Enterprise Imaging: Answers to Fundamental Questions

Approaching Enterprise Imaging (EI) engages many stakeholders from different specialties with different reasons for collecting images. Ensuring that all stakeholders are identified and supportive of the undertaking typically requires some organizational assessment. Health systems across the U.S. are mobilizing to address the current COVID-19 pandemic. Telehealth for COVID-19 has become a vital tool.

Where is the organization going?

This is a fundamental question on how an organization wants to deal with enterprise-level planning and strategy. Top management in the organization needs to agree on what the long-term goals are and how information technology can support the clinical mission while ensuring that this is achieved in a cost-effective manner.

Enterprise imaging consumes many resources in IT and clinical operations, and it requires physicians to participate. To adopt a successful EI, the effort must be cooperative to ensure the investment functions as planned and delivers the desired benefits to all parties.

Does the organization wish to unify all or most images in a single location to make them accessible to all users?

Typically, users want a simple and consistent way to access images associated with patient care. A Vendor Neutral Archive (VNA) is typically the application that can address the varieties of images and provide the tools to categorize the images as they are ingested. The VNA workflow may differ from how the originators of the images currently access the images and education provided on how these workflows would change.

Does the organization have a structure for identifying and including stakeholders? Does this include operational and clinical representatives? How well are the groups engaged in the process?

To ensure that EI as a program is successful, it is critical that both operational and clinical stakeholders engage with IT throughout the process. Engagement is usually better if the stakeholders understand the objectives and see the benefits of participation. In situations where upper management stipulates the need to move to EI, it may take an active outreach program to have them engage in the process. Inclusion and transparency can usually overcome resistance.

Is the organization comfortable with governance oversight?

According to organizations that have implemented EI, the single most critical first step is the development of a governance committee with a clearly defined mandate. The EI governance can be standalone or a specialized subset of existing enterprise governance. In any case, representation from specialties wanting EI is vital.

Does the organization have a process for developing long-range strategies?

Having governance in place will greatly simplify the development of an EI strategy. Because imaging still consumes significant IT resources, the involvement of most areas of IT is vital to ensure the future EI strategy dovetails with overall IT strategy and the overall service delivery model. Ignoring this step can lead to significant additional costs and unwanted surprises.

A good exercise for the organization is to understand the long-term implications and costs for not developing an overarching approach to enterprise imaging. This exercise should factor in redundant storage, duplicated imaging systems, multiple logins, duplicated maintenance costs, more complex security, more interfaces, more complex backup and business continuity strategies, reduced retrieval speeds, etc. Similarly, consideration must be given to how the organization manages its data and implements data compliance. Health Information Management (HIM) should be consulted in planning and developing strategies.

How does the organization interact with other organizations?

Many organizations still share patients’ medical records with other entities on CDs, DVDs, and thumb drives that are frequently unencrypted. EI brings the opportunity of moving this to a secure, encrypted connection over the internet, which is increasingly being used for portals, health information exchanges, and secure data uploads and downloads. Ensuring that the organization will support such an approach will further enhance the benefits of EI. Any move to exchanging data over the internet will require in-depth security review and testing.

Does the organization feel comfortable utilizing the cloud either for archival storage or for hosting the application, aka software as a service (SaaS)?

Utilizing the cloud can bring multiple benefits such as having the vendor provide most of the maintenance and support, keeping the system updated, moving from a capitalized expenditure to an operational expenditure, reducing the number of people needed to support the PACS, and storage. A cloud platform can bring advantages, but any contract should carefully review the exit strategy and how the data will be returned to the organization and at what cost. Note there are multiple hybrid solutions (ex. primary storage on-site and backup residing in the cloud).

Asking these questions can help determine how easy it will be to proceed with transformative undertaking within the organization and obtain the necessary buy-in by the stakeholders.