The Next Frontier in the Evolution of
Health Care Technology
Cheryl A. Petersilge of the Cleveland Clinic notes that the concept of enterprise imaging is part of the next frontier in the evolution of health care technology. She argues that by
incorporating all medical images into a single location, integrated
with electronic medical records, it will support care coordination
and the ideal of a comprehensive longitudinal medical record.
What prompted you to write about enterprise imaging?
My continued passion for radiology and a new passion for enterprise imaging (EI) provided the stimulus. I have seen how I can
take the knowledge I gained as a radiologist and apply it to all of
medical imaging. I understand workflow, the importance of proper
viewing tools, the value of correlating images from different imaging modalities, and the need for appropriate security practices. As
a member of the Cleveland Clinic, I have learned “systemness” and
thinking from the enterprise perspective. All of these tools are critical to a successful EI program.
In this time of transformation in medicine, and with the impending shift from volume to value, the radiology community is already
retooling its focus. We are reaching out to patients and no longer
letting the ordering clinician be the interface between radiology
results and the patient. The patient experience has taken a new
place in our priorities. I believe we should also be reaching out to
our clinical colleagues and to the executive suite to become the
leaders in the consolidation of imaging storage, viewing, distribution, and sharing.
In the true essence of EI, these activities are based on a single
archive and a single universal viewer integrated with the electronic
medical record. This consolidation of technology results in cost
savings due to economies of scale for technology and support per-
sonnel. Even greater value is achieved in providing our physi-
cians with the right information, at the right time, in the right
place, and in the right format.
What do radiologists need to understand about EI?
The first step in this discussion really needs to begin with
understanding what EI means for patient care. The essence of
EI is to support consolidation of medical information, including medical images, into a single source of truth—the comprehensive longitudinal medical record. In my experience there
are a few changes in caregiver thinking that must occur as we
build that record.
Radiologists have already cleared the first hurdle. We recognize that images are an important component of the information we generate and they need to be shared with our
referring clinicians. We are also beginning to realize that images need to be shared with our patients. Secondly, we recognize that in tandem the medical images and the report are a
powerful combination. Either alone is lacking. With the storage of certain medical images via printed copy, on USB drives,
or in siloed archives, this synergy between report and image
cannot be achieved. Even more concerning is the lack of access to some of these siloed systems, which essentially eliminates those images from the medical record.
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. The gaps
grow as the patient moves from caregiver to caregiver and becomes even greater as the patient moves between various
health care organizations. Gaps in information lead to duplicate testing. In the end, the patient pays the price figuratively
Radiologists are the leaders in imaging informatics. A review of the literature, websites, and journal content for many of
the other image-producing specialties revealed little information relative to imaging technology and even less information
about imaging-related security concerns. With cybersecurity
becoming one of the top threats facing health care, we have a
great opportunity to offer our knowledge and expertise to benefit the organizations we work with and work for.
I have seen a very narrow focus for EI in the radiology community, concentrating solely on interconnecting various imaging departments and centers. The need to consolidate imaging
centers is acutely felt by many large radiology groups and
forms the foundation for the radiology-focused EI strategy.
This focus is essential to the radiology practice across large
institutions and it is a necessary, yet not sufficient, step toward
Cheryl A. Petersilge
Department of Regional Radiology
At its core, EI requires a single shared archive for
all medical imaging with a single universal viewer
integrated into the electronic medical record.
Enterprise Imaging continues on p. 9