It’s winter in Rochester and the temperature is hovering around 15 degrees with a wind chill of -30.  In Orlando it’s a balmy warm day and John Patient is screaming at the top of his lungs as he shoots around the final bend of Space Mountain.  The excitement is starting to get to him though and he’s been feeling short of breath with a nagging tightness in his chest.  His wife looks at him with a knowing glance and says, “Honey, are you ok?”

Hours later John is in the ambulance en-route to Memorial Hospital.  A 12-lead electrocardiogram is transmitting information directly to the Memorial ER over a wireless modem where an ER physician is interpreting it.

The preliminary diagnosis is myocardial infarction with ST-segment elevation. The catheterization lab is notified of an incoming patient.

On arrival John’s cardiologist from Rochester, Dr. Hart, is contacted.  Dr. Hart is concerned about John’s condition and asks to see copies of John’s ECG’s to compare with prior studies stored at his office.  Memorial has no record of Dr. Hart, but they do have access to the eHealth Technologies Image Exchange system through their local Health Information Exchange.

During the ride to the Memorial Hospital ER, the ECG system used by the ambulance company transmitted the ECG data including waveforms to the hospital’s main hub, which forwarded it on to the eHealth Technologies interface on the Orlando hospital’s system.   From there it was made available to John’s electronic medical record.

Dr. Hart’s request to view the images and results is processed by the file room.  With a few mouse clicks, the clerk sends John records, including the ECG results, directly to Dr. Hart’s email as a hot-link that can be opened through the HIE Provider Portal. A PIN is included for security purposes.

Dr. Hart receives the electronic message and opens the link on his iPad Air.  He’s asked to enter the PIN and the ECG from Memorial opens.  He reviews the waveforms and confers with the hospital cardiologist.

During the consultation a recommendation is made for immediate percutaneous catheterization.  John is taken to the cath lab and a stent is placed.  A fluoroscopic study is performed to confirm the stent placement and this image is sent to the hospital PACS (medical imaging system) and the eHealth Technologies interface.  The study is available to Dr. Hart in real time through the eHealthViewer zero-footprint viewer on any of his computers or mobile devices so he carefully reviews the stent placement and electrical studies.  John is held for observation and released the next day.

On returning to Rochester’s wintery climes John Patient goes to see his primary physician who would like to review the history of the incident.  Unfortunately John’s images, discharge summary, and overall medical records are in Orlando not Rochester.  To get access to these records the front office staff must call multiple institutions, exchange a variety of forms, and wait for CDs and faxes to arrive.   This is inefficient and error prone.  When critical information doesn’t arrive medical decision-making and patient care may be impacted.  Surely there is a better way?

Over the past five to ten years regional Health Information Exchanges (HIEs) have emerged.  Many HIEs have embraced imaging and provide physicians within the community access to viewers of various forms.  In Western New York, eHealth Technologies powers the majority of these systems.  John’s fluoroscopic study, ECGs and associated reports can be made readily available to members of the HIE through a provider portal and “zero footprint” viewing technology that runs on a computer or tablet in the physician’s office.  For users within the HIE this type of solution provides a seamless way to share and collaborate on images and waveforms.

Sharing images between HIEs in different states is less straightforward.  Even when both HIEs use the same vendor it is not always possible to integrate image sharing due to differences in implementations.  Fortunately, recent efforts in standardization by the “Integrating Healthcare in the Enterprise” (IHE) body have lead to some truly interoperable solutions called “Cross Community Access” (XCA) that are designed to address the issue of sharing clinical documents and images between institutions.

From a physician’s point of view, these solutions offer the potential to be able to find and receive clinical information from out of network or out of state entities without having to leave their local system.  In Dr. Hart’s case, with this interoperable sharing in place, ECGs could be pulled up from Florida and New York and displayed side by side in the same session.

It is the author’s hope that these new standards will positively impact patient care.   The best evidence of this occurring is the IHE Connectathon – an event in Chicago where over 500 systems engineers come together to test over 150 systems.  eHealth Technologies’ Cross Community Access for imaging was tested at this event and proven to interoperate with several other major players.  This is the first step to a truly interoperable system for imaging between Health Information Exchanges and a way for physicians to get access to the images they need regardless of where they were acquired.

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