How we store, access, and manage imaging information has never been more important, and complex, than it is now. Silos of information divided by software, specialties and providers negatively impact clinical efficacy and ultimately patient outcomes. But what does this mean for those of us who are tasked with the responsibility to provide information — specifically imaging data — to providers at the point of care, to specialists working to build a treatment plan, or researchers seeking to solve population health problems through data mining and interpretation?
The rise and growing pace of developing and activating an enterprise imaging program is in response to this challenging requirement. The idea behind this larger scale approach is that all medical images are important, and therefore should be included, within the longitudinal patient jacket as well as stored and indexed within a repository or platform that provides functionality for many different use cases represented across the healthcare spectrum. One of the early technologies that sought to break down silos within radiology was the vendor neutral archive (VNA). The software, primarily designed to normalize and free imaging from proprietary systems, has quickly become a standard component within an enterprise imaging strategy.
Access the online comparison chart for vendor neutral archive (VNA) systems. This requires a login, but it is free and only takes a miniute to complete.
Within the radiology space VNAs have been developed to various degrees by nearly every vendor. Many of these vendors are now providing their VNA within the customer portfolio as a value-add, or at a nominal cost. For many, this appears to bring a better set of functionality with much less disruption, and in many cases at a reduced cost. It is critical, however, to ensure any decision related to this type of software solution be made on a codified set of criteria mapped directly to organizational goals as prioritized by executive leadership. Simply adding a module because it is deemed the least disruptive can lead to long-term challenges, frustration, additional or hidden costs, and ultimately an inability to achieve the types of outcomes expected or required.
The decision to adopt an enterprise imaging strategy must be made carefully, across the leadership and governance structure, with representation by every stakeholder group affected or invested into this initiative. One of the critical steps is to clearly define the organizations interpretation of enterprise imaging. This definition will drive the approach, specifically the technical decision and design, of the architecture that will support the strategy. The components of enterprise imaging are largely agreed to be image capture, workflow, visualization, reporting, exchange, distribution, interoperability, integration to the EHR and access for secondary use. While each of these cannot be overlooked, the VNA and its functionality, if determined to be part of the strategy, will be fundamental to achieving the required outcomes.
Choosing a VNA solution requires knowing what you need this platform to provide for your organization. In the days of PACS-centric imaging, the vendors’ solutions became more and more commoditized with smaller and smaller differentiators within the market. The systems solved a set of problems that didn’t change much from one type of setting to the next. Perhaps there were some larger differences in the acute and ambulatory settings, but largely the workflow problems it solved were slightly differing shades of the same color.
This is simply not the case in enterprise imaging. Every organization has different goals for how it will address the ability to ingest, normalize, store, provide access to and ultimately manage data. Beyond that, the types of imaging data will differ from one organization to the next based on the services, lines and specialties, let alone physician contracts and affiliations that exist. Simply doing what your neighbor is doing will spell certain disaster if one’s objectives are to continue to expand services, grow revenue, build referring community loyalty and deliver exceptional patient care. Therefore, how you define the role of your VNA — the central component of your architecture — will be one of the most important decisions to make.
Some considerations in your decision-making:
• What imaging types will you expect to store
and link to your EHR?
• Will you be accommodating non-DICOM
image data?
• How will you normalize your image objects for both internal and external interoperability?
• How will you ensure data integrity where duplicate objects exist in multiple and in many cases disparate systems?
• How will you manage access to imaging data?
• What is your strategy for ensuring privacy and security for this data?
• Will you grant patient access to their images through a portal?
• What other use cases exist for this data beyond point of care or treatment planning?
• Who will decide what data will be considered protected health information (PHI)?
• How will you manage data across multiple domains or message passing interfaces (MPIs)?
• How is data stored and indexed for
secondary uses?
As you can see from this cursory list, there is a lot to consider. This initiative will require careful thinking and clearly articulated goals and objectives. It will take longer than you expect. But doing the hard work up front building a strong definition of enterprise imaging for your organization will give you much higher odds of achieving your desired outcomes. And this, ideally, will enhance your ability to achieve greater outcomes, leading to higher quality healthcare.
Jef Williams is the chief operating officer at Ascendian Healthcare Consulting. He is a frequent speaker and writer on enterprise imaging transformation and healthcare technology topics spanning people, process, strategy and technology.
May 17, 2024 
