Feature: Meaningful use leaves medical images out in the cold
In the document, MITA stated: “Imaging in medicine represents the largest standardized and structured datasets in the world. And yet, recent guidance for building an effective medical record in the EHR includes the reports, but not the images.”
In an interview, Charles Rosen, MD, PhD, professor of neurosurgery at West Virginia University School of Medicine in Morgantown, said that he has reached out to policymakers several times regarding the subject, with no response or further questions from the committee responsible.
Likening the omission of medical images to viewing art without the picture, the document explained: “Imaging is a fundamental part of modern medicine,” and physicians should be seeing a visual dataset as well as a text report, so that what they are seeing is not solely the words of interpretation of others.
In agreement with both the National Electrical Manufacturers Association (NEMA) and MITA, Rosen was surprised to learn that the inclusion of images was not going to be incorporated into meaningful use requirements, noting that it is where he assumed policymakers would begin, as medical images represent the largest infrastructure in place.
“It seems like right now we have a hodgepodge system, but almost all of radiology is currently digitized,” he explained, noting that few facilities have EMRs for progress notes or office visits. “Given that all CT and MR scanning is digital and most people have gone to digital acquisition even for plain films and other modalities, to me, the government approach seems ignorant of the issues,” said Rosen.
And the paper is in agreement, explaining that hospitals and facilities already exchange DICOM images on CDs, which “demonstrate that the images are needed and the data standard works across sites.”
The document goes on to say that the “current ‘state of the art’ in integrating medical images into patient records is sufficiently advanced for immediate inclusion in the meaningful use criteria,” and that there should be no need for “media” (the burning of image data to DVD, CD or USB device) transport of image data. “Through internet connection, using a standards-based, secure authenticated method to access the images, studies can be shared between hospitals, care providers and even directly to a patient,” said MITA.
The whitepaper rings true to Rosen, who explained that as a neurosurgeon, a report is not significant enough and he will not make a decision about whether or not that patient requires surgical intervention based upon a radiologist interpretation of the images. “I need to see the images myself,” he said.
Rosen also noted that the effective communication of electronic imaging is one of the most important aspects of the EMR, and is an issue he has been working on for the past couple of years.
“There’s been a huge problem with the ability to effectively communicate images from facility to facility, and it is causing numerous issues for patients and patient safety,” he noted. Some of these issues include patient images not being viewed in a timely fashion and differing approaches and standards regarding how images should be presented and accessed, which according to Rosen, can result in patients needing to be reimaged unnecessarily.
Offering an example of why this problem should be addressed, Rosen said, “If you are one of my patients and you have a brain tumor, over the course of a year or two, the number of times you are going to be imaged is quite high and the amount of data that is represented by that is huge.”
Documents such as letters from one physicians to another and lab tests do not account for a great deal of data, noted Rosen, who explained that sharing images presents a greater challenge than contacting another facility to fax documents such as discharge summaries or lab results. “To put a focus on the minority of the EMR and ignore the majority, to me, seems like it’s not putting the patient’s needs in perspective,” he said.
MITA also says that imaging is an integral part of high-tech medicine, and “[d]elaying inclusion of imaging in “Meaningful Use” overlooks an obvious need."
The document, which can be downloaded here (PDF), concluded, “NEMA/MITA recommends the inclusion of imaging in the EHR as a criterion for meaningful use as of 2013.”