Enterprise imaging is a fundamental component of a modern health system. Its importance cannot be underestimated, and its need to ride close to the ubiquitous electronic health record is becoming clear.

But enterprise imaging continues to evolve, and as more vendors and healthcare organizations integrate a broader range of new and emerging technologies with imaging, providers need to be prepared for the latest and greatest.

Visual data

Enterprise imaging is similar to the electronic health record and its transactional data, but enterprise imaging addresses primarily visual content. The core components are acquisition, viewing, workflow, storage and analytics services for information used in clinical diagnosis and treatment.

Additionally, an enterprise imaging system should foster collaboration between clinicians and engage patients while providing the necessary tools to transfer and share imaging information among the appropriate stakeholders across and outside of a health system.

“Traditionally, the scope of these services was limited to departmental picture archival communication systems (PACS) for radiology and cardiology with an extended archive of imaging data,” said Frank Pecaitis, senior vice president at enterprise imaging vendor AGFA HealthCare. “With the evolution of healthcare in the U.S. and abroad, such capabilities must now go beyond departmental areas to service all departments both inpatient and outpatient – rendering imaging data accessible across the healthcare enterprise and to the patient.”

Thus, the term: enterprise. Furthermore, with the proliferation of diagnostic and procedural imaging modalities, health systems are storing massive amounts of imaging data, accounting for approximately 85 percent of their total data storage infrastructure, Pecaitis said.

Efficiencies realized

There are efficiencies to be gained with clinical productivity for radiologists, cardiologists and clinicians in general through timely access to images, collaboration tools and intelligent workflows. Many imaging procedures are unnecessarily duplicated or lacking documentation, causing both cost and lost reimbursement to the health system.

“Episodic and procedural workflows for imaging can swiftly correct those issues,” Pecaitis explained. “Integrating imaging information with the EHR provides a more comprehensive textual and visual view contextually for the physician.”

To improve patient care and decrease associated costs, enterprise imaging tools are increasing diagnostic precision while simultaneously decreasing the time it takes to complete diagnostic events, said Neil Weber, vice president of marketing for imaging and care areas at GE Healthcare.

“Enterprise imaging helps providers collaborate and reduce care cycle times by helping them manage high image volumes while securely and seamlessly providing access to data and visualization tools,” Weber added.

The shift to value from volume-based reimbursement is demanding a greater reliance on patient-centered information across the various care settings versus the historical procedure-based information based upon event activities, said Phil Wasson, healthcare solutions manager at Hyland Software, an enterprise imaging vendor.

“For healthcare organizations to adapt, they need good visibility across the breadth of clinical content associated with their patients as individuals and as populations,” he said. “Ownership of clinical content on behalf of the patient is a mandatory requirement of healthcare organizations that are preparing to succeed in a value-based reimbursement world.”

Where we are today

Before understanding where enterprise imaging is going tomorrow, it’s important to understand where it’s at today, at its peak.

Enterprise imaging is at the beginning of a cycle of implementation and innovation. Many provider organizations have implemented components of their enterprising imaging strategies, including radiology and cardiology diagnostic systems, vendor-neutral archives, and some form of collaboration features and integration with their electronic health record systems.

“The consolidation of silos of information into vendor neutral archives is progressing,” GE’s Weber said. “Sharing patient data through cloud exchanges is common practice.”

State-of-the-art enterprise imaging requires efficient management of image data, said Ludovic d’Aprea, global general manager for healthcare information solutions at enterprise imaging vendor Carestream Health.

“Maximum efficiency is achieved through use of a single supplier for enterprise imaging, just as a single EHR manages all structured clinical information,” d’Aprea explained. “This model equips providers with a comprehensive consolidated patient medical record including structured and unstructured clinical data, along with supporting imaging data from all departments.”

Providing services at a reasonable cost

Healthcare organizations with multiple imaging providers will incur higher expenses that make it impossible to provide services at a reasonable cost, d’Aprea added.

“For example, IT departments will not have the burden of managing multiple databases that must be synchronized,” he said. “And a modular enterprise imaging platform from a single vendor delivers a consistent display of image data regardless of where the user is located or which type of viewer is being used.”

Pecaitis of AGFA HealthCare describes enterprise imaging’s state of the art today as an integrated — rather than an old-fashioned interfaced — platform that can solve most encounter-based and departmental workflow imaging needs from the industrial strength exam reading of the radiologist or cardiologist to the nurse documenting wound care via medical photography.

