Defining Enterprise Imaging and Implementation Program – Part 2

In part one of this article, we evaluated the role of enterprise imaging initiatives in enhancing healthcare workflows, multi-media/content management, and electronic health records. Now that you understand three critical elements of EI, (governance, strategy, and the EI platform), we can outline how multi-media content, enterprise imaging viewers, and image exchange services are also vital components of the EI initiative.

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Clinical Imaging and Multimedia Content

A wide range of operational workflows contributes to the creation and purpose of imaging to support and improve patient care. In a traditional workflow, the categorization and support of content are based on the medical specialty that performs the imaging. While this proves a reasonable methodology for diagnostic imaging within consistent, operational workflows--compartmentalizing in today's landscape, rife with a vast span of routinely captured content, is immensely difficult.

As the integration and attention to imaging increases across departments and specialties, the probability that different clinicians will perform nearly identical imaging procedures, such as extremity radiography and bedside ultrasonography, also increase. This redundancy makes classification by specialty extremely difficult. Further, the traditional, specialty based model for classifying imaging content does not reflect the depth, breath, or purpose of images captured within today's specialties and departments.

For various forms of EI content, using modalities ultrasound modality, digital camera, file structures (DICOM Ultrasound, JPEG Photo), and image consumers as individual guides for image classification are similarly inadequate. A HIMSS-SIIM workgroup evaluated these approaches, and after proving them insufficient in compartmentalizing EI content, chose to describe and organize clinical imaging and multimedia by the "intent of use for the performing providers." By defining content across four broad categories, (diagnostic imaging, procedural imaging, evidence imaging, and image-based clinical reports) this framework steers away from hard, fast rules and positions categorizing at a highly consistent, educational level.

While the solution to EI content classification will vary across organizations, this approach illustrates the complexity and necessity for developing an individualized, enterprise-wide methodology.

EHR Enterprise Viewer

As a part of their routine activities, every physician, nurse practitioner, PA, and imaging technologist in a healthcare organization must review and manipulate images, metadata, and imaging reports through the EHR. With this broad spectrum of EHR users, imaging content, and procedure/point of care documentation comes the need for a single multi-purpose application.

An enterprise imaging viewer can be defined as a "zero-client, EHR accessible application used to distribute, display, and manipulate virtually any multi-specialty image, video, audio, or scanned document. Where some common EHRs do not provide integrated image storage or multi-specialty/format viewer capabilities, and many of today's healthcare organizations store images across a range of clinical archives, enterprise viewers permit a single integration point for the EHR to find images and offer a scalable, centralized storage solution for optimal maintenance and cost.

Ultimately, the heightened accessibility, security, and efficiency of enterprise viewers can help fulfill many clinical use gaps facing today's health systems, and solve the myriad of challenges associated with specialty-specific viewers.

For example, enterprise viewers also:

  • Integrate different forms of "non-traditional" imaging content that cannot be viewed in some enterprise PACS today. (i.e., image/video from pathology, handled cameras, or endoscopes)

  • Using high-quality application and advanced image manipulation functionality, enterprise viewers provide diagnostic image interpretation by specialties and clinicians without a dedicated PACS.

  • Some enterprise viewers offer teleconferencing capabilities and while sharing the image viewer interface, thus enhancing physician-to-physician collaboration and cross-department transparency.

  • Offer point of care secure mobile device image access for providers to connect with on-call providers, patients, and families without being tied to a hardwired workstation.

  • Patient portal, referring physician, or telehealth image viewing capabilities

Image Exchange Services

Like other parts of EHR, images need to be shared with patients and with other providers who are outside of the clinic or other business in which they were created. This means that the enterprise imaging infrastructure should be well suited to provide both incoming/outgoing image exchange services. Inbound sources, including CD/DVD, HIE, and patient/referring physician/telehealth portals are stored in stored in the VNA, indexed and viewed in the EHR, and are available to be captured on PACS for early comparison or secondary interpretations.

For outbound exchange, the EI platform can leverage the image repository to prepare the required studies or reports for export — be it to a CD/DVD burner or an electronic exchange gateway. Not only do EI exchange services offer a singular, centralized, internal model for export, but also provide a single receiving platform across specialties; this simplifies the outside entities training and operationalizing processes when sending inbound images.

Image Analytics

An image alone is often not helpful if it does not have accompanying metadata. This information includes the file type, the date the image was created, the identity of who created it, and much more. Data analytics can be done on this information to determine the number of different image use protocols. It is essential to create a plan for image analytics and metadata creation in the enterprise imaging strategy to be able to analyze information from the beginning effectively.

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Conclusion

Bringing enterprise imaging into a clinic or other organization for the first time requires more than just a plan and strong leadership. It also requires considering some technical aspects, including the content itself, how it will be used, how it can be shared, and how it can be analyzed. By rounding out the implementation process with these four elements, clinics can create a strong enterprise imaging program that provides them with everything they need.

If you are a leader in your clinic or other healthcare organization and want to know more about bringing enterprise imaging to your team, ImageMoverMD is here to help. Its experts can provide solutions to moving and incorporating existing images into these programs, as well as incorporating images into EHR and other systems.