Synchronizing EMR and PACS

September 25, 2014
By Cree M. Gaskin

Synchronization of the EMR and PACS so that both simultaneously display information on the same patient can enhance patient care by creating an environment in which radiologists have a more holistic view of the patient while simultaneously enabling efficient sharing of information between referring physicians and radiologists.

The groundwork for this improved interaction is the growing use of EMRs in physicians’ offices, imaging centers, urgent care facilities and hospitals of all sizes—driven in part by Meaningful Use legislation.

Broader use of EMRs has led to sharing of more comprehensive electronic information about patients. Prior to EMRs, I would routinely read imaging exams knowing only the age, gender and maybe a phrase of clinical history of each patient. Now I have access to each patient’s full medical record, including pre-filtered, boiled-down data relevant to me, when reading an exam.

Providers often order imaging studies electronically, which enables them to quickly input information from their evaluation of the patient. In the past, an order might say “man with hip pain,” whereas now the content is more detailed such as “48-year-old man with hip pain, subjective fever and marked increase in pain over the last two days.”

Communication between radiologists and other physicians is also improved. I might read an outpatient exam and see a major unexpected problem, such as metastatic cancer in a patient presenting with low back pain. I can add a personal note to the report that says “urgent – unexpected metastatic disease.”

This note is flagged by the EMR as an MD to MD note. It grabs the attention of the referring provider when he logs into the EMR and I can see when the provider has read my note. This closes the communication loop and I know the patient is being taken care of. If my note is not viewed in a timely fashion, perhaps due to a vacation or meeting, then I will contact a different physician at the provider site to make sure they know about this patient’s scenario.

Another example of improved communication is a case where a patient presents in the ED with an ankle injury. The ED physician looks at the X-ray, believes the ankle is sprained, marks this in the EMR and initiates discharge orders. The radiologist detects a fracture — and marks his diagnosis as a discrepancy in the EMR. This discrepancy creates a flag in the record, which is seen by the ED nurse who then halts the discharge and holds the patient for needed treatment.

The ability for radiologists to deliver reports with an embedded image is another important capability available with some PACS and reporting systems. An image can be more powerful than a few sentences in a report, and many referring physicians appreciate seeing an image that depicts the diagnosis. Embedding one or more key images in the report also may prevent the need for a physician to log onto the PACS and view the entire imaging study.

Streamlined workflow eliminates logging into multiple systems
Achieving a streamlined imaging workflow requires synchronization of patient context between the EMR and PACS.This eliminates the need for radiologists and other physicians to log onto multiple systems and duplicate patient searches — which is impractical within the pace of modern health care delivery.

If a facility has an EMR-driven workflow like ours does, the radiologist is always in touch with the patient’s electronic chart. Facilities with a PACS-driven workflow (which is much more common) need to synchronize the PACS with the EMR. Either way, the EMR must be open when the radiologist is reading the imaging study to gain the benefits described above.

Health care facilities with EMRs and PACS systems need to optimize their investment in technology to establish an efficient way for physicians and radiologists to communicate with each other that both boosts productivity and helps enhance patient care.

About the author: Cree M. Gaskin, M.D., is an Associate Professor of Radiology, Medical Imaging and Orthopaedic Surgery and Vice-Chair of Informatics for the University of Virginia Health System.