RANZCR: Clinical Radiology Forging the Path Toward Interoperability

The Royal Australian and New Zealand College of Radiologists (RANZCR) Inside News September 2020

Digital health has the potential to transform the way health care is delivered in Australia. A digitally connected health system relies on interoperability. That is, the ability of different information systems to communicate and exchange data, and use the information exchanged to improve the care provided to patients. Unimpeded workflow needs to be seamless, safe and secure for patients and clinical users. For changes to be truly transformational we need to find value-creating solutions that realise benefits for each clinician across the care pathway, and most importantly for the patients, prioritising their choices as consumers.

The College has developed a digital health white paper entitled Towards Interoperability: Clinical Radiology Forging the Path Ahead, which is currently under review via consultation. The white paper sets out a new, more open and connected clinical pathway to see patients become active participants in their health care and enable a transition towards value-based care. It is only through the careful design of a new digital workflow that we can maximise the benefits and evolve our digital health system.

The time is right to advance digital health

The impacts of COVID-19 on the delivery of health care have been substantial—perhaps none more than necessitating the rise in digital health initiatives. This has had positive impacts in some areas, while also highlighting the need for transformation in other areas. Data released by the Australian Digital Health Agency (ADHA) in June 2020 showed healthcare providers accelerated their use of technology during the pandemic. More than 90 per cent of public hospitals are now using My Health Record with 5.2 million more clinical documents uploaded by hospitals, pathologists or radiologists since March. It appears that the focus on digital health including telehealth consultations during COVID-19 lockdowns has helped fast-track the adoption of some technology.

Patients have demonstrated that they are open to using online technology to access and receive care. Current consumer expectations for a digitally enabled and connected health ecosystem are high as empowered and digital-savvy consumers are driving change in patient care and how they are treated. Similarly, health providers have relied on the technology more to consult with their patients, diagnose and deliver care in new ways.

There is now unprecedented opportunity to transform the healthcare system towards new, more open and connected clinical pathways.

Despite national leadership, and an overall framework for action to guide, we lack a common shared vision between the key players, and this is holding back technology-led interoperability and realisation of our digital health objectives. The rapid uptake of telehealth during the COVID-19 pandemic has shown what can be achieved when key players work together toward a common goal.

“Unimpeded workflow needs to be seamless, safe and secure for patients and clinical users. For changes to be truly transformational we need to find valuecreating solutions that realise benefits for each clinician across the care pathway, and most importantly for the patients, prioritising their choices as consumers.”

The College’s digital health vision

A foundational element of interoperability is the use of standardised terminologies to ensure that all participants have a common understanding of the data provided (known as ‘semantic interoperability’). Currently there is not an agreed and common language used throughout the patient’s care pathway by all those contributing along the way.

Importantly, interoperable communications and data will bring us closer towards the fundamental principle of truly enabled patient choice.

The College’s vision is to fully utilise available technology in the patient journey from clinical radiology referral, test performance and interpretation, to receiving the results. In building the technological architecture to support this vision, the focus is across five strategic projects with each leveraging and building on existing systems.

These include:

1. Standardised terminology—as an essential building block towards interoperability—to ensure consistent use of terminology in referrals to radiology.

Multiple global and local catalogues already exist. A targeted project is required, supported by the Department of Health, ADHA and the broader clinical radiology sector, to review the relative merits of existing catalogues, mapping against other relevant systems and standards, such as the Medicare Benefits Schedule (MBS) and existing legacy catalogues. This review would produce a Radiology Referral Set which would establish the consensus terminology to use for radiology referrals. Agreement of this as the common standard for Australian clinical radiology terminology forms the foundation for the College’s digital health priorities.

The College has already started work on a related project to introduce structured radiology reports containing templates for components of the report and providing support for data reconciliation with the request.

2. Streamlining, and improving the quality of, referrals with electronic referrals.

Secure electronic referrals can improve how clinical and administrative information is exchanged between healthcare providers, resulting in better delivery of care. Safeguarding patient choice will be the most important factor in implementing eReferral. In prioritising patient choice, the College strongly prefers the exchange repository model for eReferral.

“A foundational element of interoperability is the use of standardised terminologies to ensure that all participants have a common understanding of the data provided (known as ‘semantic interoperability’). Currently there is not an agreed and common language used throughout the patient’s care pathway by all those contributing along the way.”

3. A platform that allows secure access to prior medical images.

Clinicians subsequently caring for a patient would benefit considerably from having access to prior images to complement the clinical radiologist’s report. The infrastructure of My Health Record can provide a registry of tests performed previously which could be leveraged to a greater degree by incorporating links to historic images, stored at the practice which performed the original test. The College believes a platform is needed to connect My Health Record with the practice’s stored images, while validating who should have access to sensitive patient data.

4. Enabling clinical decision support (CDS) into the workflow.

Technology needs to be utilised in a way that allows clinicians to provide evidence-based care for patients. Easy access to clinical guidance on the best radiology test for a particular patient’s presentation would enhance decision-making at the point of care. CDS must be seamlessly integrated to the referrer’s workflow, which is best done by incorporating it into eReferral. This would provide timely access for general practitioners and other referrers to clinical guidelines when they are considering what radiology test or study their patient needs.

5. Leveraging artificial intelligence (AI).

The potential for AI should be considered when progressing all interoperability projects, particularly in imaging-based specialties such as clinical radiology and radiation oncology. This fifth element will be factored in to streamline the reporting process internally. Later, in the reporting cycle, AI may assist report interpretation by the referrer, where structured reports will be needed.

In realising the College’s vision to advance interoperability and required standards, strategic partnerships are required to provide the leadership commitment needed to lift the technical impediments currently holding us back. The College has identified several key stakeholders representing consumers, referrers and government, and is engaging with them to ensure active collaboration in codesigning digital health solutions.

The consultation on the College’s digital health white paper is open until 9 October 2022. Please submit your feedback to the consultation via email to fcr@ranzcr.edu.au