Implementation and Evaluation of a Regional Image Share Network

项目摘要 放射学成像最有效的解释是结合患者的临床情况和任何 先前的研究。然而，支离破碎的美国医疗体系和缺乏共享的电子健康记录 (EHR)限制对先前结果的访问，损害了医生适当地将成像研究排序为 以及放射科医生最好地解释结果的能力。因此，患者经常接触到重复的 成像和次优图像解释。这些因素反过来增加了成本，并可能导致患者 伤害。卫生信息交流(HIE)旨在克服这些障碍，并改进适当的 利用率。然而，HIE在美国还没有得到有效的大规模实施。此外， 缺乏将此类系统集成到设施的现有IT基础设施中，以及相关的不便 供应商导致现有HIE的临床使用率和对患者的影响较低。此外，现有的高等学校一般 不提供查看来自其他中心的放射图像的功能。为了应对这些挑战，我们 提议学术医学中心(纽约大学朗格尼医学中心[NYULMC])之间的一种新的合作， 大型区域健康信息交换(Healthix)，主要的电子健康记录供应商(EPIC)，以及 图像共享公司(EHealth Technologies)，以及纽约市的其他学术医疗中心 将图像和报告在本地EHR内实时提供给急诊临床医生和 为放射科医生提供原生的PACS。一旦这个图像共享系统实现，我们将比较四个 同期ED患者组：(1)有相关外部影像报告的患者 可提供，但在电子病历的单独部分中分开；(2)具有相关外部成像报告的 提供并整合到电子病历的放射科；(3)既有外部报告又有图像的报告 可用和集成的；(4)在NYULMC进行过相关成像的。这个独一无二的 安排将提供足够的数据，使我们能够确定完全集成的图像共享对 重复图像排序的关键临床结果和后续测试的建议，以及 确定部分共享(仅限报告)和工作流集成的增量效果。调查结果将不会 不仅建立有效的图像共享对患者预后的影响，而且还有助于指导正在进行的 全美图像共享网络的未来发展。

Project Abstract Radiology imaging is most effective when interpreted in the context of the patient’s clinical condition and any prior studies. However, the fragmented U.S. healthcare system and lack of shared electronic health records (EHRs) limit access to prior results, impairing both physicians’ ability to appropriately order imaging studies as well as radiologists’ ability to best interpret results. Patients are consequently frequently exposed to duplicate imaging and suboptimal image interpretation. These factors in turn increase costs and may cause patient harm. Health information exchanges (HIEs) are intended to overcome these barriers and improve appropriate utilization. Yet, HIEs have not been effectively implemented on a wide-scale basis in the U.S. In addition, a lack of integration of such systems into facilities’ existing IT infrastructures and associated inconvenience for providers leads to low clinical use and low patient impact for existing HIEs. Moreover, existing HIEs generally do not provide the ability to view radiology images from other centers. To address these challenges, we propose a novel collaboration among an academic medical center (NYU Langone Medical Center [NYULMC]), a large regional health information exchange (Healthix), a major electronic health record vendor (Epic), an image sharing company (eHealth Technologies), and other academic medical centers in the New York City region to make both images and reports available in real time within the native EHR for ED clinicians and within the native PACS for radiologists. Once this image share system is implemented, we will compare four contemporaneous patient groups of ED patients: (1) those with relevant outside imaging for whom reports are available but segregated in a separate section of the EHR; (2) those with relevant outside imaging reports available and integrated into the radiology section of the EHR; (3) those with both outside reports and images available and integrated; and (4) those with relevant prior imaging performed at NYULMC. This unique arrangement will provide sufficient data to allow us to determine the impact of fully-integrated image sharing on key clinical outcomes of repeat image ordering and recommendations for follow-up testing, as well as to determine the incremental effects of partial sharing (reports only) and workflow integration. The findings will not only establish the impact of effective image sharing on patient outcomes, but also help direct the ongoing and future development of image share networks across the U.S.