Digital imaging & electronic health record systems: Implementation and regulatory challenges faced by healthcare providers

Abstract

Electronic capture of patient records, including digital imaging, facilitates: i) collaboration and communication between providers and entities involved in patient care, ii) compilation of lifetime patient histories that are more accessible to treating physicians, and iii) aggregation of population data for evidencebased medicine and creation of decision support tools. The Medicare and Medicaid electronic health record (EHR) Incentive Programs and associated Meaningful Use (MU) requirements are a driving force in the evolution towards digitized patient recordkeeping. For the foreseeable future, MU will continue to exert pressure on EHR vendors, hospitals, and ambulatory practices to conform to increasingly stringent government reporting requirements or else face obsolescence and/or reduced fees for services. This is encouraging many practices -including radiology and digital imaging centers -that may have opted out of MU compliance in the past -to re-examine how they integrate their work flows with EHR systems and with other physicians and treatment facilities. This paper describes digital imaging technology and strategies to interface and integrate it with EHR systems and clinical work flows. A case study based on the open source electronic health record software, OpenEMR, is presented as an illustrative example of challenges integrating imaging and EHR technology across and between clinical practices. The case study demonstrates how poor EHR integration with picture archiving and communication systems (PACS) and radiology information systems (RIS) complicates and adds to the clinician work flow and reduces the diagnostic value of imaging data. EHR, PACS, and RIS vendors need to improve system interoperability and image sharing capabilities in their product offerings. Better, more complete standards are needed to enable this to happen. DICOM, HL7, IHE, and other standards are evolving to address gaps in data integration and continuity across the spectrum of health information technology used in patient care. This will alleviate burdens on healthcare professionals and information technology staff who must use and implement systems infrastructure while maintaining compliance with Meaningful Use (MU) and Health Insurance Portability and Accountability Act (HIPAA). This is essential to achieving technology's promise of optimized healthcare delivery.Keywords-medical digital imaging, Health Insurance and Portability Act (HIPAA), Meaningful Use, DICOM format, OpenEMR, electronic healthcare records (EHR) systems, picture archiving and communication systems (PACS), radiology information systems (RIS)

Review on Digital Radiography: Open EMR workflow and Wi-Fi Networking System

“…One such work flow with OpenEMR is described in this paper using the case study mentioned in a paper [3]. OpenEMR is a software for keeping medical record and it is used for electronic practice management.…”

“…Storage facilities are also available using OpenEMR. And due to its smooth working over a third of users are based in United States [3].…”

“…It happens that some file formats are not compatible with OpenEMR for example DICOM, then a zip file is uploaded [4]. Since there is no direct interface between OpenEMR and DICOM, certain webviewers which are not yet approved by FDA are used [3]. But this is not legal, so people convert the DICOM file to PNG or JPEG which causes compression and hence loss of data.…”

“…And also according to the FDA's law to keep the patients record for a particular span of time wasn't feasible using the traditional technique [2].Along with the manipulation, quality improvisation and immediate image viewing which was not possible in the older technique is made plausible with Digital Radiography (DR) Now, Digital Radiography (DR) makes use of digital X-ray sensors like flat panel detectors and high density line scan detectors. For this digitalization Picture Archiving And Communication System (PACS), Radiology Information System(RIS), Electronic Health Care Records(EHR) systems and more complete standards like Digital Imaging And Communications in Medicine(DICOM), Health Layer 7(HL7), Integrating the Health care Enterprise(IHE),are used to provide more holistic patient data capture and disinterested sharing [3]. …”

Analysis of DICOM Image Compression Alternative Using Huffman Coding

“…The larger the size of the data, the more the storage media and bandwidth for the data transmission are required. It certainly causes the problem in terms of procurement cost for larger storage and bandwidth [2–4].…”