Picturing Solutions for Enterprise Imaging

Scott Mace, for HealthLeaders Media , February 13, 2013
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This article appears in the January/February 2013 issue of HealthLeaders magazine.

Talk about enterprise imaging, and you're likely to witness some pained expressions from healthcare CIOs.

In recent years, the healthcare information technology industry has been particularly innovative when it comes to creating images. Picture archiving and communications systems are in every radiology department, and mini-PACS have proliferated in many other specialty departments, everywhere from cardiology to pathology to dermatology. Meanwhile, tablet computers equipped with 5-megapixel cameras are in the hands of a large number of shutter-happy clinicians.

The vendor industry's response—enterprise imaging—largely amounts to a series of promises waiting for implementation at all but a few pioneering organizations. According to a July 2012 survey by KLAS, most healthcare providers are just in the early stages of forming an enterprise imaging strategy.

"This is both an exciting time and a little bit of a confusing time for enterprises. Vendors have recognized that there is a need for and an emerging marketplace for 'vendor-neutral' archives that will handle not just radiology DICOM images, but all kinds of documents and images from multiple disciplines, everything from photos and light photography to pathology slides and ophthalmology images," says David S. Mendelson, senior associate in clinical informatics, director of radiology information systems at Mount Sinai Medical Center, a 1,171-bed tertiary care teaching facility in New York City. He also serves as cochair of the board for Integrating the Healthcare Enterprise International.

"Enterprises, through their CIOs predominantly, have said that there is an economy of scale by trying to have one central archive ultimately that would handle all these things. Intelligent applications sitting behind that archive would enable the ability to distribute all those various types of images in an intelligent manner to the right people," Mendelson says.

"You need some authentication rules behind it. Not everybody is entitled to see everything, but if you have everything aggregated in one place, it may become less expensive to manage. It may become less expensive to build a business continuity or disaster recovery system behind it. Then what you need is a set of business rules for who can look at what and when."

Traditionally, PACS applications and PACS archives were closely integrated. In an enterprise imaging model, the archives—the storage and the information associated with the stored images—are often separate from the applications. At least, that's the ideal. Between reality and the goal lie a host of issues. Existing PACS archives have to be upgraded to vendor-neutral archives, able to store and serve up images in all their many file formats. A fast, powerful network architecture must be able to scale and yet provide assured levels of service, both in terms of availability and latency. Rule sets established at the archive must be enforced across an ever-growing toolbox of imaging applications.

"For those of us, particularly radiologists, who have existing archives, the cost of data migration into a vendor-neutral archive is a real factor that has to be taken into account," Mendelson says. "Not just the cost, but the process and the time it takes."

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