Implementing Strategies for Enterprise Image Management
Paul ChangImage archiving, communication, and management are no longer radiology-specific concerns, although radiology departments can (and should) play pivotal roles in guiding their organizations’ image management strategies. That was the message delivered by Paul Nagy, PhD, Gary Wendt, MD, MBA, and Paul Chang, MD, in a session at the 2013 meeting of the Society for Imaging Informatics in Medicine (SIIM), held June 6-9 in Grapevine, Texas. All three presenters wear dual hats as radiologists and informaticists, and their experiences transitioning to enterprise archives formed the basis of their talks. Implementing an enterprise image management strategy has multiple advantages, the presenters noted. Among them are improving customer satisfaction and patient service; incorporating outside images; improving workflow; creating new revenue; improving productivity; developing standardized metrics for financial analyses; quantifying costs and benefits; and engaging and maintaining relationships with organizations’ stakeholders. “Enterprise image management is multifactorial and has a lot of moving parts,” said Chang, who is a professor of radiology and vice chair of informatics at the University of Chicago. “The hard part is having optimal workflow across the organization, which is increasingly important as we move from fee-for-service to value-based medicine.” The Other–Ologies Critical to the implementation of an enterprise archive is inclusion of what presenters called “the other –ologies,” or clinical specialties outside of radiology that utilize images as part of their workflows. While cardiology and radiology utilize similar modalities in similar ways, other specialties, some of which only recently began using images on a routine basis, may differ in terms of acquisition methods, clinical contexts, and downstream needs. Chang broke the models used for imaging throughout the enterprise into three categories: modality, kiosk, and mobile. Modality imaging is the radiology/cardiology model, he explained, in which almost all studies are available in DICOM format and acquisition tends to be scheduled. In the kiosk model—used by ophthalmology, endoscopy, and dermatology, Chang said—acquisition is scheduled, but DICOM is not always available, meaning some images may require conversion. In the final model, mobile, non-DICOM images are taken on the fly, at unexpected times and often by untrained clinicians. Examples might be trauma medicine, he said, or even cases of child abuse. The first challenge in developing an enterprise imaging strategy is engaging these disparate specialties, which can be difficult, cautioned Nagy, who is associate professor of diagnostic radiology and director of informatics for the Armstrong Institute for Patient Safety and Quality at Johns Hopkins School of Medicine. When his organization went to select an enterprise image viewer, it had to reconcile the needs of business, technical, and clinical staff. “I didn’t want radiologists in the room for the selection process,” Nagy noted. “I wanted a viewer that would work well for the enterprise.” By looking at technical and business requirements first, Nagy and team narrowed their prospective viewers from 12 choices to three; they then invited physicians to participate in online, on-demand demos of all three solutions, which were followed by short assessment surveys. Two iPads were raffled to participants as an incentive to spend the time. “If you respect the physicians’ time, you’ll get better participation,” Nagy advised. “The more you can get users to participate in the selection process, the better your adoption will be.” From Radiology to the Enterprise Meanwhile, Wendt, who is professor of radiology, enterprise director of medical imaging, and vice chair of informatics at the University of Wisconsin-Madison, shared how radiologists can become leaders in bringing enterprise imaging to their organizations. Critical to that process is engaging the C-suite, he said, in particular the CIO and CFO. “In the course of one year, we went from a PACS approach to an enterprise approach,” he noted. “We didn’t want to have 25 different groups building and maintaining separate silos of image data.” Radiologists make natural evangelists for enterprise image management because of the depth of their experience with PACS, Wendt said. They are the specialists best positioned to contribute their expertise to the development of a strategy, as well as those best equipped to speak to value. “This is how you argue the value proposition: the medical enterprise has a huge imaging volume outside of radiology,” he said. “Moving the vision of radiology PACS to other clinical departments will replicate the success radiology has had everywhere.” CFOs will be swayed by the downstream cost differential between a unified solution and maintaining multiple separate silos, Wendt said, while CIOs will see the advantages in terms of business continuity, ease of scalability, cost-effectiveness of support, and facilitating access to imaging services outside the enterprise. Today, he noted, the organization’s enterprise image management committee is actually captained by its CIO. “Our next big jump will be providing point-of-care image import access,” he said. “Wherever a patient is having a care encounter, we will provide them with access to images and the ability to import them. It’s becoming more and more important to provide a single portal where patients can get all of their images.” Chang added a single caveat: while radiology departments “have the most comprehensive, topological view” of how enterprise imaging should be handled, they have to be careful not to take on the financial and operational burdens of image management for other specialties. “You have all the expertise, but radiology isn’t a charity,” he warned. “This is a huge opportunity for you, but don’t be foolish and give it away for free.” Cat Vasko is editor of HealthIT Executive Forum.