Seeing Things Differently With Enterprise Imaging in Radiology

As the enterprise imaging market matures, the technology used to access and view images is rapidly changing. This is a factor that directly impacts the ways in which physicians, radiologists, clinical teams, administrators and patients interact with healthcare image objects. Whether the image is a chest X-ray, computed tomography (CT) angiogram, echocardiogram cine loop, wound picture acquired by a mobile device, or a newly introduced 3-D breast tomosynthesis image, there is a growing expectation that the viewing technology must deliver vendor-neutral, seamlessly integrated, mobile, secure and interactive results.

Integrated delivery networks (IDN) undergoing enterprise image consolidations are faced with the challenge of combining various data and imaging silos that are indexed under multiple medical record numbers (MRN) or master patient indexes (MPI), thus creating a barrier for single longitudinal record access and visualization. In these cases, senior leadership will be looking for short-term bridge strategies that will allow them to produce a single technology to deliver all image objects regardless of the end-user mix. Having multiple viewers and picture archiving and communication systems (PACS) is no longer financially sustainable or clinically feasible in the new healthcare model that is now so sharply focused on clinical quality outcomes.

Current market viewers, however, offer healthcare providers the ability to federate their legacy PACS or other image repositories and display these images in a single patient context. This model allows expedited image enablement of the electronic health record (EHR) while eliminating cumbersome migration costs. Therefore, an organization struggling to decommission legacy systems is now able to integrate various image repositories and provide a single point of image viewing for all of its physicians via an EHR portal.

This opens the door to new innovations. Clinical and reference viewer vendors are now looking to expand on existing technology, designing it to offer broader diagnostic features and tools, whereas in the past, radiologists, for example, would simply have used an entirely different viewer. From the perspective of healthcare IT, having a single viewer to integrate and support is financially appealing, especially when it meets the ever-growing requirements of the clinical end-user community.

Watch the video "Creating an Enterprise Imaging System — RSNA 2015."

Mobile Access to Patient Data and Images

In this changing healthcare culture, patients are also becoming significantly more involved in their own care and are proactively looking for ways to stay connected. As a result, mobile access technology has grown exponentially over the last several years to provide a better means for doctors and patients to view the same sets of image objects. Whether a physician is reviewing a patient’s post-surgical hip X-rays in the office or a patient is gaining access to her fetal ultrasound via iPad, the Web-based HTML5 technology inherent in the viewer allows this to occur. 

Outside the reference viewer industry, many applications that offer built-in viewers are also focused on providing such alternatives to their proprietary and thick-client coded architectures. Combining secure access with the freedom of mobile technology, physicians are no longer glued to a single workstation in the hospital limiting their ability to increase their rounds and improve patient-to-physician interactions.

True zero-footprint viewers that have no plug-ins required are now capable of using server-side rendering to stream large image sets like CT angiograms with ease, giving clinicians the ability to do HTML5 image markups and annotations. This means streaming medical images to a mobile device has become as easy as streaming music videos online. As a result, depending on the user preferences or privileges, tablets in a busy healthcare environment have become powerful tools for physicians on the move.

Equally important is the ability for members of a care team to collaborate on patient care. As the concept of value-driven healthcare evolves, referring and specialty physicians will need to partner in new ways to enable more efficient coordination of shared patient diagnoses and treatment planning. Collaboration tools built into the viewer technology have significantly improved the ability for physicians to expedite the follow-up and clarification of any questionable pathology specialists have noted in image interpretations. In addition, such tools allow interactive work sessions between centers of excellence and areas that may not offer specialty services, bringing all available resources to the point of care and reducing unnecessary logistical challenges for the patient.

Important Considerations for Enterprise Imaging

• Know your image users: When selecting enabling technologies or designing a program for image access and visualization, it’s important to understand the various categories of image users and to define the requirements for the viewer based on the needs of the viewing audience, including:

    -  Diagnosticians: The physicians that read images and provide interpretations — radiologists and cardiologists are good examples.

    - Clinical decision-makers: Providers with a high reliance on images for patient care; these clinicians may also employ third-party software to manipulate the images. Neurologists and orthopedic surgeons fall into this category; an orthopedic surgeon, for example, will use a template to design a hip implant, manipulating the medical image to determine how much bone to shave for a proper fit.

    - Referential users: Most imaging users fall into this category; these are the care providers that view images for clinical reference purposes on a daily basis, most often via EHRs.

    - Remote users: People that are off-site — not in the hospital or clinic — comprise this category; many of these users view images on a mobile device.

    - Patients: Of course, patients are also an important consideration and a growing sector of the image viewing population.

• Keep it private: There are times when patients do not want “just anyone” inside the healthcare setting to view their images, so it is important to select a viewer that can customize the view based on the user’s role in the care setting.

For more information on enterprise imaging technology, watch the video “Enterprise Imaging - RSNA 2015 Technology Report.”

Editor's note: Val Kapitula, RT(R), CRT, PMP, senior consultant at Ascendian Healthcare Consulting, is a frequent contributor to publications and forums focused on cardiovascular operations, services and HIT innovation.