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PACS and RIS: Surviving a consolidated enterprise in the EMR era

From the January 2017 issue of DOTmed HealthCare Business News magazine

By Don Dennison

The trend of health provider organization mergers, acquisitions and affiliations to create multi-facility, multi-care setting networks is well documented. As is the adoption of a shared EMR across these enterprises. Such consolidated enterprises are faced with many opportunities to standardize their data, systems, practices and personnel structure to gain clinical and financial benefits. While the standardization of clinical records and systems is driven by the adoption of the shared EMR, imaging systems often lag behind. And past practices commonly used by imaging staff to consolidate data and systems need to be reassessed once a shared EMR is in place. Imaging informatics professionals need to understand the best practices for managing imaging records as part of a complete clinical record, owned by the EMR.

The consolidated enterprise
When several health care facilities and organizations that have operated independently come together to form a single entity, some normalization of data and systems needs to happen in order to gain the benefits of scale and integration. Also, providing authorized enterprise access to data through a common user interface increases productivity and reduces support complexity and costs. For imaging, this can mean the use of a common enterprise viewer embedded in the EMR user interface, and the use of a shared imaging archive that may be provided as part of a shared enterprise PACS or a vendor neutral archive (VNA).

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One of the common benefits of a shared EMR is the availability of an enterprise master patient index (EMPI) which establishes a link across locally assigned patient IDs. This is an essential component for providing a longitudinal patient imaging record throughout the enterprise. It does require the use of imaging systems that can receive the EMPI value and have logic to manage a patient’s imaging records that have been acquired in the different facilities under different patient identity domains.

Consolidating imaging records — traditional techniques
Prior to a shared EMR being in place, when data consolidation from disparate facility systems was performed, rudimentary methods were often used to ensure values for different patient information fields were unique. For example, patient ID and accession number. The uniqueness of these and other fields are critical to prevent the records for different patients, acquired in different organizations that may have used a similar numbering scheme, from being incorrectly linked when stored in the same system.
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