Without a comprehensive longitudinal medical record, gaps in information occur when the patient
visits multiple offices, even if those offices are in the same building.
a full EI program. However, in its broader essence, for enterprise
imaging to be successful it must include many imaging modalities beyond radiology, including non-DICOM formats such as visible light imaging.
Embarking on the EI journey usually begins when an organization reaches a fork in the road. New imaging infrastructure is needed. So many decisions occur at this point: best of breed,
deconstructed PACS or not, vendor neutral archive (VNA), imaging platform. Without an eye toward a goal of EI, decisions might
be made that could prove costly in the future as EI becomes an
expectation. At its core, EI requires a single shared archive for all
medical imaging with a single universal viewer integrated into the
electronic medical record. It is not simply a storage strategy, and a
VNA alone is insufficient. Radiology departments are typically
among the largest consumers of capital in a health care organization. As such, they are in a prime position to drive the infrastructure discussion toward the necessary features for EI. A willingness
to extend capabilities to the entire organization can only work in
favor of radiology’s consumption of these capital dollars.
Image exchange is another key component of a comprehensive EI strategy. We need to remove the intermediary media of
CDs, with the associated cost of physical media and personnel
time for processing at the receiving and sending ends. We in radiology, due to our sheer size, have the advantage of having dedicated file room or film library staff to help us with these tasks. In
many of the other imaging departments, this work is distributed,
fragmented, and usually not very efficient. If all images are
stored in a central archive, the services of the file room can be
extended to other departments. Again this willingness to extend
services will help us maintain the support structure necessary to
our current operations.
Currently, the concept of EI is actively discussed among a
very small segment of imaging providers and I believe it is time
for the concept to reach the entire radiology community. My desire is that the radiology community embrace the role that it can
play in this new world. At the very least, a deliberate debate within the radiology community needs to occur.
What advice would you give radiologists to stay on
top of these important developments?
Phenomenal foundational work on EI has emerged from a
joint workgroup between the Healthcare Information and
Management Systems Society (HIMSS) and the Society for
Imaging Informatics in Medicine (SIIM). The activities of the
HIMSS-SIIM workgroup led to several publications in the
Journal of Digital Imaging addressing the foundation, technology, governance, and workflow of an EI strategy. The articles listed below provide a comprehensive overview of EI, and I would
encourage all interested persons to review them.
HIMSS and SIIM are also working closely together to develop a maturity model for EI that will mesh with the already
published DIAM (Digital Imaging Adoption Model) developed
by HIMSS Analytics in Europe and the European Society of
Radiology. This model was developed to help the health care
industry have a frame of reference for the evolution of EI and to
serve as a guide for those organizations embarking on this journey. Additionally, the recent Enterprise Imaging Summit hosted by KLAS Research brought together thought leaders from
the provider space and vendors to discuss the current status of
EI and future directions. Radiologists and representatives from
radiology informatics dominated the provider sphere and it was
recognized that other image producers were missing representation. As other image producers such as cardiology, ophthalmology, and women’s health enter this arena, we may find that
we have yielded our position as the leader in imaging. Now is
the time for the radiology community to step forward and embrace the “enterprise think.”n
1. Petersilge CA. The evolution of enterprise imaging and the role of the radiologist in the new world. AJR 2017; 209:845–848
1. Clunie DA, Dennison DK, Cram D, Persons KR, Bronkalla MD, Primo HR.
Technical challenges of enterprise imaging: HIMSS-SIIM collaborative white
paper. J Digit Imaging 2016; 29:583–614
2. Cram D, Roth CJ, Towbin AJ. Orders- versus encounters-based image capture: implications pre- and postprocedure workflow, technical and build capabilities, resulting, analytics and revenue capture: HIMSS-SIIM collaborative
white paper. J Digit Imaging 2016; 29:559–566
3. Roth CJ, Lannum LM, Dennison DK, Towbin AJ. The current state and path
forward for enterprise image viewing: HIMSS-SIIM collaborative white paper.
J Digit Imaging 2016; 29:567–573
4. Roth CJ, Lannum LM, Joseph CL. Enterprise imaging governance: HIMSS-SIIM collaborative white paper. J Digit Imaging 2016; 29:539–546
5. Roth CJ, Lannum LM, Persons KR. A foundation for enterprise imaging:
HIMSS-SIIM collaborative white paper. J Digit Imaging 2016; 29:530–538
6. Towbin AJ, Roth CJ, Bronkalla M, Cram D. Workflow challenges of enterprise
imaging: HIMSS-SIIM collaborative white paper. J Digit Imaging 2016;
7. Vreeland A, Persons KR, Primo HR, et al. Considerations for exchanging and
sharing medical images for improved collaboration and patient care: HIMSS-SIIM collaborative white paper. J Digit Imaging 2016; 29:547–558
As other image producers such as cardiology,
ophthalmology, and women’s health enter this
arena, we may find that we have yielded our
position as the leader in imaging.
Enterprise Imaging continued from p. 5