RSNA Trendwatch: Multi-Enterprise Imaging

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This year's RSNA left no room for doubt: If you're just talking about image management within the radiology department, you might as well not be talking at all. The logical next step — enterprise image management — has emerged as a key goal both for vendors and for radiology departments seeking to bring the rest of their organizations into the future. Some are even profiting from it.

In a December 4 session moderated by Keith Dreyer, DO, three radiology informaticists covered the gamut of perspectives on EHR-PACS integration and the attendant workflow issues. Cree Gaskin, MD, of the University of Virginia Health System, advocated for an EHR-driven workflow that would deepen the clinical context available to radiologists while preparing them for future payment and delivery mechanisms. Peter Sachs, MD, of the University of Colorado School of Medicine, took a neutral position. His department still uses a PACS-driven workflow, but he stressed that without internal expertise, that workflow might not be as productive.

Gary Wendt, MD, MBA, came out swinging in favor of PACS-driven workflow. In future delivery systems like ACOs, he noted, radiologists "won't be responsible for the organization — you'll be responsible for the patient." Given that, he argued, why switch to a workflow that's not optimized for the best possible care? Further, he noted, patients "don't live in just one organization or system." He coined the term "multi-enterprise imaging" to describe a world in which radiology departments will need to use the best means of exchanging and collaborating on cases, even if they originated elsewhere.

At least one organization is putting its money on EHR-driven workflow — literally. During a luncheon session provided by Agfa Healthcare, Cheryl Petersilge, MD, described the origins of the Cleveland Clinic's new spinoff consultancy My Practice Imaging, which will help radiology departments evangelize the enterprise imaging mission throughout their organizations. Her department certainly has the experience to back up the endeavor, having brought plenty of other departments into the enterprise imaging fold: women's health, point of care ultrasound, digestive care, wound health, ophthalmology, dermatology.

Underneath any enterprise imaging initiative is, of course, the united body of DICOM, cine and non-DICOM image files. It seems every vendor has a different name for it — vendor neutral archive, archive neutral vendor, image repository, enterprise repository, clinical repository — driving home one point above others: The competition to provide this technology is going to be fierce. After all, the radiology department is a doorway into a host of other hospital departments, and early penetration could mean big market share down the line.

With that truth never far from mind, vendors will be differentiating on the bona fides that distinguish their products from the rest. Expect security, stability and speed all to be critical considerations going forward, and one additional question to ask is whether the technology has been validated in any other industry — especially one even more demanding than health care.

As imaging continues to proliferate throughout the enterprise and beyond, becoming a multi-enterprise consideration, it is perhaps this space more than any other that has the potential to become disruptive.