With little fanfare, the ACVR recently adopted a petition to sponsor a veterinary segment of the IHE in an effort to foster the development of open methods of data exchange in veterinary informatics. It is the opinion of DVMinsight that full adoption of open standards for veterinary informatics is essential. In the short term, veterinary radiologists may be the group that stands to benefit the most from the adoption of the IHE and open standards. At the risk of overstating the issue, the formation of a veterinary branch of the IHE may prove to be THE development that allows the independent radiologist to remain relevant in the future.
Why you should care
Open standards allow for the uninhibited information flow between disparate computer systems. Radiologists understand the value of open standards as our profession relies on the DICOM standard. Because DICOM is ubiquitous in veterinary radiology radiologists can receive images from any veterinarian and use any DICOM viewer to view images from their referring veterinarians. It is because of DICOM that digital radiography vendors cannot “control” teleradiology, limit which radiologists read images from which clinics, or charge radiologists “gateway fees” to read images from different systems.
In the near future, however, the uninhibited transfer of image data from a veterinary practice via DICOM will not be sufficient to allow radiologists to compete in the realm of veterinary teleradiology. As veterinarians are progressively moving toward a paperless practice and efficiency in the practice is paramount, the uninhibited transfer of radiology reports and automated billing will become as important as the transfer of images data and a prerequisite for any radiologist working in teleradiology.
Without the ability to automatically and efficiently deliver radiology reports to practice management systems and allow for a method of automatically billing for teleradiology cases, the independent teleradiologist will become irrelevant and forced to work for entities who are able to deliver reports in an efficient manner.
Currently, all methods of report distribution and automated billing are proprietary schemes and bridges made between equipment vendors, teleradiology companies, and practice information management systems (PIMS). It is clear that without an open standard for information exchange in veterinary radiology, despite our best efforts at ensuring that DICOM allows veterinarians to send images to whatever radiologists they want, it is the PIMS vendor that will be the gatekeeper for teleradiology in the future.
Evidence that efficiency will trump quality or cost
Although there has been no large study defining the issue, it is the distinct opinion of DVMinsight and Animal Insides that veterinarians are making purchasing decisions based on efficiency as much as quality and/or cost. The following are two examples. There are many others.
As a first example, we were recently working with a veterinary practice that used a local lab service for their blood work. This busy practice did approximately $9000/month in lab services. They recently switched to a PIMS that had a proprietary association with an outside lab service that allowed for automated billing for lab services and automated report integration into the patient record. Despite the fact that the veterinarians wanted to continue working with the independent lab, the lab did not have a method of efficiently distributing reports into PIMS so the veterinary practice switched labs to a service they consider to be inferior AND more expensive.
As a second example, I have numerous veterinarians who purchase digital radiography systems from vendors based on which PIMS they have. In many cases, this is the ONLY consideration despite the fact that these systems cost several thousand dollars more at the time of the purchase and thousands of dollars over the course of the life of the system to maintain AND the images quality from these systems may not be as good as other systems. Nonetheless, these costs and deficiencies are outweighed by the efficiency of automated billing and the hope of fewer lost charges.
Given that teleradiology services are an ancillary service much like a traditional lab service and radiology reports are simply an additional data set that veterinarians must integrate and assimilate efficiently into practice management and it has already been proven that veterinarians will spend more for services that they would otherwise not purchase in an effort to create efficiencies at the practice, it should be no surprise that PIMS (not DICOM or the digital radiography vendor) is the future gatekeeper to an open and competitive teleradiology marketplace in veterinary medicine.
An introduction to the IHE and some challenges to come
Integrating the Healthcare Enterprise (www.ihe.net) is a human side organization that seeks to define ways that information can be exchanged openly and independently in human medicine. The IHE, however, is not a standards development organization. Rather the IHE determines how to use existing standards to move data between computer systems. As an analogy, if information was an automobile, the IHE does not build the car. Rather it makes the rules about how we drive (e.g drive on the right side of the road, use our turn signal before turning etc.).
In order to accomplish this goal, the IHE will define a “profile” the defines how standards to use to transfer a given type of data between different computer systems. The IHE also holds connect-a-thons so vendors can demonstrate their compliance with the IHE profiles.
It cannot be overstated that the integration and adoption of an IHE profile for radiology reporting exchange (or any IHE profile for that matter) will be significantly more labor intensive than the adoption and implementation of DICOM in veterinary medicine. For the most part, DICOM was the de facto standard for imaging (so there was little choice in which standard to adopt), DICOM is well defined and easily implemented, and modifying the DICOM standard to suit veterinary applications was straightforward as it only required the addition of a few veterinary attributes.
The situation for the adoption of an IHE type profile for radiology reporting will be anything but straightforward. For example, we must first decide which standard to use (there are a number of options), we must define what should be included in a radiology report, decide how the information is moved across the internet (again, there are a number of ways), and then PIMS vendors must adopt the integration profile (unfortunately many veterinary vendors are not familiar with HL7 which will require investment on their part).
Despite the obstacles – the future is bright.
Despite the obvious obstacles to the development of a veterinary radiology reporting profile, the move by the ACVR is a positive first step. Moreover, there is a convergence in the industry as many of the large players have grown to understand the importance of open information exchange. These vendors are now working together to put the pieces in place that will allow for the development of a method of open radiology reporting. Ultimately, this will help ensure the relevance of the independent teleradiologist and an open and competitive teleradiology marketplace for the veterinarian.
In the future, PIMS vendors who fail to adopt open methods of information exchange will become irrelevant. The development of open methods of information exchange may prompt industry consolidation in the PIMS market as veterinarians move away from PIMS that only support older (closed) methods of information exchange.
Radiologists using the DVMinsight PLATFORM should be assured DVMinsight PLATFORM will fully support the new reporting profile once it is established.