Northwestern Medicine

Lack of a request process

As demand for imaging data increased, Northwestern Medicine realized it had a significant issue.

“There was no process in place. It was literally email requests,” IS Program Lead for Enterprise Research Vic Apostolovski said.

The health system’s research analytics team put the images on discs — a process that was outdated and inefficient.

How Hyland helped

Northwestern Medicine implemented a streamlined process for data delivery that utilized Hyland’s Acuo vendor neutral archive (VNA) to extract and de-identify imaging data. The solution consolidates research imaging information into a single repository that seamlessly and transparently communicates across the research programs.

Acuo’s de-identification services have made retrieving and identifying exams for requestors much more convenient, Northwestern Medicine Application Analyst Jacob Grogan said.

Northwestern Medicine’s streamlined approach now handles requests that are as small as one image and can be turned around in less than a day to small- (26 to 100 images), medium- (101–9,999), large- (10,000–49,999) and super-sized (50,000–200,000) requests.

Some of the features of Northwestern Medicine’s Acuo VNA are as follows:

• Current DICOM exams are stored in the VNA: Acuo serves as the image router and centralized repository for exams. “It’s a great data source for leveraging these images,” Grogan said.
• Configuration for DICOM tag value exceptions: “If our requestors want certain tags fully identified, which happens pretty frequently, this is a configuration file that we can make edits to and leave values intact if the user wants that,” Grogan said.
• Confidential masking: This feature, which masks or blurs regions where patient demographics or other unwanted information might be, is commonly utilized in cardiology and radiology ultrasounds.

A new research imaging request process

For Northwestern Medicine, it starts with a dedicated team to pull the exams and supply the imaging research data for the health system and university.

• Centralized intake: The VNA research team created a form that must be completed to request imaging.
• Redefined de-identification process: The health system exclusively uses Acuo’s de-identification service to remove identifiers.
• Safe and secure data delivery: Compact discs and DVDs are no longer getting lost, scratched or filed away. Now, all the data is in the Acuo VNA.
• Improved customer experiences: More than 30 departments are enrolled in the process, which is tailored to each customer’s requirements and has produced a true data pipeline.

How it was implemented

• Leadership backing: The previous process wasn’t working, and Northwestern Medicine realized it had to do something.
• Identifying the key players: The VNA research team worked with health information management (HIM) and asked to be copied on all the emails they received. Quickly, they learned which departments were making imaging requests.
• Understanding their needs: Next, they met with the departments to get a better grasp on the type and frequency of the requests.
• Efficient extraction: The team created custom scripts that made the extraction of imaging data a more seamless process.
• Managed access: Previously, departments could go into the VNA and get the data themselves. The VNA research team put a stop to that by implementing a formal request process that includes online forms.
• Testing the process: The team conduced training and did several trials to make sure the new process worked. They worked with requestors on how to complete the intake form, extract and view the data.
• Communication: This was crucial. Departments received updates on when the new process was going live and how their request was being managed once it did.

In the first 18 months, Northwestern Medicine completed more than 1,700 individual requests and delivered 500,000-plus imaging exams to their research partners.

Lessons learned

• Documentation is key: “I can’t emphasize that enough,” Apostolovski said. “When we first did this, we didn’t even have a standard workflow and documentation of the process.”
• Make continuous improvements: Northwestern Medicine is always looking for ways to enhance its research imaging request process. The team tracks improvements, as well as any ideas they’re considering for future process upgrades.
• Customer training is essential: If requestors are struggling with the online form, Apostolovski schedules a meeting to help them fill it out and better understand it.
• Identify your customer champions: Having physician researchers and technologists on your side can make a big difference and identify ways to make improvements, Apostolovski said.
• Look at every challenge as a learning process: “This is the biggest thing,” Apostolovski said. “There’s always room for improvement. Every quarter, it’s light years of things that we’ve uncovered as we’ve streamlined the process.”

What’s next?

Northwestern Medicine plans to incorporate cardiology and ophthalmology research into its existing process, which is primarily focused on radiology.

The leading academic healthcare system also wants to increase its use of automation and continue to leverage its key relationships with research leadership.

“We want to be better partners for our researchers. We want to make lasting partnerships and lasting relationships,” Schnoebelen said.

They’ve already made major advancements, boosted by a strong relationship with Hyland.

“They figured out in advance what we needed,” Grogan said. “A lot of the features were already there that we utilize, and they’re working with us to improve the product. It’s been really helpful for us.”