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Wide Load: Puzzling Out the Place of the Diagnostic Image in the Emerging Healthcare Landscape

November 16, 2017
by Mark Hagland
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Healthcare IT leaders, industry experts and observers share their perspectives on integrating image exchange into the new healthcare
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For years now, the question of how to fully inte­grate the appropriate sharing of diagnostic imag­es into healthcare data exchange—including into the phenomenon of health information exchange (HIE) has been a vexing one for healthcare IT leaders. Industry experts and observers agree: there’s got to be a better way than burning CDs and handing those to patients to hand to the next clinician down in the line in the chain of care delivery. And of course, the burning of CDs has been predicated on the shift nearly two decades ago now to digitized diagnostic images. Before that, health­care was stuck in the world of physical films.

But the landscape has been changing steadily over time. To begin with, “We’ve made a great deal of prog­ress in the industry in the last couple of years, as we’ve talked about freeing up the data and unshackling the image of the data repository,” notes Rasu Shrestha, M.D., a practicing radiologist and the chief innovation officer at the 20-plus-hospital UPMC health system, based in Pittsburgh. “We created the VNA [vendor-neutral archive] to free images from PACS systems. And then we realized that wasn’t even good enough; we needed more of a cloud-based, enterprise-wide ca­pability, regardless of where the patient, the clinician or the radiologist might be, as those are the three main actors who need to leverage the image and image-re­lated content.”

Indeed, Shrestha says, “There’s been a real mind shift in the last three years, that it’s not just about capturing the image and making it available; what it is about really is—you capture it once, you store it once, you imme­diately cloud-enable it, and you then make it available multiple different times. And what that’s given rise to is a solution that really addresses some of the key chal­lenges we have with going digital generally, which is one of scalability. There’s been an increase in demand for im­ages, with a need to focus on workflow, so that we can make this scale and make sense. We’ve moved from film to filmless, to image archives, to the VNA. And we’ve said, OK, we’re going to focus on enterprise content management, and that inherently requires that it all be cloud-based.”

And, amid that broad set of changes, one question that has arisen, as U.S. healthcare has begun to shift from a volume-based payment paradigm to a value-based one, has been how to integrate the flow of di­agnostic images, and of radiological reports, into the flow of data moving back and forth among clinicians. HIE organizations have made some inroads in some communities and states; but the sheer digital weight of diagnostic imaging studies has made their sharing via HIE networks—and their storage as well—problematic. So what is the solution? Increasingly, some healthcare IT leaders, industry experts, and observers, are conclud­ing, it won’t mean moving images around at all, but rather, providing access in situ to secured repositories holding those images.

Solutions Hiding in Plain Sight?

Speaking of the ongoing challenge of ensuring that diagnostic images and radiological reports are acces­sible and available at the point of care, Joe Marion, principal of the Waukesha, Wis.-based Healthcare In­tegration Strategies consulting firm, says that “I have personal experience of that, so it’s a hot button for me. I think there are a couple of things that are begin­ning to gel in the industry,” he goes on to say, and the most important emerging trend is that of “server-side rendering.” In that regard, he says, “Visage [the Rich­mond, Victoria, Australia-based Visage Imaging] is a prime example” of a new wave of vendors offering the ability to provide access to diagnostic images without having to laboriously move them through online pipes. In the case of these vendors, “All the manipulation of the images is done on the server side, and all I need is an HTML 5-type web-based viewer, with all the in­formation staying at the server—from a security point of view, I’m not passing information, and I’m not risk­ing PHI, because I’m not moving anything anywhere or waiting for anything to be moved.”

Another company that’s moved in this new direction is the Dallas-based WhamTech, which uses a trademarked “smart data fabric” approach to index-based data virtual­ization, federation, and inte­gration. As WhamTech’s chief technology officer Gavin Rob­ertson notes, his firm’s technol­ogy combines aspects of data warehousing, federated adapt­ers, and advanced web search, allowing authorized end-users to find images and data, as given permission, and to pull those images and data out for specific purposes, thus obviating the need to move web-heavy images around in traditional ways.

Marion says that, as these newer technologies are ad­opted, “That is going to open up the opportunity for greater sharing of images, because as a patient, I could get access to my images without physically having to access a DICOM viewer, or someone creating a CD. It’s there, it’s in the cloud. And from an ownership point of view, if I have my exam done at Aurora, Aurora can con­tinue to store the information, and I don’t need to physi­cally get a copy of it.”

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