What the heck is Enterprise Imaging…… Really?

 

According to SIIM Enterprise Imaging is

“a set of strategies, initiatives and workflows implemented across a healthcare enterprise to consistently and optimally capture, index, manage, store, distribute, view, exchange, and analyze all clinical imaging and multimedia content to enhance the electronic health record.” (SIIM Enterprise Imaging Workgrouip, 2018)

Healthcare Informatics says

“The foundations for building an effective EI program can be leveraged from traditional imaging and IT best-practice fundamentals. The following lays out the deliberate, innovative alignment between “imaging & imaging IT Fundamentals,” such as acquisition, management, distribution, archive, and governance, with evolving industry conditions impacting imaging and IT, such as the demand for centralization, standardization, interoperability, data integrity, and governance.” (Pittman, 2015)

While there is a lot of good information in both of those they are a bit unwieldy. So, lets say Enterprise Imaging is a plan to a efficiently use all images to better treat the patient. We all want to provide better care and who can argue with efficiency in the form of physician time or hospital resources? Some may be thinking, I have images in my EMR so I have Enterprise Imaging, box checked. I wo

uld challenge that there are many more images out there than we realize. The obvious departments that come to mind are Radiology and Cardiology. There are also images generated in surgery, ED, dermatology, GI, lab and countless other places. A rheumatology clinic I work with very often uses ultrasound for needle placement for injections.  Before we get to the questions like how do I optimize workflows and where do I put them, I would first ask, what is the purpose of the image? Does it need to be kept? If so for how long? Just because we can store it forever doesn’t mean we should, but that is an entirely different discussion.

Once we have identified all of the images

that are acquired and determined the regulatory constraints and useful clinical relevance we can look to apply workflow and best practices. Radiology has some of the most developed rules and processes for acquiring, moving using and storing images, and being a long time PACS person, all images look like X-Rays to me. However, they are not all the same. Appropriate use of radiology best practices can and should be applied to other imaging areas, but only where it makes sense given the need. Orders make sense in the radiology context because they provide a mechanism to attach a result to which is a separate billable component. In many instances outside of radiology images are supplemental or supporting information that belong with other clinical notes regarding the procedure. There are other workflows that can appropriately store this information in the EMR without the

order/accession number process.

Probably the most important lesson we can learn from radiology workflows is the importance of categorizing the information. Hand entered demographics don’t work. Hand entered descriptions of the data don’t work. Whatever workflow is developed it must include selecting the patient from a list, which is typically derived from admissions, and then describing the data by how and where it is acquired and again creating a discrete set of procedures or descriptions of what the images represent. Without these two things the images are relatively useless because it is highly unlikely they will be viewed again as it will be difficult to identify what they are, and they may or may not be accepted into the EMR.

The next lesson we can learn is around

data standards. Regardless of the vendor or the department vendors love to store your data in a proprietary format that is only accessible in their system. This is self-preservation and future revenue streams. No vendor wants to make it easy for you to share data and read it in another system, nor do they want to make it easy to manage your own data. This is what I like to call stickiness, because you are stuck with that vendor. A more economic term would be high barriers to exit or switching costs. If it costs $250,000 just to move the data to another system you may choose to stay with an inferior product due to the additional costs of changing vendors. So it is critical when purchasing a system that you demand that the data is stored in standard formats and that the local team has the ability to access the raw data and move it to other systems in the event the departmental team choses a different system in the future.

To return to the question, what is Enterprise Imaging? I would opine (yes, it is a word) that it means take the appropriate best practices in IT and imaging and develop a plan on how to apply them to all images that are acquired with the ultimate goal of improving patient care.

 

Kyle Henson

Please let me know what topics you would like to discuss

Kyle@kylehenson.org

References

Pittman, D. (2015, April 15). Enterprise Imaging: The “New World” of Clinical Imaging & Imaging IT. Retrieved from Healthcare Informatics: https://www.healthcare-informatics.com/article/enterprise-imaging-new-world-clinical-imaging-imaging-it

SIIM Enterprise Imaging Workgrouip. (2018, 01 28). What is Enterprise Imaging?Retrieved from Society for Imaging Informatics in Medicine: http://siim.org/page/enterprise_imaging

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Kyle Henson

I am a doctoral student, entrepreneur and longtime imaging professional. I truly love what I do and strive to make healthcare better for every patient that goes to a facility I work with. I apply the "my wife" principle to IT, if it was my wife having xxxx procedure what information would I want the physicians to have? If I provide that, I have done my job.

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