SIIM: Chang on enterprise imaging—the devil is in the details

DALLAS—As more organizations embrace an enterprise image management model, radiology informatics professionals have an opportunity to play a key role in the process. However, smart players will take care to avoid a few pitfalls, according to Paul J. Chang, MD, vice chairman of radiology informatics at University of Chicago School of Medicine.

Enterprise image management is multifactorial with many parts and corporate IT wants to simplify the process, Chang explained during an educational session at the Society for Imaging Informatics in Medicine (SIIM) annual meeting. He cautioned against oversimplification and outlined strategies for integrating enterprise images into the archive.

Chang started with a list of considerations, including:

  • Image creation and consumption;
  • Storage;
  • Distribution within and outside the firewall;
  • Workflow optimization;
  • Analytics; and
  • Governance and business model.

He emphasized the challenges related to disparate workflows across the enterprise. “Workflow is frequently ignored. Getting rid of film is the easy part of image management. Optimal workflow is hard. Every silo has an associated workflow. It is not one size fits all.”

Similarly, analytics and business planning also should not be ignored. Analytics is critical as healthcare needs to demonstrate value in all endeavors; analytics provides the platform for showing value.

As for business planning, “Radiology is not a charity,” Chang said. Enterprise departments with an eye on digital image management need to demonstrate a budget for operations, rather than expecting ongoing support from image informatics.

A series of key questions can be used to guide an enterprise image management project. Informatics professionals should ask what kind of multimedia object the request entails, if it is DICOM, what the RIS equivalent is and how the image will be stored and used, in addition to determining workflow optimization and ascertaining a business plan.

Chang offered a continuum of acquisition methods: modality, kiosk and mobile. Modality images, such as radiology and cardiology, are easy, he said. They are DICOM studies and exams are scheduled.

Next on the continuum are kiosk studies, such as ophthalmology, endoscopy and dermatology, which are generally scheduled but may not be DICOM.

Mobile images, such as dermatology and photographs acquired via smartphone or tablet, represent the most challenging data. DICOM is usually not available, and the images are generally not scheduled.   

A key decision, said Chang, is selecting the strategy for non-DICOM image storage, which means adding an independent archive and database or adding a DICOM wrapper. He suggested bypassing the independent archive model as linkage among PACS is essential.

Another essential is the RIS equivalent. “You need to know what image the image is and to whom it belongs.” When possible, leverage the existing RIS. If specialists balk at using a radiology system, he suggested dubbing it the enterprise image management system.

A final consideration is storage persistence. The goal, explained Chang, is an agnostic enterprise archive, not a proliferation of mini PACS. However, to support 'ologies with a workflow solution, the enterprise archive can be augmented with a persistent cache that retains image datasets for one year.