To understand where the imaging informatics industry is headed, it’s important to recognize the evolution of image-archiving systems. As Keith Dreyer, M.D., vice chairman of radiology at Massachusetts General Hospital in Boston, Mass. and assistant professor of radiology at Harvard Medical School, puts it, those solutions first emerged as “monolithic” systems for the radiology department. In the next phase of their evolution, they were used and adapted for cardiology departments. For a period of time, the imaging needs in hospitals didn’t often go beyond those two departments.
Keith Dreyer M.D.
Today, there are numerous “ologies,” such as dermatology, pathology and gastroenterology, as well as other hospital departments, that all have emerging imaging IT requirements. The traditional image-archiving systems, also known as picture archiving and communication systems (PACS), however, aren’t fully suited to non-radiology departments for various reasons. For one, “their workflow is different than radiology,” says Dreyer.
According to Joe Marion, founder and principal of Healthcare Integration Strategies, a Waukesha, Wis.-based consulting firm, there are additional issues that make PACS systems unsuitable for other departments. For instance, he notes that there are unique identifiers in radiology imaging systems that classify demographic information. Marion says these identifiers may not crossover to the other “-ologies.” He also says there is complexity in the context of image viewing and a lack of visualization standards.
“If a physician has to contend with more than three or four viewing applications, they will never use the system, because they just don’t have the time to remember all that,” Marion says. “So the simplicity of this means one has to get down to a universal application that can support multiple formats. You either shove everything into a DICOM [Digital Imaging and Communications in Medicine] format or you have to have the technology to manage and view multiple image formats.” Dreyer notes standards do exist, however, industry and government leaders have yet to mandate them.
Rasu Shrestha, M.D., vice president of medical information technology at the University of Pittsburgh Medical Center (UPMC), says the essential issue in imaging informatics in the near future is that most CIOs and other healthcare technology leaders are attempting to figure out an enterprise strategy for imaging informatics across the board.
Rasu Shrestha, M.D.
Don't Say 'VNA'
Despite numerous differences in other areas, the imaging storage requirements for the various hospital departments are the same, Dreyer says. Thus with the emerging imaging requirements across multiple hospital departments, coupled with the consolidation of the imaging archiving systems vendor market, vendors have begun to sell a product called the vendor-neutral archive (VNA). These products are supposed to represent an all-encompassing service for image storage. Yet many in the industry have panned the term.
Why is there such distaste for the term “VNA”? Marion explains that “It’s too limiting. It doesn’t identify the true purpose of the device. What does ‘vendor-neutral’ mean?” he asks. “Does it mean if I have Siemens in one place, and GE in another, that I have to pick a third party so I’m vendor-neutral? If all I’m worried about is archiving the images, then I’m missing the whole point.” The point, he notes, is managing and accessing the images across the enterprise.
UPMC’s Shrestha similarly agrees that the term VNA has become an overused buzzword by vendors and the issues in the imaging industry go beyond simply just storing the image agnostically. Like Marion, he says solutions must address the workflow and management issues that typically do not match up across departments. Dreyer stresses VNA solutions ignore the need for a standards-based visualization tools that can be applied to an archive.
While many have wondered if an enterprise-wide image solution lies in the cloud, a number of industry leaders aren’t convinced yet. Dreyer says the cloud is suitable for a “second store,” but he hasn’t seen anything today that would make him feel comfortable on not having anything on site. He does see advantages to the cloud, such as enabling easier access to physicians who work outside the walls of a particular hospital. Both Dreyer and Marion say disaster-image recovery is a good option for a cloud solution.
Pioneering organizations, like Shrestha’s UPMC, have stayed ahead of the industry by creating their own type of image-archiving platform. UPMC’s Singleview solution federates multiple imaging archives (UPMC has 12 PACS systems in radiology alone) into a more “patient-centric” view, where all of their images are pulled together in one place. Even with certain things that need to be addressed, like integrating imaging from various other departments, Shrestha says SingleView has become a broad platform that UPMC can use to “enterprise enable its imaging strategy.”
Over the next few years, as healthcare organizations strategize forward on diagnostic image sharing and storage, Marion says success will depend on organizations determining their own specific needs. His advice going forward for CIOs and healthcare IT leaders is before they sit down and accept a vendor-based solution, is to hammer out basics such as finding a repository that can interact with their EMR, as well as, figuring out how many service areas they have, the objects they are dealing with, and the requirements they have. “Then you can start to zero in on specifics with service areas and vendors,” he says.