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At Indiana University Health, a Push into an Enterprise Imaging Strategy

August 22, 2017
by Mark Hagland
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At Indiana University Health, leaders are pushing ahead on a broad implementation of an enterprise-wide imaging archive

As the leaders of patient care organizations move forward to evolve forward their IT infrastructures, they face a range of choices, challenges, and opportunities. When it comes to the imaging informatics sphere, most patient care organizations are moving to some version of a vendor-neutral archive-based strategy, in order to reorganize imaging informatics for more optimal data and image sharing and storage. VNAs are, over time, replacing outdated structures that have been radiology-centric and based on PACS (picture archiving and communications system) architecture, and putting instead in their place enterprise-wide architectures that encompass all the “-ologies,” as insiders refer to them: cardiology, dermatology, gastroenterology, and so on.

Moving forward on the journey into more advanced imaging informatics is certainly the reality at the 17-hospital, Indianapolis-based Indiana University Health (IU Health), where Kenneth Buckwalter, M.D. and David Hennon are helping to lead a transition towards a more advanced imaging informatics architecture. Dr. Buckwalter, a radiologist who has been practicing nearly 30 years, works at IU Health Physicians, the largest of IU Health’s four physician groups. Together, there are 2,500 physicians in the four groups, with 1,700 of them working within IU Health Physicians. Buckwalter works part-time within system informatics at the health system, on the same team as Hennon, who is IS director for clinical technologies. That division encompasses “pretty much everything except for the EHR,” Hennon notes, referring to the organization’s electronic health record.

Buckwalter and Hennon are leading the broad imaging informatics upgrade, moving through a variety of steps on what everyone acknowledges is a journey over time. Recently, in an internal document summarizing the organization’s overall strategy in this area, Buckwalter and Hennon wrote, “We are uniquely poised to take advantage of our existing VNA infrastructure and catapult our organization forward into the developing realm of Enterprise Imaging [EI]. Sharing images acquired in the current department silos opens up the potential to reduce costs, improve patient care, enhance our educational mission, and create opportunities for unique clinical research.”

What’s more, they wrote in the strategic planning document shared with colleagues this spring, “Building upon the lessons learned from our point-of-care ultrasound pilot will enable us to develop an appropriate governance model which is essential to set institutional priorities and serve as a clearing house for EI projects. If we can catalyze the momentum, we can build upon the enthusiasm of our early physician champions of EI and begin to coordinate activities.”

Recently, Buckwalter and Hennon spoke with Healthcare Informatics Editor-in-Chief Mark Hagland regarding the strategic journey around imaging informatics at IU Health. Below are excerpts from that interview.

Tell me about the clinical technologies division at IU Health?

David Hennon: Our division manages pretty much everything except for the EHR, including most of the clinical applications except for the EHR.

Kenneth Buckwalter, M.D.: And so that includes PACS, and the enterprise archive. And, in that context, I’ve worked with Dave for nearly 20 years.

Tell me a bit more about the initiative that you’re all involved in, to create an enterprise archive?

Hennon: We had been seeking funding for the infrastructure for an enterprise archive for several years, but had received the funding last year to stand up the software infrastructure to stand up an enterprise archive. And Dr. Buckwalter started our first endeavor to implement point-of-care ultrasound at one of our facilities.

Are you live with the full enterprise archive now?

Hennon: It’s live, but our spread of the technology among the various service lines is just really starting, and we’ve learned a lot of things in our first foray in integrating the systems. Ultimately, we’re making these images accessible and discoverable from within our EHR. We’re also making sure to optimize order-based, encounter-based workflows, so that everything is correctly documented.

What needs did you come into this initiative with, from a strategic standpoint?

Ken Buckwalter, M.D.: That’s a really interesting question. I would say that radiologists are both peripheral and central to enterprise imaging. It’s a bit of a paradox. This is peripheral, in that it represents a part of the infrastructure that we don’t generally roll up our sleeves and mess around with; but it’s also very much central, because, as with cardiology, we have the most experience dealing with issues like security, compliance, data integrity, and process, which are pretty much foreign for the ordering physicians, in terms of the non-radiologists. Folks who do point-of-care ultrasound, for example, are not radiologists.

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