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Advancing Imaging Informatics: Looking at the Leading Edge in Accessibility of Images Across the Medical Enterprise

November 11, 2013
by Rajiv Leventhal
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Healthcare IT leaders are changing the way they analyze and exchange medical images—but challenges remain

As the landscape in imaging informatics continues to shift, the challenge for healthcare IT leaders lies in being aggressive in their strategies to keep up with accelerating new technological and process trends. Imaging informaticists are devoting themselves to looking at how information contained within medical images is retrieved, analyzed, enhanced, and exchanged across—and beyond—the patient care enterprise. The leaders are also looking at how diagnostic images fit into a changing medical practice landscape and the thrust toward patients’ ownership of their images.

The most progressive organizations are beginning to explore a universal viewing application to interact with their electronic medical records (EMRs), says Joe Marion, founder and principal of the Waukesha, Wis.-based Healthcare Integration Strategies, which assists clients with imaging strategy and implementation. Those who are looking to advance, says Marion, are doing it through a vendor neutral archive (VNA) architecture. Historically, of course, medical image storage has been under the control of individual picture archive and communications system (PACS) applications, requiring management of that data to be completely reliant upon system functionality.

Joe Marion

Healthcare facilities have now begun to deploy VNA technology to consolidate image archive and data accessibility. As imaging data throughout the enterprise grows, so does the need for a VNA for more cost-effective storage. “Moving to a VNA can reduce migration costs and avoid the proprietary data storage often found in PACS applications, making information more accessible,” says Marion. “If you can store all of the service areas in one environment, there is a cost savings from having that singular platform as opposed to multiple platforms.” As such, according to a recent report from research firm MarketsandMarkets, the global VNA market will hit $165.3 million and will grow by 15.2 percent annually to $335.4 million by 2018.

Mark Jacobs, CIO of the Delaware Health Information Network (DHIN), a health information exchange (HIE) that serves all of Delaware’s hospitals and providers, says that for an HIE, the biggest challenge with medical images is community viewing, which can be described as “a work in progress.” But Jacobs agrees that the VNA is a critical component to community viewing. “If you look at community viewing, just implementing a UniViewer in the community is going to be problematic because of response times, access speeds, and bandwidth issues. Remember, you’re talking big, heavy images. We have learned with an HIE, if you have to wait for anything at the point of care, physicians will get frustrated and not use it. If the world was perfect, we would have the UniViewers, big communication pipes, and also a VNA—those are three success components for community viewing. But it’s a very expensive business proposition.”

The next step in image exchange is the rise of HIEs, which has been recently expanding, adds David Mendelson, M.D., director of radiology information systems at the N.Y.-based Mount Sinai Medical Center. Cross-enterprise document sharing for imaging (XDS-I.b) extends XDS to share images, diagnostic reports, and related information across a group of care sites.

Mendelson is also co-chair of Integrating the Healthcare Enterprise (IHE), an initiative designed to improve the way computer systems in healthcare share information. IHE promotes the coordinated use of established standards such as Digital Imaging and Communications in Medicine (DICOM) and Health Level Seven International (HL7) to address specific clinical needs in support of optimal patient care.

David Mendelson, M.D

When the HITECH (Health Information Technology for Economic and Clinical Health) Act was passed, image exchange became a major agenda item in the White House, and thus for the National Institutes of Health (NIH). Over the last four years, says Mendleson, using NIH funding, IHE has established a small, but growing, network of hospitals that are enabled to export—with patient consent—images into the servers of a few vendors that maintain image-enabled personal health records. The idea moving forward, he says, is to build a network such that it uses an infrastructure that is very similar to the infrastructure used for HIEs, so they can all live on the same national highway. “We are trying to get the vendors to all adopt this XDS standard, so no matter how you exchange images, it’s all the same standard,” he says.

As Jacobs notes, though, for many healthcare organizations, cost remains a major barrier when it comes to being progressive with their medical imaging capabilities. At the five-hospital University of Colorado (UC) Health, MariJo Rugh, vice president of application services, says finances are one of the system’s biggest deterrents right now. “If you look at the cost per study in your own PACS system, and an additional cost for the cloud to share the image, it adds up. Each image you need to store has a significant dollar value associated with the storage and exchange of it. Then, you get into image life management, such as how long you will hold onto it, based on how much storage you’re going to have. It all comes back down to cost.”