Feature | Enterprise Imaging | March 02, 2017 | By Jeff Zagoudis

In an itnTV video, Contributing Editor Greg Freiherr describes enterprise imaging advances shown at RSNA 2016.

RSNA Technology Report 2016: Enterprise Imaging

Conserus Imaging Fellow from McKesson collects all relevant patient data--including surgical history, medications, lab results and admission/discharge notes--and consolidates it into one easy-to-navigate interface.

In the days before picture archiving and communication systems (PACS), collaboration between various hospital departments was extremely difficult, as clinicians could only consult with each other in person. Today, enterprise imaging allows providers to interact from wherever they are with all of the relevant clinical data stored in one place.

ITN Contributing Editor Greg Freiherr spoke with numerous enterprise imaging vendors at the 2016 Radiological Society of North America (RSNA) annual meeting for a feature video, available on itnTV, to find out how they are working together with clinicians to enable this enhanced level of care. 


Combining Technology and Clinical Experience

The goal of enterprise imaging is to ensure all members of the patient management team have the information necessary to make the best decisions about patient care. While technology is an important part of any enterprise imaging (EI) strategy, the tools are only helpful if they are wielded with the proper clinical experience. 

With Conserus Imaging Fellow, its newest EI offering at RSNA 2016, McKesson looks to assist radiologists with both aspects of their enterprise imaging strategy. “You need to work with each institution to understand how are they going to differentiate on value-based medicine. What is important to them?” said Scott Galbari, McKesson vice president of marketing and portfolio, in the
itnTV video. 

Conserus Imaging Fellow collects all relevant patient data — including surgical history, medications, lab results and admission/discharge notes — and consolidates it into one easy-to-navigate interface. According to Galbari, the goal is to find “the needle in the haystack” — the information that is most important for the radiologist to make a decision about that patient and that particular clinical disease state. 

The system offers full electronic health record (EHR) integration; a vendor neutral design and flexible configuration options allow it to be used in any hospital setting. “They don’t have to search for it, they don’t have to make phone calls to other departments. It’s all right there,” Galbari told Freiherr. 


24/7 EHR Integration

The electronic health record provides another common area for all departments to contribute their expertise to patient care by creating a patient-centric view of the information. And with radiology no longer the sole executor of medical imaging, the EHR acts as an archive of its own for all image types.

Sectra believes that clinicians should have access to these repositories anywhere at any time of day or night in order to be the most efficient. “With all our customers growing and the consolidation in the market, having IT systems available 24/7, 365 days a year is of key importance,” said Mats Bjornemo, VP of product management for Sectra. “It’s both for driving efficiency — because if it’s not available, all the other tools you have won’t make a difference — and also for patient safety.” The company prides itself on maintaining high uptime percentages, showing 99-100 percent uptime at five large hospitals in five different countries over a three-year period. 

Ultimately, Sectra believes that its PACS can be used to bring together a care team that has previously been fragmented into separate technological silos. “By helping each other out and by divvying up the work across the entire health system, rather than siloing it like before, you actually get more precise diagnosis,” Anders Osterholm, Sectra VP of sales operations, told Freiherr in the video. 


Bridging the Information Gaps

As the U.S. healthcare system shifts focus to patient-centered, value-based care, hospitals have had to get creative to maintain quality care while lowering costs to enhance patient satisfaction — a key metric under the Affordable Care Act and other reform efforts. Imaging can have an impact on all three areas, something radiologists must be aware of. “Radiologists really need to look holistically at the patient and the quality of care for that patient, and not just be so focused on driving transactional reading and revenue volume,” said Frank Pecaitis, senior VP of sales for Agfa Healthcare, in the itnTV video

Pecaitis told Freiherr that organizations often purchase new technologies, such as vendor neutral archives (VNA) as short-term solutions. “We look at it more as a medical library, and those images are an organizational asset, part of an enterprise imaging platform and strategy,” Pecaitis said. With its Enterprise Imaging Platform, Agfa can help mitigate information gaps for clinicians and develop a cross-enterprise workflow. Customers can opt for a best-of-breed approach or utilize the company’s platform approach to enterprise imaging.  


Streamlining Workflow

One of the biggest challenges of coordinating care across multiple departments is that each department often has its own unique workflow, so finding information can be difficult for people outside their own group. An enterprise imaging system can help solve this problem by offering one unified workflow that all -ologies can follow. 

“When you talk about enterprise imaging, it’s no longer radiology looking out, but rather, coming from a CIO perspective, how is this helping me? How is this integrated into my ecosystem?” Cristine Kao, global marketing and growth operations director for Carestream, told Freiherr in the itnTV video

Carestream has made this principle the bedrock of all of its enterprise imaging/viewing technologies, powered by what it calls the Unified Core. The zero-footprint technology aims to consolidate all clinical content to a single point of access, supporting four workflow pillars: 

•      Acquisition — Images can be acquired anywhere with any device, including at the point of care with mobile devices. 

