10 requirements for connecting EHR and medical images


Connect your EHR and medical images without replacing your systems.

If we ignore the compliance requirements of HITECH (bear with us, we won’t make you give up your incentive payments) and focus on what physicians need to reach the goals prescribed in the original intent of the laws, what would such a system look like?

Based upon our research, we’ve defined what a combined EHR and patient image management system must include to enable the results required by the most demanding physicians. We assume that organizations will not change out their EHR systems. We also assume they are not in a position to replace their image capture modalities. And due to financial realities, we assume they will not spend any unnecessary money to change an existing working system.

Here are the ten requirements of a Complete Medical Record. If your electronic health records systems and medical imaging systems do not meet all of these criteria, you will be left behind.

1) EHR system must support an API link

We are not talking wholesale changes to your EHR system. Many EHR vendors already maintain (and some even document) an API (application programming interface) to accommodate third party applications. The simplest of APIs is a URL integration method, to enable a zero-footprint image viewer (one that doesn’t require extra software to use) to be launched.

2) Image management systems must enable a URL

So once the vendor of your EHR system has decided to play nicely with others, make sure your image management system enables the identification of an image for a specified patient via a URL link.

3) A zero-footprint image viewer

Just to keep it simple, after accomplishing steps 1 and 2 above, your image management system must integrate a zero-footprint viewer to present medical images. By zero footprint we mean that you shouldn’t have to wait each time an image is requested for some bulky software to load. Instead it should be accessed using any modern web browser. the viewer should be FDA-approved for diagnosis.

4) Single sign-on set of credentials entered once

When you summon the medical image with your EHR, you shouldn’t have to re-enter credentials (logins and passwords). If a user has authorization to view the patient’s medical record in the EHR, that should be sufficient security to view their medical images. These credentials need to be passed to the image management system via the API and used invisibly to access the linked image for viewing.

5) Patient records components maintained in their native data structures

It isn’t appropriate to try to stuff image files into the same database that stores patient records. Some may not even accept them. Maintaining the image in DICOM format in your PACS or image management environment enables much richer viewing of your medical image. And, your PACS must accommodate non-DICOM images as well (e.g. JPEGs).

6) Portable patient records available anywhere anytime on any device

Gone are the days when a doctor read an image by placing film on a light box. Almost every medical image is now digital. Digital images must be accessible from anywhere. Physicians are busy, on the go, and need their images available wherever they are. Add to that multiple office locations, hospitals imaging centers and specialists, and the demand for mobility increases exponentially. Then realize that it’s critical for these images to be shared with other physicians, specialists, technicians, for real time collaboration. Images must also be available to patients themselves in order to engage the patient in their own care. What is required is a location-less archive that is accessible anywhere, anytime, very simply available on the device you happen to have handy. Sharing images on CDs is antiquated and should not be part of your current practice.

7) Interoperable

Image management systems need to work, talk and share information seamlessly amongst each other. The idea that a PACS could not share an image with another PACS within the same practice (or beyond) is pathetic. As we said earlier, we are not asking you to replace perfectly working systems. We are suggesting a gateway to enable the immediate transport, sharing and availability of images between any imaging system. And, by the way, these credentials should only be entered once and then passed via that gateway or API to all connected PACS.

8) Easy to use

Apple has changed the game for intuitive operation of computing equipment. Unless your imaging system is as simple to use as an iPod or iPhone, it doesn’t cut it. It should take little time for experienced medical personnel to become facile with your imaging system and patient access should be intuitive.

9) Secure and Disaster Proof

It is astounding that despite the experiences some of us have had firsthand with data loss, medical images are not sufficiently protected from loss or disaster. Your image system must be disaster-proof. Images must be stored in multiple locations separated by hundreds of miles to ensure that natural or man-made disasters do not take them out in one fell swoop. Humans are forgetful; backups should be automatic.

10) Affordable

All of this is for naught if it doesn’t fit your budget. Proprietary PACS have for years maintained prices that are astronomical. They did this by being the only game in town that connected to their proprietary image capture modalities or by storing images in proprietary formats. Today, there are systems that are a tenth the cost and do the job just as well or … better?

This concludes our EHR + Medical Images series. Please check out our other blog posts on how current legislation is not enough to make this connection and where EHR-PACS communication has failed. Also, see h0w Purview can help connect your PACS and EHR with Purview ViTA. But above all…

Check with your EHR and PACS vendors and ask if they comply with all of these requirements.


Originally published at www.purview.net on December 10, 2014.

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