A Tale of a Two-Brained Beast: Part 2

Why an IHR should be an equal partner to the EHR

Scene from the movie Pacific Rim. Source: Warner Brothers

In our previous installment, we drew a parallel between Guillermo Del Toro’s Pacific Rim sci-fi epic and the chronic struggle health systems go through to ensure their IT enterprise runs smoothly. In our analogy, the Two-Brained beast is the Jeager, a beautifully interoperable robotic beast designed to fight off increasingly giant and powerful Kaiju rising from the depth of the Pacific Ocean.

It’s easy to see the parallels between this epic tale of fiction and the IT reality facing health systems: in theory, there is a primary pilot – the EHR, and a fully integrated secondary pilot just as crucial to the accuracy of the EHR records – the IHR (Imaging Health Record). In the aggregate, all things imaging represent a complex ecosystem in and of themselves.

Scene from the movie Pacific Rim. Source: Warner Brothers

Unfortunately, at least for now, this scenario will remain in the realm of fiction, both on screen and in health IT.
EHRs are not and should not attempt to be IHRs. Cerner introduced a valiant but failed effort in Camm, the Cerner PACS that is only available to Cerner Millenium EHR customers. To this day, Epic and MEDITECH, two of the most notable EHR names, only provide RIS modules and deliberately avoid developing or owning PACS or VNA solutions. Why do they stay away? It’s pretty simple and quite smart: they choose to stay in their lane and leave the imaging headaches to the hundreds of imaging IT vendors struggling with one another for interoperability and the attention of healthcare providers

Europe More Likely To Adopt IHR

Since publishing the first installment of this blog, I’ve had the chance to float this idea of the IHR as an equal partner to the EHR with various healthcare leaders, both in the US and Europe. European health systems are more likely to embrace this evolutionary concept, mainly because European countries have centralized, government-run healthcare systems. Conversely, it seems that admitting the equality of imaging relative to the EHR is a bit of a reach for US-based healthcare systems.

Intuitively, the concept of an Imaging Health Record being an equally important partner to the EHR is logical and easy to accept. So why is this such a difficult concept to embrace in the US? The simplest explanation is usually correct: Occam’s razor to the rescue.

Occam’s razor is a principle often attributed to 14th-century friar William of Ockham, saying that you should prefer the simpler one if you have two competing ideas to explain the same phenomenon. Source: New Scientist

Private enterprise is king in the US, where government healthcare is only partially natural in the military and the VA system. Wall Street typically makes health IT investments in the US, bottom-line oriented enterprises such as IDNs and payors, not government entities with accountability to taxpayers.

Caught in the EHR Spotlight: Why Imagining IT Plays Second Fiddle in Healthcare Investments

What does the public vs. private healthcare debate have to do with embracing the concept of the IHR (Imaging Health Record)? It’s all about the immense and disproportionate investment healthcare providers make in monolithic EHR vendors. It’s simply challenging to admit with a straight face that a billion-dollar EHR budget is justifiable and that everything else in Health IT, especially imaging, has little to no investment dollars left to receive in the current fiscal year or the next few. A hospital board may not blink when spending a billion dollars on a new EHR.

Still, when it comes to investing in the imaging enterprise, very few visionary organizations can look beyond the sheer size of investment made in the EHR and admit that perhaps other parts of the organization deserve consideration. In our years of experience as an enterprise imaging vendor, any other IT endeavor outside the EHR becomes a second thought, mainly because perception is reality. EHRs have succeeded in positioning themselves as the top dog and have created the illusion that any other health IT solution should play second fiddle to the EHR.

To support this point, I recently witnessed a visceral reaction from a hospital executive, who scoffed at the idea that the imaging enterprise was anywhere near as critical as the EHR. If you spend all your money on the EHR, and there is little left in the fiscal year’s budget to improve imaging IT, it’s difficult to argue for the importance of imaging because there’s nothing left to invest.
In a previous blog post, we referred to a familiar storyline: we’re implementing Epic, don’t talk to us for another couple of years. It’s like going on a speleological expedition and expecting not to emerge from the project for years; this is not an accident. By commanding such a high-dollar investment on the part of the provider organization, you’re also controlling the vast majority of their attention precisely because of the sheer size of the investment.

Imaging IT continues to operate stoically, a la McGyver, struggling with chronic interoperability and integration challenges. The Imaging Health Record (IHR) aims to create a new consciousness about health IT by introducing an alternate way of thinking. The patient record and EHR are symbiotic partners with the imaging enterprise and, therefore, incomplete without imaging. This reality logically makes the EHR and the IHR equal partners.

Photo of actor Richard Dean Anderson who played MacGyver in the television series. Source: ABC

The sheer number of imaging-related AI algorithms produced vs. AI aimed at the EHR further highlights the painful cultural gap between the EHR and the imaging enterprise; this gap will only continue to widen unless imaging vendors begin to act cohesively together as members of the IHR.

The concept of an Imaging Health Record (IHR) as an equal partner to the Electronic Health Record (EHR) is crucial for healthcare IT advancement. However, the US healthcare system’s disproportionate investment in EHRs and limited focus on the imaging enterprise present challenges. The perception that the EHR takes precedence, reinforced by substantial financial investments, hinders recognizing and allocating resources to imaging IT. As a result, interoperability and integration challenges persist, leaving the imaging enterprise to operate independently, relying on limited support, and finding creative solutions a la MacGyver.
A shift in mindset can bridge the cultural gap in the US. It requires healthcare stakeholders to acknowledge the significance of imaging, allocate resources, and prioritize investments in imaging IT. Collaboration can achieve comprehensive patient records, improve healthcare outcomes, and create a more integrated and effective healthcare system.
When vendors, healthcare organizations, and government entities are aligned, we can expect a healthcare IT ecosystem to maximize the potential of EHR and IHR. Until then, IHR will remain fiction.