•    Management — The Unified Core allows care team members to access relevant information at the point of care or anywhere else via zero-footprint worklists.

•    Archiving — The system creates an enterprise repository for all clinical images, whether from radiology or visible light photos at the point of care. 

•    Viewing — Zero-footprint technology also allows both providers and patients to quickly and easily access medical records. In addition to medical image viewing, however, solutions like Carestream’s Clinical Collaboration Platform allow clinicians and administrators to take a wider view of performance analytics to ensure they are delivering the highest quality of care. This includes looking at performance from both an operational (e.g., report turnaround times) and a clinical perspective (e.g., ensuring data is gathered and reported accurately). 


Adaptive Intelligence in Enterprise Imaging

Artificial intelligence, also known as deep learning and machine learning, was one of the hottest topics at RSNA 2016, with multiple vendors showing off applications in radiology and enterprise imaging. Philips Healthcare has incorporated the technology into its IntelliSpace PACS via a new feature it calls Illumeo. Ilumeo employs adaptive intelligence similar to a map application on a smartphone: If the user searches for a restaurant in the map app, the algorithm will drop a locating pin on the map, and then provide information on the hours and menu in anticipation of what the customer needs. Illumeo behaves similarly, isolating the clinical focus of an image and providing any relevant information the radiologist will need to interpret the image. 

“Rather than just opening a study, scrolling through and having to figure out what the radiologist was referring to in the report, we can actually guide them to the right locations and show them what is relevant,” said Eran Rubens, chief technology officer, enterprise imaging, Philips Healthcare IT in the itnTV video

Lifecycle Management

Philips also introduced the Universal Data Manager for its IntelliSpace PACS that allows differing lifecycle management rules for different types of images (e.g., ordered vs. non-ordered) as they are archived. This can be extremely helpful in a modern environment where newly integrated hospital systems often bring with them different, complex infrastructures and rules for image storage. For example, a hand X-ray may be archived for a year while a pediatric image might have to be held for decades. The Universal Data Manager sits on top of all existing infrastructures to create its own rulesets. 


Efficient Data Exchange

As previously discussed, any enterprise imaging system must fit into the workflows of the various departments it serves to best facilitate efficient data exchange. At RSNA 2016, Mach7 Technologies showcased its best-of-breed hybrid approach that combines platform and VNA approaches.

“What is different is how we’ve simplified it, how we’ve made the data workflow behind the scenes much easier to implement and much easier to execute on those standards, and therefore consumable by IT teams and PACS administrators,” said Eric Rice, Mach7 chief technology officer. Recent updates have been driven by considerations like what steps does a wound care physician have to take to associate a picture or video captured at the point of care with an encounter or a patient in the EHR. The goal is to improve workflow so clinicians can access all of the relevant data needed for treatment. 

“As much as we are a VNA company, we’re a medical imaging company that delivers a complete solution across workflow to better exchange, manage and share medical imaging data,” Rice told Freiherr. 


Expanding the Enterprise Reach

Among EI vendors at RSNA 2016, Lexmark is one of the newest, having entered the market less than three years ago via acquisition of VNA companies and others focused on the capture and sharing of photos and videos. Most recently, Lexmark purchased Claron Technology, adding the NilRead viewer to its product portfolio. Since then, Lexmark has expanded the viewer’s capabilities, enabling it to perform both image-enabled EHR functionality and a fully diagnostic workflow — a rarity, according to Lexmark Chief Technology Officer Claudio Gatti, who told Freiherr that most zero-footprint solutions are only capable of basic viewing functionality.

“We started with radiology, and we can now essentially perform all the functions of a traditional PACS in a zero-footprint manner. Then as a strategy we started specializing in other specialties,” Gatti said in the itnTV video

This year, according to Gatti, NilRead’s capabilities expanded to include digital pathology and light-based specialties. The digital pathology functionality has been cleared for use in Europe, and the company hopes to have U.S. clearance within the next 12 months. 

For light-based imaging, such as surgery and gastroenterology, Lexmark added video functionality, and clinicians can even select smaller portions of a larger video to be archived into the EHR. 

If there was a common theme among enterprise imaging vendors at RSNA 2016, it was that medical practices must break out of their individual silos to form truly collaborative patient management teams. Enterprise imaging has the potential to break these patterns, change the decision-making environment and may even change the way decisions are made.

Editor’s note: Watch the video “Technology Report: Enterprise Imaging 2016” for additional information.

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