What is Enterprise Imaging and Why Does My Organization Need It?

Someone in your organization has told you that you need an Enterprise Imaging program. What does that mean and what is the organization going to gain from this not so insignificant investment? This initial article will provide the answer to part I of the question: What is Enterprise Imaging? We’ll approach this question from a non-technical viewpoint.

Enterprise Imaging in Perspective

To put Enterprise Imaging in perspective let’s review a few facts:

• Healthcare information is doubling every year
• Medical images comprise 90% of healthcare data
• Healthcare has not yet begun to harvest the full power of medical images
• AI will provide the tools to extract this untapped information

Looking at medical images from this perspective creates a compelling motivation for making sure a healthcare organization derives the most value from its medical images. This value may be realized in the form of enhanced quality of care or pure monetary value. IBM Watson paid 1 billion dollars to buy Merge Healthcare to secure access to its imaging assets. By images we don’t just mean radiology studies. Cardiology studies, ophthalmologic imaging, photographs, videos, audio files all fall into the category of medical images. Almost every medical specialty generates some form of medical imaging.

Enterprise Imaging as a Data Management Strategy

If we consider images as data and data as assets that our organization needs to manage, we can easily put Enterprise Imaging into a data management framework. In any industry, in order to generate the greatest value from data assets, the data need to be actively managed.

A Deloitte Insights paper provides an excellent description of a data management strategy, one that was easily modified to address healthcare and imaging assets.

Original

“A data strategy provides an organization with direction. CDOs can use the data strategy to organize disparate activities, consolidate siloed data, and orient the organization toward a cohesive and unified goal. The aim is to set the stage for treating data as an asset, resulting in improved decision-making, enhanced user insights, and greater mission effectiveness.â€

Modified for Enterprise Imaging

“An Enterprise Imaging strategy provides an organization with direction. Healthcare systems can use an Enterprise Imaging strategy to organize disparate image generating activities, consolidate siloed data, and orient the organization toward a cohesive and unified electronic health record. The aim is to set the stage for treating data as an asset, resulting in improved clinical decision-making, enhanced clinical insights, and greater healthcare value.â€

According to HIMSS best practices in healthcare data management include:

1. Early implementation of governance
2. Creating a centralized repository
3. Providing accessibility
4. Ensuring data quality
5. Utilizing analytics

Healthcare has already embarked a parallel journey with the electronic medical record (EMR). Paper medical records and disparate specialty specific EMRs have now merged into one centralized EMR with dedicated functions designed to meet the needs of various medical specialties. We must approach the remainder of electronic health information with the same rigor.

The Official Enterprise Imaging Definition

The official definition of Enterprise Imaging was developed by the HIMSS-SIIM (Healthcare Information Management and Systems Society and Society of Imaging Informatics in Medicine) Enterprise Imaging Community. Their definition:

“a set of strategies, initiatives and workflows implemented across a healthcare enterprise to consistently and optimally capture, index, manage, store, distribute, view, exchange, and analyze all clinical imaging and multimedia content to enhance the electronic health record.â€

This definition embraces the entire journey of an image. It reflects the multi-faceted nature of an Enterprise Imaging program with clinical informatics and imaging informatics as important contributors.

Basic Structure of an Enterprise Imaging Program

Let’s explore the components of an Enterprise Imaging program as they relate to the basic functions of a data management program as outlined by HIMSS.

Governance

Every successful Enterprise Imaging program begins with a strong governance structure. As with any data management program this governance sets the guidelines for the program ensuring its overall benefit to the organization.

Centralized repository

The core technology in an Enterprise Imaging program is a vendor neutral archive (VNA). A VNA is able to store images in a multitude of formats from jpg and png images, to videos, audio files and file formats generated in radiology and cardiology. A VNA can accept images from any image generating device regardless of the vendor.

The VNA accepts images from diagnostic systems across the organizations. These systems range from the picture archiving and communication systems (PACS) in radiology and cardiology, to videos creating in surgery or a gait lab, to pathology whole slide images, to photographs created on a smartphone.

Encounter-based workflow tools provide the necessary integration for images generated at the point of care. For example, ultrasound in the emergency room or critical care unit.

Accessibility

A universal viewer allows patients and providers to view all of the images in the VNA. Images can be compared across time, geographic locations, and departments. The universal viewer can be integrated with the EMR to create an efficient EMR-centric provider workflow. Mobile access to images is possible.

The VNA provides a central point for image exchange. Externally generated images are imported into the VNA. Internally generated images can be shared with other organizations involved in a patient’s care.

Data quality

Standardization is a key component of Enterprise Imaging. Workflows are standardized enabling rapid reproducibility as new devices are brought online. Metadata (data about the data) is standardized so that the images are easily located, searched and filtered.

Analytics

A single source of data is critical to establishing any type of sophisticated analytics program. With the VNA all images are in one archive. These images can then be examined to gain insights about individual patients and our patient populations.

Final Thoughts

This overview sets the stage for future discussions about Enterprise Imaging. It addresses Enterprise Imaging in the framework of data management and introduces the basic structure of a program. We will continue to utilize the data management framework in future articles. Our next article will address the value of Enterprise Imaging as it relates to the Quadruple Aim.

References

1. Beyond Imaging: the paradox of AI and medical imaging innovation. https://www.myesr.org/article/1934. Accessed September 18, 2020
2. Why IBM just bought billions of images for Watson to look at. https://www.technologyreview.com/2015/08/11/166774/why-ibm-just-bought-billions-of-medical-images-for-watson-to-look-at/#:~:text=Images%20are%20estimated%20to%20make,information%20systems%20at%20IBM%20Research. Accessed September 18, 2020
3. Data as an asset. https://www2.deloitte.com/us/en/insights/industry/public-sector/chief-data-officer-government-playbook/data-as-an-asset.html. Accessed September 20, 2020
4. Realizing the true value of data management. https://www.healthcareitnews.com/blog/realizing-true-value-data-management. Accessed September 20, 2020
5. A foundation for enterprise imaging: HIMSS-SIIM collaborative whitepaper. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5023525/pdf/10278_2016_Article_9882.pdf. Accessed September 21, 2020