“The enterprise imaging system must seamlessly interface with the EHR, but the true enterprise imaging platform itself should be a single integrated set of services,” he added. “In addition to advancing vertical clinical use cases, the best practices system includes a workflow engine that supports sophisticated task management and a segmented storage layer that optimizes speed of ingestion and retrieval by utilizing the most economical media.”

With all of these services in place, clinicians are able to collaborate electronically on case interpretation, to work efficiently and with a high degree of confidence in rendering diagnosis and treatment, he said.

Planning with the future in mind

So what does the future hold for enterprise imaging, anyway?

More technologies and more complexities. And there are many ways to “future-proof” today for enterprise imaging tomorrow.

“In the future, enterprise imaging will have the same diagnostic and clinical viewer across all of imaging for simplification and ease of use,” GE’s Weber said. “2-D, 3-D and 4-D visualization will be part of this universal viewer. Analytics embedded throughout the imaging chain will be used to analyze clinical outcomes and continually improve system performance.”

Artificial intelligence will take over mundane and repetitive tasks while also prioritizing workloads based on automated pre-screening of data, he added, and information will be securely managed while allowing easy access to authorized users.

“Provider organization executives need to assess which vendors are positioned and committed to deliver on the enterprise imaging platforms of the future,” Weber said. “Analytics and artificial intelligence are rapidly evolving and require significant resources to bring to market. Embedding these technologies into user workflows will yield the highest benefit.”

More data = more advanced learning

Wasson of Hyland Software believes as healthcare organizations resolve the capture and management of enterprise imaging and develop new methods to fully use this content, there will be ever-increasing amounts of data that can contribute to more advanced learning.

“Although this represents an overload of information and will present new challenges in how it is managed, it will also offer opportunities in the form of artificial intelligence,” he said. “Artificial intelligence will emerge not as a replacement for the human evaluation of images and other data, but will offer the provider a new set of tools to analyze new wells of information.”

These technologies will augment the provider’s diagnostic evaluation by providing the ability to more quickly and accurately find key, relevant data needed to care for patients, Wasson added. Such tools also will allow the data to be digested in a more functional format that will be more readily presentable to patients as they assume more accountability for their care decisions, he said.

Today’s enterprise imaging strategy focuses on improving the productivity of medical professionals while enhancing outcomes and reducing costs. Artificial intelligence is an essential tool that can simultaneously enhance both the productivity and quality of diagnostic information, said Carestream’s d’Aprea.

“Many start-up companies offer image and data analytics,” he said. “Healthcare providers are seeking these solutions but are also developing algorithms in-house in an attempt to apply these developments to their workflow. Examples include advanced decision support tools and an algorithm-enabled radiology assistant powered by artificial intelligence.”

Advanced analytics

Advanced analytics tools also must be integrated smoothly into the reporting workflow to help triage cases so radiologists can easily determine which exams are urgent and must be read first.

“A combination of workflow orchestration, advanced clinical decision support tools, radiology assistance and reporting can improve both productivity and quality in a world where physicians are expected to do more in the same amount of time,” d’Aprea said. “Algorithm-driven technology will optimize workflow by finding the best-qualified radiologist to read each imaging study – instead of radiologists reviewing a list of imaging exams to determine which study to read next.”

The time savings achieved by this improved workflow not only makes radiologists more efficient, it also enables faster diagnostic reporting for critical exams, which can enhance patient care, he said.

Another future direction is the delivery of enterprise imaging using cloud technology, d’Aprea said.

“Cloud services are managed by skilled engineers and deliver excellent availability while reducing IT expenses,” he added. “Data integrity is also better managed from the cloud, which can enhance the quality of data to enable delivery of higher quality care.”

These services address the needs of healthcare providers of all sizes and deliver increased security and comprehensive functionality at an affordable cost, he contended. The cloud, he added, also equips desktop and mobile users with secure access to patients’ medical images and radiology reports.

What with analytics, AI, analytics, cloud and EHR integration coming, enterprise imaging is on the cusp of a revolution that hospitals need to prepare for now.

Learn how the University of Rochester Medical Center is doing just by setting a high bar for enterprise imaging.

Twitter: @SiwickiHealthIT
Email the writer: bill.siwicki@himssmedia.com