While some organizations are still struggling to implement electronic health records (EHR) or even computerized physician order entry (CPOE) HealthPartners (St. Paul, Minnesota) is way ahead of the curve, now one of the first organizations in the country to integrate electronic X-rays, MRIs, CT scans and radiology reports into patients' EHRs.

In addition to reducing radiology report turnaround times from two days to four hours, the organization's overall efforts to eliminate paper and film and evolve into a complete electronic reporting environment have yielded an estimated $14 million in savings for the health plan since 2007. But that's a drop in the bucket compared to the resulting everyday efficiencies and patient satisfaction.

"We've had a radiology information system – PACS (picture archiving and communication system) – in place for quite some time that was standalone and separate from our EHR," Kim LaReau, VP and chief information officer at HealthPartners' Regions Hospital told Medical Device Daily. "In 2006 we put the radiology report in the EHR with a link to images. The final phase was replacing the radiology information system and looking at whether or not there was value in having an integrated system. We chose to move forward with Radiant Radiology Information System from Epic (Verona, Wisconsin). As part of that process, we looked at what efficiencies and economies we could get."

Although LaReau works at Regions, this step to digitize radiology records is part of a massive ongoing effort by HealthPartners, which is both an insurance plan and a group of healthcare facilities, including Regions and 25 clinics.

The time savings produced by integrating X-rays and radiology reports into EHRs is especially significant given the fact that HealthPartners Clinics and Regions perform about 34,000 radiology exams every month.

Part of the solution was to also install, PowerScribe, a web-based speech recognition reporting solution from Nuance Healthcare (Burlington, Massachusetts) that eliminates the need for transcription, producing a savings of $130,000 per year on expenses to transcribe radiologists reports.

LaReau explained that radiology services were still very paper-oriented. A piece of paper flowed through the department and that's what drove the workflow for a radiology image.

"We wanted to eliminate the paper process," she said. "We also looked at the radiologists; they had a need to look at the clinical record, to be able to work off a radiology work list and to dictate and transcribe."

The process to move HealthPartners wholly from paper to screen started in 1997. The big EHR rollout came in 2003. CPOE was implemented in 2006.

But the clinics didn't have PACS and that was implemented in 2008, bringing all parts of the organization into one central system.

"We've been in the process of optimization since then," she said.

Although every HealthPartners location still does not have every element of all of the systems implemented, the process is moving forward.

"Whenever you have to connect disparate technologies it's always a challenge in getting them to work appropriately," she said. "It's easy to have multiple versions of the truth out there when sending information back and forth."

To make the connection between all of the different facilities, a software program was created from scratch, built by a vendor.

Other challenges involved changing the workflow within departments.

"Technologists and radiologists were learning a new work flow; it was a big cultural challenge that involved lots of training. People were very involved in the development of the new workflow and design sessions," she said.

And when it came time to go live, the IT department provided what LaReau calls "at-the-elbow support 24/7. We also ran a large command center to take challenges and questions by phone. Certain people get in the groove fast, but for others it took months."

Now, instead of being cued to read a film or act on an order by paper, the prompts come electronically.

"An order is placed and they go into cues," she said. "Technologists look at those and they are prioritized depending on the urgency of exams. They constantly monitor those cues. Once an exam is completed it goes to a radiologist's cue. As they pull an item off their PACS read list, it simultaneously launches the EHR for them. It also pulls up images and then they hit the button for dictation. At that point they can send their report to a transcriptionist or they can self-edit and complete the document. It also files a copy in medical record."

The team at Regions affectionally calls these multifunctional radiology workstations "Star Wars."

She said that having access to imaging reports sooner has been a "patient satisfier" and has allowed the organization to handle more patients.

They've also eliminated the cost of film storage – a $300,000 per year savings.

"The health plan recently implemented decision support for diagnostic imaging so volume levels have been greatly impacted by high-tech imaging," she said. "If you look at national statistics on things such as MRI, volumes for MRIs have exploded. The question is, are all of them necessary? The American College of Radiology has developed guidelines on necessity for images. So decision support was built into the system. Based on that, our volumes of MRIs have decreased."

LaReau concluded by saying all of these advances at HealthPartners fit with healthcare reform.

"It's about having the right information on hand. If a patient shows up in the ER, you know their medications, problems, history, and you don't have to start from scratch," she said. "This just ensures that whole continuum of care by following the patients throughout an integrated system."

She estimates the radiology project cost $1 million.

The organization is now simultaneously focusing on medical device integration directly into the EHRs.

"What we're trying to do is to reduce the onus on the clinician to have to enter information into the EHR," she said.

Lynn Yoffee, 770-361-4789; lynn.yoffee@ahcmedia.com