfolio simplification.

"It just makes things a whole lot easier," Edwards said.

"I don't ever want a patient to have incorrect information that goes into the system, is archived into the system and then somebody's having a procedure that's completely incorrect because the data in the image is incorrect," Edwards said. "We're trying to make sure, 100%, that whatever goes into the VNA is clean."

The UNC Health Applications Developer outlined five key steps:

Input validation

UNC Health has "a lot of different rules" in place to ensure that image information is entered correctly. One example is the 12-digit medical record number. If the image's metadata shows a number that isn't 12 digits, the health system will fix it before it's archived.

Removal of duplicates

By analyzing the data in the VNA, UNC Health can notify PACS administrators when there are multiple versions of the same image.

Device naming conventions

When new departments want to start storing images in the VNA, the health system makes sure they follow an application entity (AE) title naming convention.

Device throughput

The AE titles are connected to the department, location, type of device and type of modality that stores images. That allows UNC Health to send alerts when images aren't being stored properly.

Audit trail

UNC Health adds a confidentiality code to its data. The lower the code, the more research PACS administrators must do to verify that the information is correct.

"Having that extra step as far as validating the data will make sure that the information is cleaned up," Edwards said.

By "keeping the continuity of care clean," UNC Health realized many benefits, Edwards said.

For referring providers

• Longitudinal view of images, regardless of where imaging is performed

• Incorporating relevant images external to UNC Health

• Tighter clinical integration and better continuity of care

• EHR desktop and mobile access

For patients

• Access to radiology and cardiology images from MyChart patient portal

• Ability to share images with another provider, leading to reduction in repeat tests

• Ability to get imaging done closer to home, regardless of specialty care location

For the health system

• Reduction in use of DVDs and CDs for image sharing with patients

• Elimination of DVDs and image duplications for specialty referrals within UNC Health

• Faster access to external images

• Improved data security

• Operational efficiency and reduction in annual support and enhancement costs

• Improved focus on business continuity readiness

> Additional insights | How to improve efficiency in clinical operations

Key learnings

• Start with a governance and program framework: Ensuring that a solid framework is in place can avoid imaging silos and produce consistent, accurate workflows.

• Case a wide net in conversation: Stakeholder input is crucial, Edwards said.

• Involve IT early and with every program change: "Even if you don't think it's IT related, it probably is," Edwards said.

• Leverage analytics capabilities whenever possible: This can improve efficiency, mitigate risk, "and it just keeps data clean," the UNC Health Applications Developer said.

Anywhere, anytime access to images

UNC Health now has diagnostic images available via the EHR in more than a dozen departments and specialties. The list — which includes radiology, cardiology, neurology, ophthalmology and pathology — continues to grow and gives patients and providers immediate access to information.

With Hyland at the heart of its enterprise imaging strategy, UNC Health is the "producer and consumer for all the different departments" that store and access images.

"Acuo VNA has been great to us," Edwards said.