Whitney Palmer

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Enterprise Imaging: Beyond Cloud-based Image Sharing

Published on the April 8, 2013 DiagnosticImaging.com website

By Whitney L.J. Howell

Zero-footprint viewers. Vendor-neutral archives. Image mobility. Individually, they are helpful tools to radiology and becoming more ubiquitous. But together, they help create a cohesive enterprise imaging strategy.

Enterprise imaging (EI) isn’t a particularly new idea, but to date, it has been largely misunderstood, industry experts say. It’s more than simply implementing new technology. And, achieving the full benefits EI can provide will require both sophisticated software and provider engagement.

“Enterprise imaging is a hot topic, but there’s a big misconception around what we mean by it,” said Paul Chang, MD, University of Chicago School of Medicine’s enterprise imaging medical director. “Enterprise imaging is a much broader, more complex problem when you take the enterprise perspective rather than the silo perspective.”

What is EI?

Put simply, the goal of an EI strategy is to ensure the correct image is delivered to the right place at the appropriate time. It has the potential to fundamentally change how facilities, providers, and patients interact with diagnostic images. Reaching that goal, however, requires a great deal of collaboration, Chang said.

According to a 2012 KLAS report, many facilities are already moving in that direction. Of the 134 providers surveyed, most reported being in early EI stages. To create a fully integrated EI system, Chang said, these facilities and others must address five factors that affect how the healthcare system currently views and uses diagnostic images.

1. Archive architecture. For many providers, EI simply means implementing a vendor neutral archive (VNA), an archive-neutral vendor, or using a zero-footprint viewer, all methods for easily sharing images within the facility and off-site. However, the archive is only one part of a successful EI strategy, albeit an important component. It’s important, Chang said, to free radiology departments and practices from being tethered to one PACS, but identifying and employing an effective VNA is largely an IT responsibility.

“VNAs and zero-footprint viewers are just the middle wear that links commodity storage to the application layer,” he said. “We’ll do it, and we’ll go to the cloud. But it’s all buzzwords and plumbing. That’s designing the car. Now radiologists have to learn how to drive it.”

2. Multiple creators and consumers. Radiologists are no longer the only specialty that produces and uses diagnostic images. Today, cardiology, gastroenterology, pathology, and several other departments rely on imaging to provide proper patient care, so facilities must have a streamlined way to distribute scans throughout the health system.

“To do this right, you do need the architecture of a VNA or archive-neutral vendor, but there’s a bigger concept behind enterprise imaging,” Chang said. “This view is the realization of the modern enterprise that it must deal with both consumers and producers of images simultaneously throughout the hospital — not just radiology.”

 3. Ubiquitous electronic health records (EHR). The concept of an EHR isn’t new to radiology, an industry that has used PACS and RIS for many years. But now, meaningful use requirements are calling upon the specialty to interface seamlessly with patients’ records through an entire health system. Consequently, according to KLAS imaging research director Ben Brown, all new systems must be interoperable. It will be up to a facility’s IT department, Brown said, to create an infrastructure that manages and stores PACS, maintain a patient index to ensure proper patient identification, and determine how long images are stored.

4. The enterprise concept. Years ago, when radiologists discussed “the enterprise,” the term referred to anyone outside the department who still worked within the hospital’s firewall. But as health systems have expanded and more specialties have become image producers and consumers, the definition of “enterprise” has expanded, Chang said. Radiology groups have consolidated, many facilities within the same system are separated by hundreds of miles, and providers are now required to read scans for multiple hospitals.

The logistics of moving images from one facility to another aren’t difficult — the real challenge comes in coordinating the workflow needed to properly use transferred scans. According to Rasu Shrestha, MD, MBA, a University of Pittsburg Medical Center radiologist, however, the potential exists, for EI to have a significant positive impact on work  flow management.

“[EI] allows for a patient-centric approach to care versus an image- or application-centric approach,” he wrote in a 2012 Applied Radiology article. “It allows for the possibility of true collaboration among care teams, which would bring the value of imagers back into the spotlight.”

5. Tying it all together. The real challenge behind effective EI, Chang said, is to fuse the needed technology with the proper workflow perspectives. But it can be helpful, he said, to consider that EI is less about imaging and more about radiology’s need to re-invent itself as healthcare enters a new chapter of value-based purchasing.

“The concept of enterprise imaging is a proxy or code word for having to re-engineer a more useful, comprehensive workflow solution for a more complex enterprise,” he said. “It’s better not to talk about enterprise imaging but talk about re-engineering ourselves so we can continue to add value.”

How can you plan?

It’s no longer a question of whether EI is right for your practice or department. Radiology’s move toward EI is clear, and it’s up to you to determine how you will navigate these new waters. There are many moving parts with this imaging strategy, Chang said, but you can outline your course of action by remembering one question: “What is the role of radiology or the radiologist in this decision?”

For example, as the end-user, you can — and should —tell your IT department what you need out of a VNA, but don’t expect to be included in any purchasing decisions. The facility’s chief financial officer and chief information officer will make that determination, he said.

You will, however, have a greater role — alongside cardiologists and other providers — in determining how the VNA architecture will support your needs and workflow. In addition, you must make it clear to your hospital administrators and IT department that any EI system must offer interoperability for the strategy to succeed, said Robert Barr, MD, president of Mecklenburg Radiology Associates in Charlotte, N.C.

