Medical imaging informatics is the next data step forward

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When choosing medical imaging software, go with the enterprise model

As healthcare providers upgrade or replace their medical imaging technology, they should strive for an enterprise approach rather than keeping strictly to cardiology, expert says.

When healthcare providers upgrade their medical imaging software, they should look to the enterprise imaging model.

Medical imaging software expert Joe Marion gives that advice to providers, whether they're replacing an older radiology picture archiving and communications systems (PACS), or going wholesale into the vendor neutral archives (VNA) world.

"If they don't start out going to an enterprise solution, they end up coming to that," said Marion, principal at Healthcare Integration Strategies.

In other words, Marion's key tip for organizations tinkering with their medical imaging software is not to confine imaging and its workflow to its traditional home in the radiology department. Instead, spread out the ability to store, retrieve and view advanced medical images among as many of the ologies as is feasible, from cardiology to dermatology.

In one recent upgrade scenario, a client of Marion's wanted to swap out its old radiology PACS. As it happens, the provider was also storing some cardiology images in that PACS.

"When they started the process, it was a strictly radiology project. But when discussion got down to the nitty gritty, it turned into questions like 'What do we do about cardiology?' and 'there are some people in dermatology talking about storing images,'" Marion said.

"So, very quickly, it evolved into a discussion of 'do we really need a vendor neutral archive and universal viewing solution?'" he said. "So that's the way it went to an RFP [request for proposal]."

Marion said providers would be mistaken to not consider a full enterprise system option for their new medical imaging software, and he suggested that a VNA be part of that.

So, if you're going in the direction of a VNA and a new PACS, you don't need an archive solution for that PACS. But you do need to be able to display and handle images as part of [your] workflow, and you need to look at it from an enterprise perspective, not just a service line perspective.
Joe Marionmedical imaging expert

However, another tip Marion offered was that users shouldn't look at VNAs as the complete answer to their medical imaging software needs, including workflow management, but rather as a sophisticated archive. And that image repository should likely be connected to a PACS, or a component of a PACS, in a deconstructed PACS strategy.

"So, if you're going in the direction of a VNA and a new PACS, you don't need an archive solution for that PACS," Marion said. "But you do need to be able to display and handle images as part of [your] workflow, and you need to look at it from an enterprise perspective, not just a service line perspective."

Marion noted that there is no universal definition of deconstructed PACS, but that approaches can include keeping pieces of existing PACS and buying new PACS functionalities as subsystems to work with VNAs.

For example, providers can buy a diagnostic viewing PACS component, such as advanced visualization for the enterprise, to replace device-specific viewers, such those attached to MRI or CT scan machines.

Or larger healthcare systems, such as academic medical centers that already have sophisticated 3D viewing workstations, can opt for a VNA that enables different departments to pull images to those workstations

Joe Marion Joe Marion

Marion said a good time to evaluate your medical imaging software upgrade strategy is when replacing an EHR or when a healthcare system is incorporating physician practices or clinics. But it's also a good idea to think about image-enabling your existing EHR. This is because, typically, the big EHR vendors still lack advanced medical imaging technology on par with established PACS and VNA vendors, Marion said.

In any event, however healthcare providers decide to forge ahead with medical imaging software, they should keep the whole organization in mind, not just a specific imaging-intensive department.

But with API links to a sophisticated VNA, the EHR can provide viewing links both to clinicians and to patients via newer streaming, zero-footprint technology that presents a fairly simple version of complex images accessible on mobile devices.

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How is your medical imaging strategy changing from departmental to enterprise?
Shaun, It depends on what's driving the change. If your looking at it from a cost savings point of view or to reduce service contracts, you can look at an enterprise system to move most if not all storages silos to a enterprise storage and reduce or eliminate the the other systems. Many of the newer archives and let's get this straight, a VNA is really a archive with more rules which will allow you to hang viewers off of them, again, allowing for more cost saving. But you can argue against putting all of your eggs in one basket. So then you start to spend more money by using the failover part of the archive, replicating features, workload sharing and the cost go on to the Millions. You can go either way. I would look toward something that gives you what you need to plan for the future growth of your system.
The EHR began with best of breed applications and is now an enterprise solution. Healthcare needs less fragmentation and more integration and an enterprise imaging strategy and platform are essential.
Newer than VNA technology - Image Exchange/Super PACS Technology should be considered because it's flexibility, lower cost and future mandates for MU. A simple explanation of this solution is the ability to index, auto prefetch, connect, on demand move, view, access all of your silos of images. Not just across your network but across everyone's networks.
Spot on Joe. The VNA solution isn't enough to meet the needs of what ONC is telling us as vendors we must support by 2025. Its no longer just about Syntactical Persistence of data to the disk but now where can we find it how do we retrieve or do we retrieve it? What is it who is the user, which the lines of the user have now blurred and changed. Its all about taking the "data" and giving it Semantical Perception based on the context of a user on behalf of the Patient.... YOU and I! Clarity in context.