The Impact of CDs and Image Sharing on Radiology Kang Wang Ph.D, CEO, HealthFortis Amy Vreeland, SVP Strategic Accounts, lifeIMAGE 9/24/2013

Agenda Value of Clinical Decision Support Value of Image Exchange Power of the two systems working together

It’s also a Patient Safety issue “… just from overuse of CT, will result in 12 preventable radiation-induced cancer deaths a day”* "A 20-year old woman who gets an abdominal-pelvic CT scan (i.e., just about any young woman coming to the ED with belly pain) has a 1 in 250 chance of getting cancer from that single scan.“** *Robert Stern, Patient-centered imaging, Am J Med 2012; 125:115 **Dr. Rebecca Smith-Bindman - professor of Radiology, Epidemiology, and OB/GYN at UCSF in http://community.the-hospitalist.org/2011/02/11/a-game-changing-statistic-1-in-250  

Current solutions and their problems Speed bumps RBMs Referral pre-authorization Claim analysis and provider profiling Problems Human intensive Trying to change decisions that are made Little physician involvements No consistent evidence based decision making No financial incentives for physicians

Decision Support at the point of Decision A better solution A better solution Decision Support at the point of Decision Clinical Decision Support (CDS) Order Entry System Integrated with EHRs

Proactive vs. Passive CDS Proactive Decision Support Decision support BEFORE the decision is made Symptom/Diagnosis driven decision support Change of the current CPOE order workflow More effective: the right exam is the easiest to order Passive Decision Support Judgment AFTER the decision is made Procedure driven decision support Keep the current CPOE order flow, add a CDS step after order submission Less effective: physicians don’t like to be judged

CDS: What to look for EHR integration vs. stand along CDS order entry Comprehensive rule sets with option to customize American College of Radiology, ACC ODG Ability to set institution specific rule set Reporting Module: provides actionable information KB Editing Tool: can you publish your own guidelines? Cloud hosting vs. local installation

Integrated with physician workflow Tight integration with EHRs Single sign-on Patient context sharing Patient chart information passed to CDS Real time submission of the CDS result

Data Mining

Knowledge base editing

Cloud-based deployment model Centrally managed content Regular updates from content providers Multi-tenant system Each customer can subscribe to its preferred content or create customized content Centrally managed system Minimal client side IT requirements Frequent system updates

Trend of Order Distribution by Appropriateness Score System Adoption Trend of Order Distribution by Appropriateness Score

98% orders follow guidelines (up to 67%) System Adoption 98% orders follow guidelines (up to 67%) March 18th

CDS: demo

The Network of Networks Highest Ranking Providers 16 of 20 best Cancer 10 of 20 best Gastroenterology 10 of 20 best Gynecology 10 of 20 best Cardiology 10 of 20 best Neurosurgery 10 of 20 best Rheumatology 9 of 20 best Geriatrics 9 of 20 best Urology 7 of 20 best Pulmonary 7 of 20 best Orthopedics No.1 ranked hospitals in 18 out of 27 states & D.C. 561 M Images / 2.64 M Exams 205 hospitals - Connect to another 410 hospitals 35,000 users - 12,000 monthly active users Our customers represent 54.9 M outpatient visits/year 7.4 M ER visits/year 32.0 M radiology exams/year 85,000 physicians (12% of total)

A future proof platform for image sharing 5 Cross community sharing 4 Image enabled community & CDS 3 Managing connections 2 Referral workflow & publishing results 1 Outside exam ingestion Baseline: PACS and EMR is already in use with an existing enterprise viewer

Image-Enabled HIE Demo

Imaging Service Provider Site Health Information Exchange (HIE) Physicians access to priors, and relevant priors alert during an order Physician Office 1 HIE Portal Imaging Orders Imaging Results Community Patient ID Member ID (Patient IDs) & local MRN lifeIMAGE Imaging Results Physician Office 2 Imaging Orders Patient ID Registry Imaging Results Metadata Repository While most hospitals have mastered the exchange of images within their system, they still have issues with exchanging both with importing images from the outside and transferring images to referring physicians outside of the system. These issues are particularly acute for image intensive specialties. Most hospitals still lack efficient and effective solutions for importing images into their system. For hospitals that receive referrals from outside of the system, most images are received via CD. Outside CD studies can present significant issues across three key areas: workflow to import the image, image visualization, and data normalization for both use as well as importation into the PACS system. These issues can create clinical issues– for example with trauma transfers, where every second counts. It can also create administrative burdens for specialties that receive high volumes of CDs such as cardiology and neurology. Transferring results out of the system is similarly difficult. Most hospitals still utilize CDs given to patients to bring to their specialists. The issues that health systems face in getting these CDs into their system are also experienced by the referring physicians that receive these CDs– with the added complication of needed to rely on the patients to bring the CD to the physicians. These issues are most acutely felt by imaging intensive specialties. These physicians rely on imaging for their livelihood and are forced to resort to relying on patients or use of phones/faxes/mail and couriers to receive images. lifeIMAGE was founded on the premise that there needs to be a better way to exchange images. A way that is simple, effective and efficient to support the physician-patient relationship. As we have developed and refined our vision, we’ve expanded it. Reports & Thumbnails Imaging Service Provider Site HL7 Report RIS LILA C: Find PACS Image Metadata 19

CDS & Image Sharing Integration: demo

Thank You CDS can help to increase guideline compliance and reduce utilization Imaging sharing facilitates coordinated care delivery, reduces duplicated radiology orders, and provides meaningful Return on Investment An integrated CDS and Image sharing platform helps to improve patient and care giver experience with their radiology services