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‘Enterprise imaging’ is one of the most popular topics within healthcare IT circles today, and it’s no surprise why as within these two simple words lies a lot of potential. Enterprise imaging promises to tear down the silos that traditionally existed between disparate healthcare providers, departments, and facilities. It promises to create a truly unified patient record that is centrally managed and accessible by care providers and patients alike, in real-time. And, it promises to do all this while reducing costs and improving operational efficiency.

Such a state would finally allow patient records to be truly portable, enabling patients to assume ownership of their medical records and empowering them with the flexibility and freedom of choice to navigate the healthcare system with greater ease. As well, care providers would be equipped with critical insights into their patients’ medical conditions and history directly at the point-of-care, allowing them to make timely and informed decisions that ultimately lead to better clinical outcomes and preventative care initiatives.

So why then is Enterprise Imaging still a topic of discussion, and not yet a widely adopted reality?

While the vision is straightforward, the path there is considerably less-so. Every healthcare organization is different, every vendor is different, and it seems that most of the time there are more questions than answers. Should we go with a single vendor that offers a consolidated platform, or pursue a ‘best-of-breed’ strategy that allows us to pick and choose my favourite solutions? Should we update or replace our systems all at once, or take a more progressive approach that leverages our existing infrastructure? Should we host solutions ourselves, or consider a cloud-based and vendor-managed alternative?

Successfully deploying a centrally-managed enterprise platform that intelligently aggregates diverse imaging data from across the care continuum has broad implications and requires a carefully orchestrated approach to solution design that includes a thoughtful analysis of your current situation inline with your unique near and long-term goals.

Our Six Tenets of Enterprise Imaging provides a roadmap that can methodically guide you through the process of developing a complete Enterprise Imaging strategy that is tailored to your unique needs. While it may not provide all the answers up front, it breaks down the key components for success into manageable and actionable steps that consider your workflows, resources, and budget:

  1. Governance: ensures you have the people and processes in place to make informed and timely decisions
  2. Enterprise Platform: addresses the technologies required to build a scalable and performant foundation
  3. Workflow: enables efficient task orchestration and communication between providers and systems
  4. Visualization: delivers unencumbered access to images and tools to care providers across the care continuum
  5. Exchange: allows secure sharing of critical patient information with outside provider or payer networks
  6. Analytics: unlocks the clinical and business insights hidden across your enterprise

To see the big picture, download our infographic. To learn more about each tenet subscribe to our blog, where we will be discussing the key considerations and implications of each in turn.

 

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As we slide toward RSNA, there is growing interest in Enterprise Imaging. We saw a groundswell of activity related to sessions, roundtables, vendor narratives, and provider interest at SIIM just a few months back. We are clearly in a phase of growing momentum in achieving better outcomes, cheaper, more efficiently, more carefully, and with a long view toward future success. Including imaging as part of the patient jacket has always been top of mind with those of us who engage primarily with imaging service lines, but it now becoming important to those in leadership for several reasons. First, it is the completion of the work with adopting EMR – adding all patient information to the patient jacket in a single platform or portal. Secondly, the sheer cost and complexity of imaging requires adopting newer technologies and innovations to achieve better business models. Third, policy is driving change in how we are, and will be, reimbursed; sharpening our data management models within imaging require better solutions. And finally, patient-driven care is rapidly approaching the point where it will bend the curve on business strategy and volumes.

The success of this initiative will rest largely on the comprehensiveness of the organization’s self-awareness, the empowerment of a healthy governance structure, and the willingness to learn and adapt interactively throughout the project lifecycle. Success is no longer built on the technology platform or vendor of choice, albeit this is certainly a factor. Consider that few, if any organizations are still following their original imaging roadmaps. This is due to many different forces including mergers, acquisitions, vendor changes, policy modifications (MACRA), market changes and technology innovation. Carefully adapting to these shifts in an unstable environment means spending enough time on strategy, goals, outcomes and philosophy. These foundations serve as guiding principles and indicators of the ongoing success of an enterprise imaging initiative.

Finally, it is often said that everyone is approaching EI differently. Yes, this is true. But there are many things systems are doing similarly. We have standards, and we all deal with the challenges associated with proprietary formats, proprietary tags, immature IHE profiles, integration workarounds, and supplementing solutions with peripheral technologies and workflow. There is much we can learn from each other’s experiences. This exchange of ideas is of growing value as demonstrated by the level of involvement in the HIMSS/SIIM Enterprise Imaging Workgroup as well as the growth in attendance at imaging shows as well as the breadth of session topics. We do well to avoid common mistakes. While we cannot “copy and paste” someone else’s specific strategy or roadmap to our own ecosystem, there are many lessons we can learn from each other. Moving our industry away from an “Us versus them,” mentality to a collaborative system of shared experiences will not only assist with greater local success, but ultimately reduce costs and risks associated with remediation of bad implementations.

 

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I travel for work. A lot. I meet many people and as those that know me will tell you, I talk to as many as I possibly can. I love hearing stranger’s stories, and am always hoping to learn new things and make new friends. Last week, I struck up a conversation with a woman at an airport who was looking like she could use an open ear. We were both waiting for the same flight, and worrying about a missed connection in the next city. It turns out she was travelling to tell her daughter that she has been battling breast cancer for over a year, and her outcome was not looking good.
Her reason for not telling her daughter sooner, or over the phone, was that her only daughter is in her last year of college, and she was afraid that the news would cause her daughter to quit school to care for her. As a mother, her need for her daughter to be successful was more important to her than anything going on in her life at that moment.

Catching Up

We talked about how the diagnosis was missed for well over a year. Her original complaint was pain from her breast radiating to under her arm. First it was thought that she had pulled a muscle, but when rest and physical therapy did not resolve the pain, she was sent for imaging. Despite a mass being visible on mammography and ultrasound, her physician said ‘it wasn’t solid and didn’t look cancerous’. Over a year of increasing pain and fatigue and numerous visits to different doctors, she had a breast MR. With this study, cancer was found in both breasts and had invaded her lymph nodes. Further studies showed metastasis outside of her breasts. She was thankful for the imaging studies that found her cancer. She was thankful for the Affordable Care Act (Obamacare) and her ability to maintain insurance throughout the first round of treatments, but frustrated at her perception that NO ONE would listen to her when she was telling them something was wrong.
We talked about the lengths mothers go to protect their children. We talked about how proud we were of our daughters. We hugged and cried together, and exchanged email addresses. I told her my work brings me into contact with some resources that may be of assistance to her in the near future.

Our healthcare system is broken. A daughter will lose her mother, she will never see her daughter be married, or her grandchildren be born. The world is losing a kind, compassionate woman who put herself into the hands of medical professionals who failed her at every turn.

I have no closing statement, just a heavy heart and a new friend who I hope will be around to share her story with others. Peace.