Customer Spotlight: Carondelet Health Delivers Enterprise-Wide Imaging Access

Carondelet Health of Kansas City (CH) doesn't have to imagine it anymore ... they are experiencing it. Kay Nelson, along with a dedicated project team from CH, Emageon and MEDITECH, were able to make this dream a reality. Kay spent some time talking with us about their experiences.

Project Scope:

Carondelet Health is a member of the Ascension Health organization. Their two acute care hospitals are St. Joseph Medical Center in Kansas City, and St. Mary’s Medical Center in Blue Springs, Missouri. St. Joseph Medical Center is a Magnet-designated 300-bed hospital with a medical staff of 700. St. Mary’s Medical Center is a 139-bed hospital with a medical staff of 300.

Carondelet Health partnered with Emageon to implement an enterprise-wide, fully integrated radiology imaging system with advanced visualization tools and clinical content management. Part of the project scope encompassed integrating images from Emageon’s Enterprise Visual Medical System (EVMS) with MEDITECH’s Hospital Information System (HIS) and Radiology Information System (RIS). The initial phase of the implementation was completed in late summer of 2005, with the deployment phase completed in March 2006.

Early on, CH decided a major aspect of the project scope involved how clinical providers could easily and securely access the imaging system and electronic medical record both within and outside the hospital network. Other expected benefits included access to the images that is ubiquitous, intuitive, complete, consistently available and easily accomplished with single logon security.

What were the main objectives of this project?

The objectives of CH’s implementation plan exceeded the original intent of a Picture Archiving and Communications System (PACS) implemented as a departmental solution for Radiology. For CH the ongoing plan is to implement an enterprise solution with a broader interest base represented by, but not limited to, the involvement of Referral & Specialty physicians; the departments of Emergency, Surgery, Cardiovascular, and Critical Care; Information Services; Nursing; Marketing; Administration and Physician Relations. The vision for CH’s enterprise solution is a secure, seamless exchange of patient data and images anytime and anywhere. The purchase of this technology was only a small part of the solution: integration, training, optimizing workflow processes, and enabling clinicians to accept and use the new technology presented their own challenges.

With the objective of achieving an enterprise-wide solution, CH decided system integration with the electronic medical record (EMR) was a top priority for the implementation project. System integration created a bridge between the imaging system and the clinical applications in the EMR. This was a difficult task made easier by the uniform usage of open standards in Emageon’s EVMS. The manageability of the task was eased by collaborating with Emageon, an imaging vendor who supports and is a leading proponent of IHE (Integrating the Healthcare Enterprise) Technical Framework and the Open Systems and Standards policies.

The concept of interoperability and the necessary sharing of proprietary system information was a vital link in the integration of these systems. There is a common perception that it takes a long time to get vendors to work collaboratively in this type of undertaking. Fortunately, this was not the case during the project. A collaborative partnership between CH’s Information Services staff, Emageon’s project team and MEDITECH’s system programmers led to a timely, well-managed completion of the integration objectives.

What deployment methods did Carondelet Health utilize?

In order to meet the goal of access ‘anytime, anywhere’ for the enterprise solution; CH and Emageon developed several plans for the deployment of the imaging system for clinical provider access:

• Integrated Viewer Launch Platform with Application Programming Interface (API) technology to allow access through MEDITECH's HIS and RIS to the imaging system for general clinical user access within the internal hospital network access
• Direct access within the internal hospital network through the EVMS desktop application for Radiology department personnel and specified clinical users with EVMS user ID’s and passwords
• Web based rollout functionality for clinical users outside of the hospital network in Physician offices and homes for direct access to EVMS

Integrated Viewer Launch Platform

The integrated Viewer Launch Platform is CH’s option to integrate images from the EVMS with all of the other online patient data in the EMR. This option employs the technique of an integrated, embedded viewer application utilizing an Application Programming Interface (API). For Emageon, these pre-defined programmable events and methods, when combined together, form the Viewer Launching API, which in many respects is a remote control/interface to the EVMS. For MEDITECH this option also requires some development within the HIS in order for it to conform to the Emageon defined function calls. This allows MEDITECH’s HIS to integrate easily, creating the appearance and atmosphere of a working system that is one application on the desktop. Once a clinical user logs into the HIS application, the access to the images is found in a distinct data source displayed in the same context as the other clinical information.

