Monday, March 10, 2014

Certification forms foundation for integration challenges facing PACS

John DeLong, VP Marketing,
Medicalis Corporation
As healthcare reform drives the transition from a fee for service to a fee for value reimbursement model in the US, the focus for IT and PACS administrators is shifting to one of providing patient-centered solutions for integrating clinical and imaging information. Medicalis has been developing and refining evidence-based decision support, work list and workflow solutions to the radiology/PACS community since 1999. To learn how the company’s solutions help meet healthcare reforms imperatives for quality and efficiency, PARCA e-News talked with John DeLong, Vice President of Marketing at Medicalis.

Q. Can you give us an overview of what Medicalis does?

A. First, I think it is very important to understand that although decision support and radiology workflow have a technical component it is very much a clinical transformation process and not an IT project. Where PACS was very much an IT project, we need to look at the next generation radiology workflow and decision support as clinical transformation supported by an IT project.

At Medicalis we provide three different solutions but they are all tied together. They are all driven off the axes of quality and productivity. It is not enough in these times to just increase productivity and it is not enough to just improve quality. You have to balance both axes simultaneously, particularly as we transition from the fee-for-volume to fee-for-value environment that radiology finds itself in today. The differentiator will be quality but you can go broke if you don’t have the volume and productivity from the studies that you should be doing. What Medicalis is trying to do is help our clients be the highest quality providers for healthcare enterprise and be as productive as possible.

Q. How do you do that?

A. The first solution we have is clinical Decision Support.   At the point of order, when a physician is working in NextGen, Cerner or Epic, they select the procedure and the clinical attributes from the problem list, and when they submit or sign that order the EMR makes a query to our work flow technology platform, and based on the evidence-based clinical best practice guidelines, that order is then vetted against the standard of care put in place by the radiology group, or the cardiology group, or whichever group sets the standard of care within the enterprise. If I’m a provider ordering a CT of the head of a 45-year-old female, the EMR will enter a query about family history of stroke, and just gather the evidence for that patient for a CT and then offer the most appropriate imaging procedure. So right from the start you are trying triage whether the orders coming into the system from an imaging perspective are going to benefit the patient’s care by applying evidence-based clinical best practices.

Then we have our Enterprise Worklist solution for large hospital systems that have multiple sites, multiple PACS for multiple radiology groups using different technologies. You can put the Medicalis workflow layer in place where all the radiologists are working from our technology and work lists but we’re launching the local viewer for the particular PACS they are using.  This allows moving images around so the radiology groups can drive self-specialization. This is the biggest touch point from the PACS administrator’s perspective because it really falls on the shoulders of the PACS administrator to understand all the complex routing rules, days of the week, time of the day, site location and so forth, so that when you put in a sophisticated workflow layer in like Medicalis the PACS administrators can configure the system to meet workflow, clinical and business needs of the department given the resources available.

The third solution we call the Operations Solution, which extends the workflow platform to include all the technologists’ workflow, the nurse workflow, and scheduling workflow within the radiology department, very similar to a RIS, but we are not a RIS, it fills the gap between the enterprise EMR and all the clinical data, and allows schedulers, techs and radiologists to complete their workflow. It is a very robust integration layer that is not just HL7, but also bridges proprietary communication, EBI, flat file, SQL access. Wherever there is data in a clinical environment we can go at it from a transport protocol perspective and a harvesting mechanism perspective. That is really where a lot of the value is in terms of bringing clinical data in context to the various constituents, what does the nurse need, what does the tech need, what does the radiologist need, to complete their workflow without having to jump onto other systems. We’re very strong believers in preserving the clinical context through the workflow. It really is the value added that Medicalis brings to the table.

Q. How does Medicalis’ solutions address quality of care as one of the imperatives for reimbursement under the Affordable Care Act?

A. The decision support solution checks the order to ensure it is the right order for the patient as far as answering the question the referring physician is trying to answer. We also have a peer-review module that drives the quality of reads within the radiology group, and we have critical results management that both informs the referring physician and tracks it to make sure it is followed up. All together the decision support, peer review, critical results, capture and notification, really drives that clinical context and clinical quality.

Q. How do your solutions improve economic outcomes in healthcare delivery?

A. Gone are the days are when it was just how fast can we cut down all the trees, or we get paid for every radiology report we do, so the more reports we do the more money we make and everybody is happy. As the environment shifts there still is an awful lot of that from a practical, tactical perspective, but what is happening now is hospital enterprises are entering into ACOs and bundling payments. Now radiology has gone from a revenue generator to a cost line item that may or may not cause patients to leak out of a health system. They’ve gone from the golden boys and girls of the hospital to, “Why are we doing all this imaging?”

As a result, it requires very delicate navigation at this point in time and depends on your fiscal reimbursement, your contracts with health plans, and how are you operating. You want to have the same level of quality but you also need to have the tools available that allow you to still do as much work as you can from a competitive environment perspective, and on the flip side ensures that you are delivering value for the hospital or enterprise. Our Decision Support solution combined with the Enterprise Worklist and Operation solutions provide the ability to navigate this new environment and deliver quality and productivity.

Q. I noticed in your bio that you are a HiMSS Certified Professional in Healthcare Information & Management Systems, what do you see as the value of certification?

A. The way I look at certification is very much like building a foundation that you build a house on. Certification allows you to say, “I have a strong foundation to actually build whatever house in whatever shape or whatever size.” I’ve actually found that we are always asking individuals to build from a knowledge-acquiring and knowledge-usage perspective to build bigger and bigger houses on their foundations, and if they don’t have that solid foundation they end up failing as they are asked to do more all-encompassing, or more technically difficult things. That’s why I’m a firm supporter of certification because it sets the standard for that foundation and what the foundation looks like. The result is any organization can look at an individual’s foundation and know that they can build a house together on that foundation.

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