Description
This requirement is for a system which enables electronic, bi-directional exchange of radiology imaging exams and reports with commercial healthcare facilities providing services to VA patients. The Mission Act has made it possible for Veterans to seek diagnostic imaging services outside of the VA. As a result, diagnostic results, which are in the form of DICOM images and textual reports, need to be couriered back to the VA for further patient care. As it exists currently, CD-ROMs and DVD-ROMs are hand-carried or mailed to and from the VA at the completion of a diagnostic test; this causes bottlenecks and delays in the continuity of Veteran care. There has also been a delay in archiving the images, delivered to the ordering provider by the patient who diligently obtains the requested images from the outside provider on a CD-ROM. The VA relies on CDs to share imaging examinations with community care providers, but examinations are often repeated when CDs are not requested, get misplaced, or are not “readable” due to software incompatibility or because the commercial facility does not accept them due to security concerns. CDs and repeat imaging costs the VA an estimated $163-181 million per year, nationally. But more importantly, the Veteran can be harmed when previous examinations are not available: delayed diagnosis of cancer, aggressive and needless workups, and increased radiation exposure. Medicom’s Imagex deploys a proprietary peer-to-peer network that would give the United States Department of Veterans Affairs Hospitals the ability to electronically exchange data with the community. In so doing, Medicom’s Imagex would minimize delays in the delivery of care and reduce the operational costs associated with seeing a Veteran imaged outside of VA under the Mission Act. By using the unique peer-to-peer secure network technology provided by Medicom, the VISN 23: VA Midwest Health Care Network would be able to, in effect, retrieve the requested images from our community providers electronically, saving the time and cost of using courier services to transport the CD-ROMs to the Radiology File Room. The Medicom Imagex technology is TRM approved and hence does not require completion of the form 6550. The required services must integrate with VistA Imaging Importer, Visage PACS, VistA Imaging, Computerized Patient Record System (“CPRS”), Laurel Bridges’ Compass DICOM router or any other DICOM router provisioned by the VA, and Cerner which will be implemented in the future. The Radiology department currently uses software to import images from CD-ROMs received by the VA. The current importing process, which uses VistA Importers allows the user to select either a CD-ROM or directory on the workstation containing DICOM images and import them to VistA Imaging and Visage PACS. The acquired network services must ensure the VA can continue to save these images to Visage PACS and to VistA Imaging. The acquired services must authenticate and validate bi-directional, electronic exchange of DICOM images, Radiology reports, and Radiology orders using a FIPS 140-2 validated cryptographic methodology. The service must allow the Radiology department to search the commercial imaging providers located within the VISN 23: VA Midwest Health Care Network service area, locate prior medical images and reports, and retrieve them to the VA where they can be inducted to VA systems using a quality assurance step. In addition, the system must automatically match patient IDs to update the patient’s MRN # with the VA’s MRN #, when possible. Further, the system must generate a non-VA order through VistA Imaging in CPRS and update the inbound studies with the VA accession number for reconciliation in Visage PACS. In some cases, these studies may be stored through Compass DICOM Router. The acquired services will directly increase the workflow for importing Radiology exams into VistA Imaging and Visage PACS – the process will occur as follows: Receiving Information at the VA A one-time setup is initiated, and a trust with various permission sets is formed with outside facilities through the system. The system can have an unlimited number of trusted connections to the private sector through this single acquisition and through a single MoU/ISA with the service provider. A query or request will be initiated by the VA through the acquired system: This query can be end-user initiated or initiated automatically by the acquired system based on an upcoming appointment, a care in the community consult, an upcoming Radiology procedure, or an admittance to the hospital. The query is broadcasted to the entire community of providers participating in the health information network. The prior medical images and reports are located at outside facilities. The images and reports are retrieved from the outside facility using DICOM, FHIR, proprietary APIs, HL7, and other methods which are available in a web-portal. The images and reports are sent through a one-time-use conduit negotiated through the internet and terminating through a Site-to-Site VPN with the TIC. The images are downloaded to the local system at the VISN. The local system attempts to match the correct patient demographics, update the patient ID, generate an order, and import the studies and reports with the VA MRN and a VA Accession number. In cases where this automated reconciliation process fails, the system provides a mechanism for modifying this information before importing it. Sending information to the private sector: A one-time setup is initiated, and a trust with various permission sets is formed with outside facilities through the acquired system. The system can have an unlimited number of trusted connections to the private sector through this single acquisition and through a single MoU/ISA with the service provider The private sector facility can place a request through a portal. The file room at the VISN 23: VA Midwest Health Care Network will be notified of the request. The VA employee can initiate a query of the VA systems to identify whether any studies exist which meet the specifications of the request. If no studies exist, the request can be rejected. Once the internal query is complete, the staff can select studies and reports which meet the specifications and initiate sharing with the outside facility. The system will package and send the images and reports through the direct conduit through the internet to the outside provider by way of the Site-to-Site VPN. The commercial provider will receive the images and the acquired system can automatically import the images to private sector facility’s PACS and EMR. In all the above cases, there is no cost to the private sector or commercial facilities and there is no limit on workflow. Furthermore, information can be exchanged bi-directionally with no limitation on volume. In summary, the acquired system facilitates the exchange of medical images and reports through encrypted, peer-to-peer conduits between providers on a federated health information network by way of the FIPS 140-2 validated Site-to-Site connection. The system provides enhanced automation which: Utilizes an upcoming appointment, procedure, or community consult to automatically pre-fetch relevant images and reports from commercial or private sector imaging providers relevant to the upcoming care event. Conducts patient matching to automatically match inbound data to an existing patient and generate an order to obtain a VA accession number. Handles electronic requests that allow community care providers to request information electronically instead of sending a fax to the VA. Gives the VA the ability to request and conduct a broadcast query of the private sector providers to locate prior images and reports conducted through a care in the community program. Facilitates order generation and retrieval of results from community care providers, opposed to calling community care providers to track down patient results and wait on a fax. Supports advanced integrations with DICOM, FHIR, API, and HL7 standards.