EHRs and Imaging Studies: The Text or Image Question

As practices move towards the integration of more information in their EHR systems, a question that frequently comes up is how much information should be incorporated from imaging and radiology studies. This information is usually available in three primary formats:

  1. A narrative report received either as a faxed document or scanned into a commonly used format such as adobe .pdf.
  2. Narrative text that is integrated into the EHR system via an external interface.
  3. Image files or digital files of the study.

Understanding how your practice will use this information should guide your investment. Regardless of which option(s) your practice pursues, you should anticipate in the immediate future that some results would continue to be received via fax or in paper format. Any operational strategy will need to be sufficiently flexible enough to deal with this reality.

Ask yourself what you are looking to accomplish with diagnostic information. For instance, if you are orthopedic surgeon and need the X-ray or MRI results for diagnostic and treatment purposes, setting up a DICOM interface and viewer along with a PACS server and diagnostic quality monitors may make a great deal of sense. If you are an independent primary care provider, this configuration may be overkill.

Beyond a fax server, the most basic type of interface for imaging studies is an interface that transmits a written report directly to your EHR. A bi-directional interface, which allows you to order the investigation directly through your EHR system, can facilitate tracking of the test and population of decision support tools. This type of interface is generally set up between your EHR and an imaging center or local hospital. For additional guidance on setting up an interface with your local hospital I suggest reading the recent AmericanEHR Partners post on Tips and Tricks to Interface Successfully with Hospitals. You may find an imaging company willing to cover part of the cost of the interface; however, you should expect to pay for the maintenance of the interface.

If you want access to the actual images, you have two options:

  1. The least integrated approach is to access the files through a portal provided by an imaging facility or hospital. Images available through these portals may not be of sufficient resolution to be used for diagnostic purposes. In addition to the resolution of the images you may need access to diagnostic quality monitors to effectively interpret the studies.
  2. The most integrated option is to have an imaging interface that transmits the full images/files to your practice.  This exchange of information is accomplished through a DICOM (Digital Imaging and Communications in Medicine) interface. These files will then need to be saved on a PACS (Picture Archiving and Communications System) server located either at your practice or on a cloud-based server. When looking at this type of interface, you should anticipate the imaging studies requiring significant storage capacity. Fortunately, storage costs have come down significantly in recent years, but there could be substantial implications when designing your practice infrastructure, including server size and Internet bandwidth constraints.

When setting up imaging interfaces you will need to consider the different types and formats of imaging studies, as each may have specific requirements. Given the number of different imaging study formats, e.g. ultrasound versus X-ray versus cardiac studies, different viewers may be required for each to be viewed correctly. Your practice may need to purchase viewers and supplemental software to access and read these files.

As with any investment, you should determine whether access to the actual images is a mandatory requirement in order to provide safe and effective care or just a nice-to-have feature.

This post is the personal opinion of the author and does not necessarily reflect the official policy or position of the American College of Physicians (ACP). ACP does not endorse a specific EHR brand or product and ACP makes no representations, warranties, or assurances as to the accuracy or completeness of the information provided herein.


One response to "EHRs and Imaging Studies: The Text or Image Question"
  • February 13, 2012
    William W. Reed,MD

    Do you have a sense or idea of numbers of rheumatologists, physiatrists and primary care D.O.s who are opting for image storage and a DICOM PACS system?

    Can one filter the EHR data base for those who have successfully interfaced with specific PACSs commonly used in imaging centers?

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