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Understanding the Workflow Challenges of Enterprise Imaging

Today, those in the medical field need to view, use, and manipulate images for everything from diagnoses and documentation to treatment. While enterprise imaging is an effective strategy for evaluating, illustrating, and sharing a patient’s clinical journey, some problems can arise within this digitalized healthcare culture.

Here are some of the main issues that come with enterprise imaging:


Different scenarios require different reports, such as referral letters and operative notes. Because reports vary in their purpose and approach, they are often stored in different locations within electronic medical records.

Some images even require multiple reports -- but in current enterprise viewing systems, it's difficult to assign multiple reports to a single image. Reports may also be made during different stages of image acquisition. Associating reports and images in both systems allows medical providers to review information according to their preferred workflow.


Like reports, metadata gives an image context. Series and image-level metadata also run into problems in enterprise imaging, such as:

Body Parts — Different disciplines use different terminology for body parts. These variations can create conflict when some terms are too specific or not specific enough.

“An example of a term that is too specific is the humerus. This term makes sense while performing an X-ray of the arm, but may not be the best way to describe a skin condition in the same location. Alternatively, using the term abdomen is not considered specific enough for a surgical or pathological image.” - (Example from Workflow Challenges of Enterprise Imaging)

Adopting a standard ontology for body part mapping would resolve this issue. An ontology that allows for synonyms and a relational structure of “parent and child” terms would allow for cross-disciplinary work in the setting of an enterprise imaging strategy.

Procedure Description — Procedure descriptions can vary widely depending on the setting, making study-specific orders further compound the issue. When using an enterprise imaging strategy, a standard procedure description needs to be developed to increase specificity and differentiate different studies within the same department.

Each description should contain:

 • The study type

 • The body part imaged

 • An indication of which side of the body…etc

For example, “In the case of naming a chest Xray, depending on the setting, this procedure can be named Rad Chest, Chest X-ray, Chest XR, or CXR among others…As we move to enterprise imaging, it is possible that certain imaging workflows are encounter-based, not order-based. In both of these scenarios, there should be an efficient way to create a standard procedure description.” - (Example from Workflow Challenges of Enterprise Imaging)

Department — The department field should also be standardized. To do this the correct level of granularity for each specialty needs to be identified, whether that be achieved by providing the named divisions or merely the department field.

Imaging Source — Today, patients can upload their images to an electronic medical record or enterprise imaging archive. With images coming from such different sources, you will want to utilize a standardized system for tagging images as “patient-obtained” or “provider-obtained” for quality assurance purposes, liability reasons, and reporting related to meaningful use.

Legal Concerns

There are a few legal concerns that need to be addressed as enterprise imaging emerges as a widely-used system:

Privacy — Of course, certain photographs bring up specific privacy concerns. Vendors have given institutions the ability to manage privacy and permission. Today, they can view images through a variety of options, including:

 • Case-by-case permission requests

 • The ability to view reports without viewing associated images

 • The capability to flag users who frequently view restricted images

 • These approaches all ensure viewings are compliant with patient care duties

Maintaining Images — With the potential of keeping digital photos forever, hospitals need to decide when, and if, images should be discarded.

     “For example, in radiology, some images or series are rejected at the modality (such as due to motion) and never sent to the archive. In ultrasound, the technologist may select the images he or she wants to capture during live imaging. In most cases, the entire study is not recorded. Other specialties have a similar workflow.” - (Example from Workflow Challenges of Enterprise Imaging)

Many factors come into play in terms of determining what to keep, like:

   • Amount of time since the encounter

   • The quality of the image

   • The necessity of the photos

Video — It is predicted that video documentation in hospitals will grow exponentially in the near future.

As this form of media is used more and more, hospitals have a few factors to consider:

  • The limits to video length

  • What types of procedures will be recorded?

  • How they will record the video?

  • A method of archiving the video

Image Fidelity — Image quality and file size are steadily increasing, which could create problems with the imaging archive and may require some images to be compressed. This brings up the questions of which images should be compressed, by what ratios, and whether or not files should state that an irreversible compression has been applied.

For example, JPEG lossy with a quality factor of 85 or better is seen as “high quality” or “visually lossless” to most people. If medical photographs were saved using a high-quality factor, significant space savings may be achieved without apparent loss of image quality. (Example from Workflow Challenges of Enterprise Imaging)

File Format — Similarly, the use of a certain file format is not standardized; organizations need to decide what format they want, based upon desired file size, industry standard, or the capabilities of an enterprise’s image viewers.

Mobile Devices

The use of mobile devices for taking pictures, videos, sounds, or patient information raises further concerns regarding patient privacy. Nonetheless, mobile devices are essential for professionals in their day-to-day work, so vendors need to leverage a system that enables providers to use their devices in such a way that both clinical needs can be met and patients can be adequately protected.


Fortunately, many of these workflow challenges can be resolved through the adoption of ImageMovers deeply integrated EHR image management system. With ImageMover’s Mobile Image Capture solution you can:

• Instantly access images directly from a link in the EHR.

• Archive images with meta tags for immediate retrieval and searchability.

• Upload images directly to a PACS or VNA from a smartphone or tablet without compliance issues or compromising security.

• Leverage the PACS or VNAs to standardize the file formats and accessibility.

• Identify the image sources with meta tags.

• Use a body map to indicate the location of the body part portrayed in the image.

• Add basic annotation to each image.

• And more…

Along with the benefits derived from the standardization of an enterprise imaging strategy, a range of unique challenges must be addressed. Privacy, security, and proactive organization are all primary concerns when implementing an efficient enterprise imaging strategy. Thankfully, there are options like ImageMoverMD, a company that can help work through these challenges and provides the best solutions for every unique situation.