Healthcare Software

What Lessons does DICOM have for EMR Deployments?

With the push to move to electronic medical records, it is important to note the high risk for healthcare institutions to adopt them. It is also necessary to be able to gauge how EMRs will evolve over time and the challenges they will face. Interestingly enough, the DICOM standard has been going through the same pain points that EMRs will face for over 20 years and as a result provides a treasure trove of experience from which EMR development can only benefit. Medical images have already gone through this transition from analog to digital and faced greater challenges in terms of storage requirements and available technologies.

What is DICOM?

For the readers unfamiliar with DICOM, it is a standard for the transfer, storage and display of medical images. Information about the image is embedded directly into the image file ensuring that its context is never lost. From its beginnings in the 1980s, it has evolved over time and devices have progressively adopted the changes. Current medical devices need to support current and past versions of the standard in order to be able to interoperate with other devices or systems which may all speak a different version.

What has DICOM taught us?

• Publication of standards allows different vendors to exchange data in a meaningful way.
• Data capture should be analogous to taking a picture. It should retain:
  • What is captured
  • How it is captured
  • For whom it is captured
  • When it is captured
  • The standard the capture adheres to
• Proprietary data fields are problematic but will be needed until standards evolve.
• Backward compatibility for standards is important, especially given that the lifecycle for medical deployments are very long.
• Both analog and digital versions will need to coexist until adoption covers all modalities and all analog images can be converted into digital format.
• Having digital versions of files improves accessibility and alters workflows.
• The amount of time needed before the standard stabilizes is long and changes with new technologies.

What should change about how EMRs are built and deployed?

There should be a focus on developing standard data sets and clinical reports. Although there is much work being done in developing general standards, like CCD, more effort is needed to develop specific implementations of it for specific reports, rather than a single solution for all. An example could be a report generated for a cardiac exercise stress test. Right now it is at the discretion of the vendor and usually not very well done. Hospitals circumvent these and produce their own formats. The result is that patients do not get a consistent view of the data results or the medical interpretation. With established standards, the specific vendor would not influence the output—their time is better spent on improving the data capture portion anyway!

As new best practices or approaches are adopted, changes to the standards can be made. Report writers would then be updated to support the new version while viewers would have to support both versions. When a vendor creates a new data capture application, they would also have to develop and update the standard so that the EMR would be able to support it.

Conclusion

The DICOM standard should be viewed as an example of successful application of IT in healthcare and EMRs should adopt the same approach so that 10-20 years from now it will achieve the same level of meaningful integration into hospital processes.