How to Optimize Image-Enablement for EHRs

Clinical specialists and other health professionals have varied needs for diagnostic interpretation, and clinical image/video image consumption. While juggling a myriad of media throughout their day-to-day responsibilities can be stressful, the development of enterprise viewers has helped form a central, secure platform for the retrieval and usage of the necessary multimedia for all environments, patients, and professionals.

‍What is an Enterprise Viewer?

From physicians and nurse practitioners to assistants and technologists, every member of a healthcare organization needs to review/adjust different images, metadata, and reports through the use of patient electronic health records (EHRs).

In addition to the medical staff, patients are increasingly interested in evaluating and understanding their own diagnostic images, which only expands the user-platform. EHRs need access to such a wide spectrum of images and content types that organizations need a single, simple application to contain and allow access to all these content types.

An enterprise image viewer is the solution. In short, enterprise viewers can be defined as, “a thin-client or zero-client application used on any off-the-shelf device to distribute, display, and manipulate multi-specialty image, video, audio, and scanned documents stored in separate centralized archives through, or standalone from, the EHR.”

‍Enterprise Viewer Growth

In recent years, the usage and implementation of electronic health records have increased, and with this expansion comes a greater need for enterprise viewers. Many EHRs don’t have integrated image storage of multi-specialty image viewers, leaving health systems lacking the integration of care records that they need.

Thus, health enterprises are now looking for applications like enterprise viewers that can contain all clinical multimedia in a single archive. Furthermore, enterprise viewers can fulfill many of the additional needs facing hospitals today, including single viewer access to the EHR, physician-to-physician collaboration, on-call provider image review, and patient portal image viewing, among others.

Technical Considerations

The following points offer a brief overview of data flow and system design, demonstrating some of the amenities that enterprise viewers offer.

  • Dependencies: Enterprise viewers display images in the ideal state for the environment the user is in, without the need for manual changes. Whether the user is in high or low light, consistent or inconsistent environments, or off-the-shelf stations, the technology can adapt on its own. Recent models also do not require the same plug-ins or runtime environments as did older model.

  • Security: Enterprise viewers are accessed through secure authentication, offer audit records, and, if desired, can delete content immediately after a presentation to avoid compromising.

  • Integration: Enterprise viewers can offer a menu set measure that incentivizes certified electronic health record technology integration. Thus, they can be used as clinical reference tools, seamlessly integrated extensions of the HER.

  • Differentiators: Enterprise viewers have different forms and services that can adapt to any hospital environment. These include mobility, breadth of functionality, security, speed, and affordability.


The FDA regulates mobile platforms, which it defines as, “commercial off-the-shelf computing platforms that are handheld in nature, such as smartphones, tablet computers, or other portable computers.” Those enterprises which produce mobile enterprise viewer applications typically pursue the FDA classification of Class I or Class II medical device.

Class I devices have general controls that protect the user and offer low-risk of harm. Enterprise medical image viewing devices of this classification are usually cleared for image review. Class II devices, however, are subject to more stringent performance and design controls.

Outside of the U.S., many producers of mobile app enterprise viewers seek classifications which are equivalent to an FDA Class II. Thus, those with Class II products offer an advantage over those categorized as Class I, due to their intensive evaluation and mitigated risk to the institutions which use them.

Nonetheless, it seems that very few physicians today perform diagnostic image interpretations on a mobile device, due to the screen size, gesture functionality, and operational workflow support. Mobile applications are more generally used to review images from other departments, access images remotely, and enrich patient consultations with image findings review.

‍Enterprise and Specialty Toolsets

Modern enterprise viewers offer a variety of toolsets, including the following:

  • Basic toolsets: For enterprise viewers, these tools are the “necessities” for both imaging and non-imaging specialties alike. Basic tools include image manipulation and navigation mechanisms, such as panning, rotating, zooming, distance and angle measuring, window-level, cine controls, report display controls, and more.

  • Advanced toolsets: these are specified as more complex image processing functions. There include multitudes of advanced tools, some of them being: surface and volume rendering, centerline placement, multi-modality fusion, multi-planar reconstruction, bone removal, and minimal and maximal intensity projection.

  • Specialty toolsets: for more intense, specific needs, some enterprise viewers offer specialty diagnostic tools which offer highly configurable and optimized diagnostic display for efficient diagnostic image review. Many of the amenities of specialty toolsets are still in the works but are being rapidly developed for implementation in the near future.

  • Workflow toolsets: These tools help with day-to-day management of imaging enterprises or imaging-finding communications. Enterprise viewers vary in their usage of workflow toolsets, some incorporating collaborative tools, voice dictation, and structured data passage to downstream systems.

‍Enterprise viewers can simplify and optimize image enablement for EHRs. They come with a variety of tools for different skill levels, needs, and occupations; their mobility and centrality streamline the containment and retrieval of documents, records, data, and images. Enterprise viewer technology is fast developing and continually improving to offer the best, most efficient experience for health professionals.