John Muir Health, California

Smart cloud-based solution, strong people skills prepare John Muir Health well for exchanging images with neighboring providers

The imaging division at John Muir Health in California’s Contra Costa County has been supplying topnotch image-handling capabilities to end users located across the system’s sprawling family tree—three hospitals, seven outpatient imaging centers, a 1,000-plus physician network and a dozen or so sites providing outpatient, urgent-care and surgery services—since 2001. That’s when Sectra PACS entered the picture for the Walnut Creek-based organization.

I think the biggest bang for our buck on the Sectra IEP has really been the improved patient care, the lack of repeat studies and the safety of not re-radiating patients.

Linda Womack, MHA, executive director of imaging services, John Muir Health

All well and good. But when Linda Womack, MHA, joined as executive director of imaging services in 2013, members of the imaging team set their sights even higher.

That’s because Womack noticed how pressing the need had become for John Muir Health, which serves a broad swath of the Bay Area population east of Oakland, to share images with numerous neighboring provider organizations.

At the top of the list were Muir Health’s close working partners. These include such healthcare powerhouses as UCSF Health in San Francisco, Stanford Children’s Health in Palo Alto and Muir Orthopedic Specialists in Walnut Creek. “We recognized that we had to improve our clinical coordination,” Womack says. “We have Epic EHR, and our EMR is optimized. However, you cannot move images through Epic’s Care Everywhere record-sharing platform.”

Step by step, the path to optimized, cross-enterprise image sharing would lead Womack and team to Sectra’s Image Exchange Portal (IEP). This burgeoning cloud-based solution facilitates collaboration on imaging-intensive care while protecting patient data and cutting out the costs and risks of shuttling CDs or USB drives.

What’s more, Sectra’s IEP facilitates image sharing among and between not just providers, referrers and medico-legal professionals but also with patients themselves. Plus it can be used to transmit all kinds of imaging-related information not just from radiology but also from cardiology and pathology, for example.

Navigating the road’s speedbumps—namely, the human-factor hindrances inherent in any cross-enterprise or even inter-departmental endeavor—would call on not only the Sectra IEP’s broad utility and adaptability but also on Womack’s skills as a coordinator and a negotiator.

PACS-friendly interface

“When I came to John Muir, I inherited the Sectra PACS,” says Womack, who previously worked for Sutter Health. Not long after getting to know Sectra staff as well as Sectra PACS, she mentioned to her rep that she had begun looking at various vendors’ image-exchange solutions.

At the time, Muir Health was relying on point-to-point VPN tunnels to connect with its top provider partners. This was a pricey way to go, as the costs ran nearly $20,000 per VPN. “Just talking with Sectra about what their PACS can do, as I was learning the system, the next thing they said was that they were just birthing an image-exchange solution” in the U.S., says Womack. (Sectra rolled out IEP in Europe in 2010, and it has been growing fast there ever since.)

That came as music to her ears, since her early foray into the image-exchange space turned up a cacophony of close to 30 vendors vying for business.

“I took a look at what Sectra had, and I saw that it was very easy to use,” Womack says. “I’m not very shy, and I gave them a lot of feedback on how the product could work better from a user-interface perspective. They listened, they tweaked it and we installed it.”

That was just about a year ago. Womack and team found the Sectra IEP installed easily and won enthusiasts immediately. “Our people who are used to working in our PACS can do image exchange right within the PACS they have been using all along,” Womack says. “It’s not like they are launching or having to learn a new program.”

In the first year of operation, the Sectra IEP handled more than 800 transactions and is now processing well more than 100 per day. That’s a small but expanding fraction of the 345,000 imaging studies Muir Health does annually, but it encompasses a growing number of cardiology studies and all radiology modalities except PET.

Womack and colleagues like that the IEP allows them to share images safely and securely, as the data transmit through an encrypted cloud exchange, and they appreciate that the system automatically tracks each study’s routing and viewing history.

Slow but sure image-exchange expansion

Improving the communication of image exchange helped greatly due to the varying image-exchange solutions in use throughout the Bay Area, Womack says. There are at least 12 different cloud-based products scattered nearby, she found, and getting the Sectra IEP cloud to talk to the other vendors’ clouds meant corralling vendors and providers into discussions.

“Luckily I have been in the imaging field for 30 years, and I have a lot of contacts in the Bay area at the various hospital institutions and radiology departments,” Womack says. “So I called people up.”

Gradually the vendors have been coming along, tweaking their clouds to talk to one another, she says. The first Muir Health partner to get its vendor to get aboard working with Sectra was Stanford Children’s.

With the technical bugs now worked out, Stanford “doesn’t need to get onto the Sectra IEP to send an image to my Sectra PACS,” Womack explains. “They get onto their own image-exchange vendor’s cloud, load up whatever images Muir Health needs and over to the Sectra cloud they go. The studies hang out up in the cloud until somebody from my team goes into our Sectra cloud and pulls them down into our PACS.”

Much has been accomplished, although more remains to be done before every provider organization that could and should be exchanging medical images with Muir Health in this fast and secure way is doing so. For example, Womack wants Muir to be exchanging images with area heavy-hitters Kaiser Permanente and Sutter Health. And it’s in the works: The former is close to working out details on its main concern IT security, and the latter is actively shopping for an image-exchange solution, she says.

“These things are different in every hospital organization. It matters how their IT departments work and what they lock down or don’t lock down. We are all very different from one another,” Womack says. “I know how challenging it can be, trying to be able to interconnect with people, especially pushing vendor-to-vendor activities.”

Confident in her relationship with Sectra to help keep things moving forward, Womack expects that the day will indeed come when all Muir Health’s partners, neighbors and potential collaborators are exchanging images as seamlessly as would a single patient-care entity.

Quality, compassion and appropriate care

“Looking back over the past year, I think the biggest bang for our buck on the Sectra IEP has really been the improved patient care, the lack of repeat studies and the safety of not re-radiating patients,” Womack says.

In the past they’d get patient transfers from other hospitals and couldn’t read their images on the CDs, she explains. Or trauma patients would arrive with CDs that had been damaged, went missing or were unreadable due to proprietary design components. And so on. Whatever the details, the upshot would be Muir’s having no choice but to re-image the patient.

Another problem solved: Hospitals are needlessly transferring patients to Muir Health with far less frequency. “Today a hospital will call and tell us they need to transfer a patient to Muir Health,” Womack explains. “And now my transfer center will request the images,” which a non-partner hospital can do upon Muir’s simply sending an upload link. “By reviewing the images before the patient is transferred, we’re able to evaluate the criticality of the potential transfer. Perhaps the patient is more stable than they thought and transferring would not add anything clinically significant to the patient’s care.”

Such appropriate-utilization decision-making is right for the patients and their loved ones as well as the care system, Womack notes, as avoiding transfers generally translates not only to cost control but also to improved patient and visitor experience.

It also accords with Muir Health’s stated mission to improve the health of the communities it serves with quality and compassion. As does the institution’s decision to expand its relationship with Sectra. In January, Muir Health decided to acquire and install a Sectra cloud-based archive for enterprise imaging.

“I’m very proud about how far we’ve come with image exchange over the past year,” Womack says. “By the end of this year, I would love to be able to use the Sectra IEP to exchange radiology images with Kaiser and Sutter Health.”

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