Do you want to see success with your enterprise imaging program? You'll need to implement seven key elements, according to a white paper jointly produced by the Healthcare Information and Management Systems Society (HIMSS) and the Society for Imaging Informatics in Medicine (SIIM).
In the first of five planned white papers on enterprise imaging topics to be published in the Journal of Digital Imaging, the HIMSS-SIIM enterprise imaging workgroup shared its definition of enterprise imaging and offered suggestions on how to achieve success.
"A patient's electronic health record should include easy access to the wide range of medical imaging records obtained for that patient across all departments and service lines," wrote an author team led by Dr. Christopher Roth of Duke University Hospital. "A well-defined, well-thought-out strategy, with the right governance and infrastructure, will go a long way toward making that possible."
What exactly is enterprise imaging? The HIMSS-SIIM member workgroup has defined it as 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."
The HIMSS-SIIM workgroup has identified seven elements for a successful enterprise imaging program:
- Governance
- Enterprise imaging strategy
- Enterprise imaging platform (infrastructure)
- Clinical images and multimedia content
- Electronic health record (EHR) enterprise viewer
- Image exchange services
- Image analytics
Governance
In enterprise imaging, governance bodies bring together clinical, administrative, and IT stakeholders to make decisions. It takes effective and engaged governance to have a successful enterprise imaging implementation, according to the white paper.
In addition, governance must be addressed early in the enterprise imaging process, as there is typically very little knowledge across other departments and sharing of infrastructure.
"Personal and professional culture between departments may be nonexistent or even negative because of historical turf battles," the authors wrote. "It is critical to start anew with a core group of constructive stakeholders, executives, and sponsorship in overseeing all imaging activities and service lines.
Enterprise imaging strategy
The authors noted that a strategic plan should spell out the required enterprise imaging infrastructure and services and include, at a minimum, plans for the seven elements of enterprise imaging. Strategic decisions are particularly critical for the requirements, scope, and outcome of enterprise imaging; these decisions will clarify how any pre-existing technology will fit into the enterprise imaging platform and how much capital or operating funds will be necessary.
IT support might need to be restructured from a departmental approach to an enterprise model, which could require hiring new personnel or reassigning or releasing other staffers, according to the authors. These changes can affect the timeline for enterprise imaging implementation.
"Engaging the specialties creating images in the strategic decisions will become important when clinical champions become needed during infrastructure and application selection, workflow redesign, and implementation," they wrote.
Enterprise imaging (EI) platform
The enterprise imaging platform encompasses the infrastructure, modalities, devices, and integration points that provide the basis for enterprise imaging strategies.
"A standards-based DICOM and non-DICOM clinical image and video storage repository is central to the EI platform," the authors wrote. "This central repository may be a vendor-neutral archive or, if it meets defined enterprise-wide requirements, an existing PACS archive."
Core services for the enterprise imaging platform include the following:
- "Standards-based" integration, including provision of accurate patient/procedure information for most departmental systems that create images in their workflows
- Providing a reliable archival service, with a patient-centric index, or registry of all content in the archive
- Providing a thin- or zero-client enterprise viewer that can display all images and multimedia content stored in the archive
- Support for standards-based access methods, such as DICOM, HL7, XDS/XDS-I, Fast Healthcare Interoperability Resources (FHIR), and DICOMweb services
- Support for various acquisition and import methods, such as native DICOM communications, DICOM "wrapping," digital video capture systems, and exchange gateways
- EHR integration, including clinically relevant descriptors of imaging content, imaging orders created by the EHR where necessary, imaging results and availability notifications reported to the EHR, and image viewing from the EHR
- Providing reliable retrieval services, with secure access control and auditing
- Disaster recovery and business continuity with minimal to no disruption to service
Clinical images and multimedia content
Instead of describing and organizing clinical imaging and multimedia content by the imaging source or type of images created, the HIMSS-SIIM workgroup chose to focus on the performing providers' intent of use for the images. As a result, the workgroup focused on defining content across a spectrum or continuum of four broad categories: diagnostic imaging, procedural imaging, evidence imaging, and image-based clinical reports.
"The framework is intended to be high-level and educational, rather than provide hard and fast rules, as even within an individual encounter's imaging examination, images often serve more than one intent and thus fall into more than one category," the authors wrote. "For example, during a cardiac catheterization, images may initially be captured and depict slow flow through a coronary vessel (diagnostic), as well as catheter and potentially stent manipulations and time stamps (procedural)."
This type of categorizing, while complex, may be useful for guiding strategic decisions for enterprise imaging, according to the authors.
EHR enterprise viewer
Because one of the primary goals of enterprise imaging is to provide all forms of imaging to the EHR, it's necessary to have an enterprise image viewer, the authors noted. It's crucial, therefore, to understand image viewing needs in developing an enterprise imaging strategy.
According to the authors, most clinical users of enterprise image viewing can be placed into one of four categories:
- Diagnostic image creators and interpreters needing the most advanced image manipulation and reporting capabilities
- Surgical subspecialist providers also needing advanced image manipulation tools to plan a procedure
- General provider and nonprovider users needing access to basic image viewing tools
- An external user such as a patient or referrer with a need for basic image review
"Users in all four groups expect fast and efficient review and manipulation of image datasets on any desktop, laptop, or mobile device," the authors wrote. "The enterprise viewer will meet the needs of most image reviewers, though presurgical and diagnostic image review still typically requires a dedicated viewer with specialty-specific data integrations, functionality, calculations, and user interface for the most advanced patient care and provider efficiency."
Image exchange services
The enterprise imaging platform should also be well-suited to handle both internal and external image exchange services, according to the authors.
"Benefits to an enterprise-wide-level image exchange service include not only a single centralized operational model internally for export but also simplifying the training and operationalizing of outside entities to send inbound by providing a single receiving platform across specialties," they wrote.
Image analytics
While detailed analytics tools for enterprise imaging are still in their infancy, the enterprise imaging platform offers an infrastructure that supplies both the image and associated metadata to enterprise data warehouses, according to the authors.
"Defining and standardizing this metadata across the enterprise provides a repository of data that can provide departments with detailed study statistics, utilization reports, and image acquisition patterns," they wrote. "True deep learning and complex neural networks of image data contents are beginning to be developed that will play large roles in the future of EI."
For more details, you can access the white paper here. The HIMSS-SIIM enterprise imaging workgroup plans to publish four more white papers on enterprise imaging topics over the next couple of months.
