If anyone might be said to have a big-picture view of the future of imaging informatics, it would be Rasu Shrestha, M.D., vice president for medical information technology and medical director for interoperability and imaging informatics, at the University of Pittsburgh Medical Center (UPMC) health system.

Shrestha, who practiced as a radiologist for a number of years before gradually moving towards full-time imaging informatics management and strategy, is helping to lead a revolution in informatics across this vast integrated healthcare system, which encompasses 20 hospitals, 400 outpatient sites, nearly 50,000 employees (including 2,700 employed physicians), and, when it comes to imaging, has a staggering 400 terabytes worth of radiologic images stored in its servers (out of 1.9 petabytes of data and images system-wide), and whose clinicians are performing 2 million diagnostic imaging exams a year across UPMC's 20 hospitals and 30 imaging centers.

Given such a huge volume of images and studies, as well as diverse PACS systems across its hospitals and imaging centers, it should come as no surprise that Shrestha and his colleagues would have “developed a number of things around addressing the pain points” in terms of physician access and management of information, as Shrestha puts it. Indeed, one of the signal informatics achievements of the past few years at UPMC has been the development of a platform called SingleView.

SingleView is not a vendor-neutral archive, Shrestha emphasizes. Instead, it is a federated platform. “It's like an umbrella,” he explains, “deployed across 20,000 desktops across UPMC. And both attending radiologists and referring physicians rely heavily on SingleView, because it provides a federated view of the patient across systems.” Rather than acting as an archive, SingleView works in the background, he explains, “bringing up different radiological reports from other hospital's within the enterprise, and from other PACS systems that previously did not talk to each other.”

Work began on developing SingleView after a conversation Shrestha had had with a UPMC radiologist who is considered one of the top MRI neuroradiologists in the U.S. That doctor had fortuitously guessed at the existence of a study for a patient who had been treated in two different UPMC hospitals during different periods of time. The logic of creating a federated view, Shrestha says, was unassailable. So he and his team set to work, architecting the federated platform within about six months.

SingleView has proven to be a great success among physicians across UPMC, Shrestha reports. What's more, the platform's capabilities will only become more broadly applied, as the integrated health system moves forward in multiple informatics areas, including, notably, its breakthrough digital pathology initiative, announced late last year as a partnership with GE Healthcare, through the longstanding UPMC-GE joint venture, Omnyx.

As digital pathology comes online, and as other specialties move forward with digital informatics initiatives, it will be through such architected solutions as SingleView that UPMC clinicians will be able to make the most of the vast, if highly diffuse, resources, of their integrated health system, Shrestha says. He adds that the benefits will be improved patient safety, care quality, clinician workflow, efficiency, and cost-effectiveness. In other words, getting the big picture will continue to be an essential part of the journey forward in clinical informatics.

Healthcare Informatics 2011 November;28(11):14-15