From diagnosing disease and documenting abnormalities to guiding treatment and interventions, healthcare providers view, use and manipulate images to help illustrate and better understand a patient's clinical journey. In today's healthcare landscape, multi-media content has increased in both importance and spectrum of use; be it with mobile devices, scope cameras, ultrasound, or various other modalities at the point of care, more and more medical specialties use some form of imaging in their practice.
While many healthcare organizations are leveraging enterprise imaging initiatives to optimize the capture, management, storage, and distribution of multimedia content, the lack of systems and workflows necessary to access and view images have presented challenges for traditional and "non-traditional" services alike.
These areas include:
In this article, we will outline the differences between an encounters-based or orders-based imaging workflows and address some of the common challenges and solutions to optimizing imaging procedures from an enterprise-wide approach.
Encounters-based imaging is performed during a patient's appointment or procedure -- when content acquisition is not the initial purpose, and therefore imaging is performed with no prior indication. Encounters-based imaging often is used to complement other medical documentation associated with the patient's visit/procedure, such as progress notes, and may be referenced by medical professionals during follow up appointments, surgery, or additional diagnostic exams.
In contrast, orders-based imaging follows a more traditional approach; where an order placed in the source information system makes an imaging request to a different department, specialist, or location. A physician, for example, will place an order/request imaging from radiology, who fills the order and returns it to the physician.
Regardless of an organization's enterprise imaging strategy, orders-based and encounters-based image storage and management workflows both utilize a standards-based methodology to achieve similar goals.
Outlined below are some of the key elements of this methodology:
Identify all images associated with a patient/care event.
Associate images with a patient encounter, typically through a modality work list or patient schedule. By leveraging an EHR integration, associate images are much easier to capture, index, and access.
View images within or directly from the EHR, with an attached note describing the visit where the images were obtained in the enterprise viewer.
Again, the EHR integration simplifies this process by adding a link to the patient’s images inside the patient encounter.
It is important to note that the patient’s images are not stored in the EHR but instead are accessible in the PACS/imaging archive along with the rest of the patient clinical images.
Manipulate image data if necessary for the use case.
Efficiently identify the type of imaging performed, as well as the anatomical region described in the EHR description.
While both workflows share common goals, there are many differentiators between encounter-based and orders-based imaging workflows. Regarding the impact on user workflow, we've outlined the most notable considerations and implications of orders-based and encounters-based imaging.
Impact to User Workflow
Imaging that needs to be acquired during a clinical visit or associated with a specific procedure is both inefficient and unintuitive for the clinician who requires order-based imaging.
Specialties such as dermatology or wound care might require multiple imaging orders to differentiate varied body parts and evaluate multiple anatomic locations. The problem is that the body parts that need to be imaged are rarely indicated prior to the clinical visit which negatively impacts the order-based workflow.
On the other hand, encounter-based imaging that is integrated with the EHR allows you to optimize that workflow for the user. With the EHR integration, you are able to capture and archive these images at the point of care. Additionally, you are able to select the body part from a body map to add to the images meta data, organizing the images almost instantaneously.
The Required EHR Build for Order-Based Systems vs. Encounter-Based
One key differentiator between pre-procedure orders vs. encounters-based image management is the size of the EHR build required.
In an orders-based system, the EHR build has to be significant, able to accommodate orders and different pieces of specific information, including procedure dictionary and maintenance concerns.
In encounters-based image management, the EHR build doesn’t need to be as significant because the integration allows providers to host the image outside of the EHR.
Defining Procedures and Body Parts for Imaging
The final difference between order-based and encounter-based imaging involves defining the procedure or the part of the patient’s body that will be captured before imaging is performed. In an orders-based system, this is inherently a part of the scheduled workflow. In today’s healthcare landscape, however, medical imaging performed outside the context of an ordered procedure has significantly increased.
An encounters-based system ensures that images acquired during a patient encounter are combined with the associated metadata about the patient, the encounter, and the performed imaging procedure. The encounters-based workflow facilitates imaging/data management; not only linking the captured content to the patient’s medical record and related data, but also creating relevant, easily accessible indexing fields that seamlessly integrate the images with archives and medical records.
ImageMoverMd integrates encounter-based imaging solution deep within the EHR, giving users ready access to meta-data and patient records/archives at the point of care. Further, with access to a full body map diagram, providers can instantly choose the location of the required image and view the associated patient information; this reduces imaging record silos, streamlines navigation/differentiation of multimedia content, and increases the efficiency of the encounters-based workflow. When encounters-based image acquisition solutions are not thoroughly integrated, however, the efficiency and quality of care can be negatively affected.
Searchability of EHR Content
All too often, prior exams are vastly under-utilized. Inefficient imaging workflows create roadblocks for physicians; delaying their access to previous imaging procedures taken from external sources or other specialties. The ability to quickly review and evaluate patient history information and prior imaging procedures is immensely important. Take mammograms, for example: one of the most prominent breast cancer indicators is drawn from the growth of mass comparison between past and present mammography imaging procedures.
By integrating an encounters-based imaging solution deep within the EHR, physicians can achieve greater “search-ability” — and access past images and specific patient documents during an encounter. Further, EHR integration employs enterprise-wide search-ability, bridging the gap between departments and specialties so that information can be readily shared, viewed and exchanged.
Further facilitating search-ability, ImageMoverMD’s imaging platform allows clinicians to not only access patient records through the EHR, but also pull in the appropriate meta-data so they can easily search for a patients previous imaging procedures. The integration of EHR, PACS/VNA has paved the way for more efficient image interpretation.
While orders-based systems have traditionally made well-use of technology and offered a more refined workflow, they can also create challenges for those areas of treatment that are unpredictable and more encounters-based. On the other hand, encounters-based workflows are highly intuitive, and when integrated with the EHR, can make image storage, sharing, and access more holistic and optimal for providers and patients alike.