By Tom Coppa
As an industry, we should be long past the question of what we are trying to do;
rather, we should be asking how, when and where. And as an industry, we should know the details of what to do at the radiology department level to improve workflow, but often get so caught up in those details that the big picture of how to spread imaging to the entire enterprise is lost. When considering when and where to store and access the vast amount of data, you cannot miss the forest for the trees.
Many health care systems are finding themselves in the same situation. Their general PACS and cardiology PACS are both aging, their image storage is reaching capacity, and the budget has been allocated for the implementation of an electronic health record (EHR) solution. In this climate, how does the diagnostic imaging department address the needs of their radiologists and cardiologists, the needs of other clinicians and patients for automated, reliable information at the point of care as well as the hospital’s business needs to achieve meaningful use for their EHR?
The trend in the industry has been to separate the PACS application from the image data and workflow engines, earning the title of vendor neutral archive. When I hear this terminology, I tend to cringe. Can a vendor ever be neutral? Of course not. Or maybe more appropriately, can you ever be neutral from a vendor? Not often. But the image repository or archive can be neutral. That’s why I prefer the term PACS neutral archive. Instead of locking you into a specific imaging system, images can be stored and retrieved from the neutral archive because it was built to exchange data with disparate systems.
The basic need — to share data outside the walls of diagnostic imaging — becomes more important as organizations continue implementing EHRs. Imaging, of course, is a key component to providing the complete picture of the patient’s health. We all know a diagnosis is not just about words and numbers. It is about seeing the problems and affected areas as well. Clinicians need a picture of the wound, the reports that include the different scopes that were used, images from digital cameras, voice clips and any piece of paper that was part of the workflow.
Whether you have already implemented an EHR or are about to undertake an implementation, it is important to establish an architecture that syncs the workflow and technology with the management of the radiology image archive. There should also be consideration to expand the manageability and size of the image archive to include all imaging sources and types. The architecture should allow the site to leverage and choose whatever workflow makes sense for radiology, cardiology and the other ‘ology’ departments while at the same time using the enterprise archive technology to connect the entire enterprise through the EHR. Access to this archive data is not only important to the hospital’s EHR but will also ease the difficulty of broadening to the more universal image sharing of a Health Information Exchange throughout a community. Accountable care organizations also have the need to integrate patient records into electronic databases.
Now is the right time to look at your organization’s global imaging archive strategy. Besides the complexity of adding EHRs, health care organizations must also navigate the waters of continually growing image volume and the rapid consumption of imaging resources. All of these business challenges can be minimized with the right archive architecture and workflow solution.
The ability to migrate from multiple silos of imaging storage to one consolidated archive helps to reduce all of the associated costs for storage and archiving.
Image repositories provide a single point of access for EHR integrations while helping to reduce maintenance tasks through centralized system management.
Lifecycle management helps you manage risk while having a positive effect on storage consumption.
An integrated workflow engine can assimilate information from any number of pre-existing systems and provide opportunities to fill the quality initiatives’ gaps.
The paths to an enterprise archive and data access may not be identical, but every long-term strategy should consider the forest as well as the trees.
About the author: Thomas Coppa has many years of experience working on the enterprise IT team at Iowa Health System as an infrastructure architect, and was part of a team that led the charge toward an enterprise-wide solution for image data management. Currently, he is the technical consultant with McKesson Enterprise Image Repository.