When a medical imaging study is stored in Emageon’s EVMS, the imaging system generates and sends an HL7 interface message to notify MEDITECH’s HIS that an image is available for viewing by having an indicator appear in the EMR. With just a few keystrokes, the image appears and the CH user has full use of production tools for advanced visualization to dynamically manipulate and analyze images. The integrated Viewer Launch Platform is transparent to the clinical user allowing complex tasks to be done with minimal training. The seamless functionality of this option appears to the user to function in the same manner as the other routines in the HIS and RIS. Clinical users find this easier to use since the imaging system is now designed to be a part of the program they are already accustomed to working with in their daily workflow processes.

There are other benefits to this type of deployment such as single user logon access. The security and access of the single user logon is governed by the rules set up by CH in MEDITECH’s system. The clinical users simply use their current MEDITECH user ID and system password for access into both the HIS and the EVMS. As a result there is less need to manage the creation and maintenance of EVMS user ID's and passwords. Since the workstations with MEDITECH’s HIS are at the point of care in the CH system, this method of deployment supports the highly “nomadic” workflow of clinical providers, by providing quick and easy access to the patients’ medical images and online data.

Web Viewer rollout for Access into EVMS

The deployment method to be used to support clinical provider access to Emageon’s EVMS easily and securely from outside the hospital network is the Ultravisual Web Viewer. This deployment method provides a secure and reliable process for clinical providers who need to access the images when they are outside the hospital network.

This method utilizes both HTTP communication protocol and secure socket layer (SSL) encryption. Once access to the imaging system is accomplished, clinical providers will see no difference in the utilization of this method compared to how EVMS is operated within the hospital network. There is full use of advanced visualization tools to dynamically manipulate and analyze the images.

The process to set up this access will be provided through a secure link on CH’s hospital website. The web link will provide instructions about minimum technical requirements needed to run the program from outside the enterprise network. It is expected that this will benefit CH by giving it a competitive edge in their marketing ability by providing access to the imaging system for clinical providers from their offices and homes. Currently, there are many clinical providers accessing CH’s EMR from their offices and homes, so this method will serve to enhance those current capabilities.

What benefits did Carondelet Health realize from this project?

Along with the benefits noted with the different deployment methods, there are other benefits being realized by CH. Enterprise-wide digital imaging enables business process re-engineering which has implications for CH in cost management, workflow efficiency and clinical efficiency. The EVMS product, due to its stability quickly demonstrates great benefits for CH. The Radiology Department was “filmless” within one month after the live softcopy reading date. A paperless, filmless environment not only supports a truly virtual reading environment for the radiologists, but it also enables the clinical providers to be able to obtain all of the patient information they need in one place. This virtual reading environment allows the Radiologists to read images at both hospital sites.

Having the images integrated into the EMR is increasing the efficiency of the Radiologists’ workflow patterns. Since the referring physicians can now view images along with the EMR at the point of care, the Radiologists are experiencingfewer interruptions in their daily work and thus have increased their productivity.

In addition, more efficient workflow is being provided through immediate and concurrent access to images. Implementation of Emageon’s EVMS in the Emergency Department has accelerated the process of reviewing the radiology exam images, resulting in faster turnaround times, and enabling physicians to show patients their medical images at the point-of-care.

The traditional goal of implementing a radiology-centric PACS system for cost savings is being far surpassed by all of the benefits of enterprise-wide efficiency with Carondelet Health’s implementation of Emageon’s Enterprise Visual Medical System into their electronic medical record. Carondelet Health, along with their long-term partnership with Emageon is well into the journey to build a strong foundation that is placing them in a strategic position to continue accomplishing their commitment to serving the community with innovative, convenient and quality healthcare.

Kay Nelson, RN, wasa Senior IS Applications AnalystatCarondelet Health for 12 years. She has an MBA from the University of Missouri and 15 years of Information Systems and Marketing experience withinthe Healthcare industry.If you have any questions for Kay, feel free to contact her at knelson5@kc.rr.com This e-mail address is being protected from spambots. You need JavaScript enabled to view it .