UNC Health Care

By integrating enterprise imaging with its EMR, UNC Health Care eliminated PACS, facilitated image exchange and created a true longitudinal patient imaging record

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The challenge

Based in Chapel Hill, NC, UNC Health Care , is a HIMSS Stage 7 validated provider in inpatient, ambulatory and analytics, and a national leader in healthcare information technology (IT). To achieve HIMSS Stage 7 recognition, the provider originally image-enabled its EMR by linking its PACS to the core clinical system. However, UNC Health Care soon realized this approach was insufficient. 

"We had 32 radiology and cardiology PACS in use throughout our enterprise and were inheriting even more imaging systems through facility acquisition," says Vineeta Khemani, Director of Information Services Division Architecture and Clinical Systems at UNC Health Care. "You could launch these multiple radiology and cardiology browsers from the EMR, but the experience was inconsistent. It was both departmental- and facility-focused. As the patient moved from one location to another in our network, the longitudinal patient record, from an imaging perspective, was lacking. This is a gap we needed to address." 

The disparate proprietary PACS meant a provider needed to burn medical images from a departmental PACS to a CD or DVD in order for those images to be shared with and viewed by a clinician in another UNC Health Care department or location.

Things got even more complicated when UNC Health Care ventured outside the core imaging areas of radiology and cardiology. Several specialty imaging systems (e.g. dermatology) were used and clinicians performed a significant number of point-of-care imaging procedures with no formalized structure or image retention policies being applied.

The solution

UNC Health Care believes images are a crucial extension of the patient record and sought to provide its physicians with system-wide access to these assets. It aimed to accomplish this goal by implementing a single clinical image repository and universal viewer that it would integrate with its EMR. 

“ Since 2016, we have eliminated nine PACS and three reporting systems, and we have six more planned for elimination in the coming months. This not only results in hard cost savings, but also reduces annual support and enhancement costs”

Vineeta Khemani , Director of Information Services Division Architecture and Clinical Systems UNC Health Care

UNC Health Care selected the Acuo VNA to serve as the provider's core image repository and the NilRead universal viewer. A phased ‘Go-Live’ began in May 2016. During each Go-Live, the PACS was unplugged and the VNA was installed as the primary repository for all patient medical images. This included not just radiology and cardiology DICOM images from PACS, but visible light, point-of-care and a variety of other non-DICOM images from specialty departments throughout the health system. The new, non-proprietary repository and the universal viewer were then integrated with UNC Health Care’s enterprise EMR, providing clinicians with a complete view of a patient’s entire image history from directly within this core clinical application.

In addition to providing access to images via the EMR, the new enterprise imaging solution offers a host of valuable information about the images as well. By hovering over image icons within the viewer, clinicians can see the type of study, when and where the image was captured and more. Additionally, with the universal viewer, images aren’t just accessible via the EMR, but also via a mobile app for convenient and secure remote viewing.

Perhaps the biggest benefit of the enterprise imaging initiative has been the portfolio simplification. “Since 2016, we have eliminated nine PACS and three reporting systems, and we have six more planned for elimination in the coming months,” says Khemani. “These are systems that we are migrating to the VNA and then shutting down. This not only results in hard cost savings, but also reduces annual support and enhancement costs.”

Notable patient-centered benefits have also been attained as a result of the enterprise imaging solution. For example, the tight integration between the imaging system and the EMR means CDs and DVDs no longer need to be burned in order to share images from one UNC Health Care facility with another. Instead, images are electronically available enterprise-wide in near-realtime, which accelerates physician consults and reduces instances of unnecessary repeat imaging tests.

Portfolio simplification:

  • Nine PACS eliminated
  • Six additional PACS to be decommissioned
  • Three reporting systems eliminated

Improved image sharing:

  • CD/DVD image transport eliminated
  • Physician consults accelerated
  • Repeat imaging tests reduced