Imaging was largely absent in Stage 1 meaningful use, but with new requirements in Stage 2 to include viewing of image data within the EHR, there will likely be a new focus to develop enterprise imaging strategies and expand interoperability solutions. The picture in this space isn’t as clear as some might hope, but there are pioneering organizations nonetheless making headway to allow anytime, anywhere access to diagnostic images.
Picture archiving and communication systems (PACS) technology has seen great market penetration in the new millennium, according to a white paper from the Dorenfest Institute and HIMSS Analytics. In 2000, 8.5 percent of hospitals reported PACS technology installed, which grew to 76 percent in 2008. (Four more years later industry experts agree that PACS systems are universal.) The report also found that image distribution, through PACS will continue to spread outside of the hospital, as more procedures are performed in the outpatient setting or as technology enables users to access images outside of the hospital.
When it comes to a choosing a particular enterprise image strategy, Joe Marion, founder and principal of the Waukesha, Wis.-based Healthcare Integration Strategies, says there is a lot of FUD—fear, uncertainty, and doubt—out there. “There’s still a lot of confusion,” he says. “The consequence of that is that I don’t think a lot of people have enough of a grasp yet what differentiates [vendors].”
Marion recommends organizations first identify their objectives for imaging enterprise solutions. If the organization needs to find a common way of archiving images between radiology and cardiology, that’s not really a true enterprise solution, he notes. “If the need is a common image accessibility source for an electronic medical record, that is probably more of a true enterprise requirement,” Marion adds. “I think there is a significant difference in the context and the definition of what the intended purpose of the device is. It really boils down to defining what you’re trying to accomplish with the device.”
According to a KLAS (Orem, Utah) study, “Enterprise Imaging 2012: Provider's Strategies and Insights,” most healthcare providers are in the early stages of forming an enterprise imaging strategy to enable “getting the right image to the right place at the right time.” Many providers are having to rely on more than one vendor to deliver all of the pieces needed for their enterprise imaging strategy, and are considering one of two main approaches: a vendor-neutral archive (VNA) centric approach or a PACS enterprise archive solution.
“Providers are looking at two different paths to go down,” says Ben Brown, KLAS’ imaging research director and author of the report. “Almost all providers have a PACS, so there are a lot of them that want to leverage their PACS that started in radiology and leverage this archive for other DICOM images or other clinical content. It tends to be smaller facilities that are sticking with a PACS-centric archive solution.”
Brown says that the larger organizations (more than 500 beds) that were interviewed for the study are more focused on a vendor-neutral archive, incorporating not only DICOM, but non-DICOM images and clinical content “that can be archived in some type of repository for access with the patient record.”
Brown sees more providers taking steps to image-enable their EHRs and begin leveraging image archives as a service within their community, using private cloud models and virtualization. “I think you’ll see larger organizations leverage something like that as a resource, not only to give clinicians in the area that are either affiliated, owned or employed by a healthcare system access to these images,” he says. “I think you’ll start to see in next few years these types of models evolve like an archive that could be leveraged for disaster recovery, business continuity, long-term archive, image accessibility to providers in the area.”
Health Imaging Exchanges
Diagnostic images would be a natural fit for health information exchanges (HIEs) to include along with the clinical care summaries to be exchanged, but most HIEs haven’t addressed images largely because imaging preceded HIEs, says Marion. “[HIEs] haven’t done that with imaging because I can walk into any facility that I’ve had a study done at and request my images and walk out with a CD or a film folder under my arm,” he adds.