Through interoperability, he said, his practice — which has been using EI for several years — is able to quickly migrate images between all subspecialties, streamlining patient care and facilitating greater access to patient records.

Your biggest role, however, will be in providing evidence that supports the true value you bring to your facility. Your worth is no longer tied solely to the number of interpretations you produce daily, Chang said. You must now demonstrate your impact on patient outcomes, population management, and down-stream resource utilization and cost control.

“In the fee-for-service environment, we could be selfish and insular in our thinking. We floated everyone else’s boat,” he said. “But now we’re a cost center, and every CT you order better be worth it. Justify it, and demonstrate its positive impact.”

To read the remainder of the article at its original location: http://www.diagnosticimaging.com/enterprise-imaging-beyond-cloud-based-image-sharing/page/0/1

April 10, 2013 Posted by | Healthcare | , , , , , , , , , , , , , , , , , , , | Leave a comment

Vendor-Neutral Archives: The Rapid Shift in Image Archiving

Published on the Aug. 24, 2012, DiagnosticImaging.com website

By Whitney L.J. Howell

When it comes to image storing, PACS still rule the industry. But vendor-neutral archives (VNAs) — products that help you store and share studies across manufacturer systems — are gaining market share fast.

While only 5.4 percent of the nearly 1.5 billion worldwide imaging studies were stored by VNAs in 2011, VNAs are expected to archive more than 30 percent by 2016, according to a May 2012 InMedica report. In fact, a 2012 KLAS report found 27 percent of providers already plan to include VNAs in their image-storing strategies.

“As we’re moving into health care reform, sharing data with other hospitals to coordinate care will be tough if we have to do it across 10 different PACS vendors,” said Chris Tomlinson, executive director of Radiology Associates of The Children’s Hospital of Philadelphia. “By purchasing a VNA, we could segment ownership from the viewers we read things in. It was like getting out of PACS jail, and it’s a great way for radiology to take a lead role within an institution.”

The shift toward VNA implementation has been — and, by most estimates, will continue to be — rapid. And, it’s a move that will impact your purchasing decisions, your image management, and how you shuttle images between institutions. The question, however, is what those impacts will look like.

Making a Purchase

Whether you work in a private practice or a hospital, roughly one-third of image CDs sent from one institution to another are unreadable because the PACS systems are different. This problem has long been understood as a patient-care issue, but it’s also a financial one, said Steve Tolle, senior vice president for solutions management for Merge Healthcare, vendor for the VNA system iConnect.

“Every image CD sent costs about $15 in addition to staff and physician time,” he said. “A hospital can spend between $60,000 and $70,000 annually on courier costs just shuffling CDs between hospitals. That’s a hard savings that can be had with the enterprise and share functionalities of a VNA.”

But you must be careful when selecting a VNA. Examine potential VNA vendors carefully, said Michael Gray, lead consultant at Gray Consulting, because some have modified their marketing efforts to sell PACS systems as VNAs. After you’ve narrowed your vendor choices down, request quotes from each. Remember, if the price tag is high, you can implement a VNA in stages, such as only replacing your tape library, to control costs.

“Identify what’s the most important thing for you to do right now. Do you want to move all your data? Do you want to stick it in a data center?” Gray said. “Have vendors show you creative pricing for putting in part of a VNA. Few real VNA vendors are so busy chasing the $4 million deals that they’re too busy to tell you what you can do for a couple hundred thousand.”

Impacting Image Storage and Management

Most hospital departments operate in separate worlds, making it difficult to share images across institutions. However, expected increases in team-based care and bundled payments will likely make this business and care model unsustainable.

“Interoperability is where we’re going in this world. We’re going to have to share images, so we can’t have these silos of data sitting around,” Holle said. “VNAs offer an entire view of a facility’s diagnostic images, and they provide a solution for all specialists — the cardiologists, the radiologists, the pathologists and others.”

Merge’s iConnect brings together images from any PACS in an institution and offers replicated content management, a feature that supplements back-up recovery by making and storing elsewhere automatic copies of images and data. iConnect also uses a standardized DICOM format that all vendor equipment can access, Tolle said.

Using a VNA will also impact how you interact with your referring physicians, said Merge’s Kurt Hammond, vice president for interoperability solutions. This tool can help you meet growing patient demands.

“Turnaround time is getting really aggressive as physicians expect faster and faster image reads for their patients,” he said. “With a VNA, you’ll save time because there will only be one place to go for images no matter which department they’re coming from.”

According to Shannon Werb, chief operating and strategy officer for Acuo Technologies, employing a VNA also provides you the autonomy to change how you manage your system or distribute your images without contacting the manufacturer.

Acuo’s VNA product, UCP3, is similar to iConnect. However, in addition to DICOM standards, it supports the global authority on international health information technology interoperability Health Level Seven International (HL7) and Integrating the Healthcare Enterprise (IHE) profiles, including Cross-Enterprise Document Sharing (XDS).

VNAs can also save you the time and money you’d expend when migrating imaging data from an old PACS to a new system. Currently, it’s easier to let your PACS vendor transfer the data because it’s time consuming and can be confusing. Often, vendors change DICOM headers, such as CT of the head to CTHead or HeadCT, making it impossible to find some images if they aren’t categorized correctly in the new PACS. The cost for this service is often between $200,000 and $300,000.

To view remainder of story at original location: 


August 31, 2012 Posted by | Healthcare | , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , | Leave a comment


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