Radiologists recommend the PES approach
Our top story this week on Pulse+IT was about the submission by the Royal Australian and New Zealand College of Radiologists (RANZCR) to the Australian Digital Health Agency's (ADHA) current consultation on its interoperability roadmap.
While the submission concerned the Australian policy climate, there are some very interesting ideas within it that have relevance for both the Australian and New Zealand healthcare systems and deserve serious thought.
The college has put forward five priority areas for the discipline when it comes to digital health that we think should be pursued, including eReferrals, standardised terminologies and order sets, imaging guidelines and decision support for requesting doctors, access to historic images, and artificial intelligence.
Unlike the pathology sector, referrals for diagnostic imaging in the private market in Australia are still very much dominated by paper, with eReferrals still in their infancy. The college would like to see an end to this and released a position paper in September last year which strongly endorsed a cloud-based electronic referral exchange approach rather than point-to-point referrals as done in pathology.
The system the college envisages is similar to the two electronic prescription exchanges, eRx and MediSecure, used for the electronic transfer of prescriptions in Australia. As is the case now for prescriptions, the patient would be handed a piece of paper with a barcode on it but at the same time, the script or referral would automatically be uploaded to a virtual exchange from practice management systems. It would then be accessible electronically by scanning the barcode at the imaging centre.
Like pharmacy, this would ensure the principle of patient choice of provider is retained, and it would also smooth the transition to a fully electronic system as it would allow practices that don't currently have an eReferral capability to continue on paper as usual. Eventually though, the need for a paper referral will lapse as the whole system goes digital.
This approach has a huge amount of merit and would also smooth the transition to imaging reports being uploaded to the My Health Record in the private sector as the patient and requesting doctor identifiers would be electronically transmitted. There are already a number of radiology practices connected to and uploading to the system now, but the college sees eReferrals as a way to make the MyHR much more widely used.
Like pathology, the diagnostic imaging sector also sees the need for a common terminology standard and the development of an ‘orderables’ catalogue. The college sees this as not just a key building block to ensure consistency in referrals to radiology, but a foundational element for other digital health projects. Allied to this would be some agreed imaging guidelines and clinical decision support tools to help improve the appropriateness of referrals from requesting doctors.
Then there is the question of access to historic images. The college agrees that there are multiple stakeholders who would benefit from access to historic images for review and comparison, including requesting specialists and clinical radiologists themselves. Easy access might also cut down on repeat ordering of examinations.
This is something that RANZCR and the Australian Diagnostic Imaging Association have wanted going back to going back to 2012-13, when the two organisations first developed a roadmap to support image sharing by clinicians across different health providers. However, as the college points out, at that time the costs of establishing the IT system were prohibitive, not seen as a priority for the government and was subsequently not progressed.
These days, however, it is the done thing to provide online access to images through portals rather than film or CD, and patients also have apps like My Film Bag that allow patients to control their images and give access to them to their specialists.
As the college argues, a shared system would also lead to a reduction in repeat referrals due to difficulties in locating prior images. The college also sees value in using the My Health Record as a platform to direct the clinician to that patient’s historic data. Just like adding a hyperlink to Lab Tests Online in a pathology report on the My Health Record, a link to the image could be added to the radiology report, although a method of authentication to access the image in private portals will still be required.
We think these are all pretty good ideas, but not so hidden in the college's submission is criticism of what it perceives as a lack of engagement with the sector from ADHA. We're not sure whether the college is being a little precious or if it has reason to be miffed, but the submission itself argues quite strongly for a shared vision for digital health beyond the My Health Record, which can then be worked into funding proposals for state and federal governments.
There is some real worth in these proposals and we'd been keen to hear what you think.
That brings us to our poll question for the week: is a system that allows access to historic images worth publicly funding?
Last week, we asked: Will Sonic Healthcare's connection to the My Health Record spur greater use of eOrders? A clear majority agreed, with 63.5 per cent saying yes and 36.5 per cent saying no.