Enterprise Imaging: Not Business as Usual

Posted on July 27, 2018 by Larry Sieb   

A common complaint is the difficulty in getting traction for Enterprise Imaging (EI) Systems in health care systems, especially in IT departments. Three issues arise when the topic of EI comes up, usually in the following order. First is that EI is just another project. Estimate the cost and the timeline, and it may get on the approved list. Next would be what is the ROI or why should we do this? The last hurdle may be a stipulation to use the existing imaging resources for EI.

Enterprising Imaging
Image from: A White Paper Foundation for Enterprise Imaging: HIMSS-SIIM Collaborative Roth, C.J., Lannum, L.M. & Persons, K.R. J Digit Imaging (2016) 29: 530.

Enterprise imaging is not another project but an enterprise strategy. EI puts all of the images generated in the health system into an indexed, digital archive. Images can be immediately accessed by all clinicians with relevant information on how, when, and where the image was acquired.

An assessment of image generating departments can illustrate the magnitude of an EI program. Finding 60 plus departments acquiring images employing hundreds of devices is common. EI is not just another radiology or cardiology PACS but is an enterprise strategy and a commitment to 60 plus or more imaging projects over a period of years.

Enterprise imaging is a value proposition to both the image generating departments and to the enterprise as a whole. Storing images with appropriate documentation allows these exams to be billed recovering lost revenue – a benefit to the department and the enterprise.

Having the exams indexed in a central archive reduces cost by eliminating manual searches by departmental staff to retrieve images. These images are also viewable in the EMR by appropriate clinical staff which benefits the enterprise.

Moving images from departmental silos increases security avoiding potential breaches and fines. Cost avoidance benefits the enterprise and the department. The increased revenue, decreased cost, and cost avoidance can be quantified for each department that moves to the EI system.

The HIMSS Analytics Electronic Medical Record Adoption Model (EMRAM) was modified to include patient centric storage of non-DICOM images in Stage 1 on January 1, 2018. The HIMSS Analytics Digital Imaging Adoption Model (DIAM) addresses Enterprise Imaging with an 8 stage model. It is on track to be finalized by the end of 2018.

Most US Hospitals participate in the EMRAM program.  All will need to address EI to continue in the future.

Enterprise imaging is not another PACS project or a series of PACS projects. Nor is EI a radiology project. The work flows and the types of images do not follow the PACS paradigm. Often images are taken at the point of care with no orders with visible light devices that are not DICOM compatible. A separate Enterprise Imaging team and governance structure are needed to manage and implement these projects. Successful EI strategies usually have strong C-Suite support.

The governance council will determine the EI roadmap, set priorities, and criteria for selecting candidates to move to the EI system. The council should include members from IT, operations, cardiology, radiology, and representatives from the other o’logis.

The governance council membership will evolve as the EI strategy progresses and other departments are brought onto the EI system. Initial members from the other o’logies are often departments with the greatest interest and/or greatest needs. Some health systems require a clinician champion from the department prior to starting a project to include it on the EI system.

Understanding the breadth of an EI strategy, the overall value to both the departments and the enterprise, and the importance of governance are crucial to the success of Enterprise Imaging.