Is Enterprise Imaging Ready for the Spotlight?

Two years ago, KLAS hosted around 60 thought leaders in enterprise imaging (EI) in an effort to determine where organizations stand, and identify key functionalities and best practices to help propel the industry forward. What they found, according to Monique Rasband, was that best practices are still in short supply, especially with something that hasn’t been considered a top priority by many organizations — and yet, comes with high expectations.

Recently, we spoke with Monique Rasband, VP, Imaging Informatics & Oncology, KLAS, about the trends they’re seeing when it comes to creating an EI strategy and purchasing solutions, why imaging was on the backburner for so long, and the importance of having a dedicated leader in the space. She also talks about why imaging is “near and dear” to her heart, the lofty expectations users have, and the importance of collaboration across departments.

 

Gamble:  In the past few years, Enterprise Imaging has been gaining traction, and has caught KLAS’ eye. What drew you to this topic?

Rasband:  I think it’s incredibly interesting, and it’s always been near and dear to my heart. My background before coming to KLAS was in oncology, with some crossover into radiology and radiation oncology. And in fact, that’s why enterprise imaging (EI) — which isn’t what it was called at that point — is so important to me. When I visited cancer treatment centers, I’d see shoeboxes full of images and disks. It was heartbreaking. Images would get lost, and patients would have to go through the process again. People were channeling MacGyver and duct-taping things together. That’s one reason why I wanted to get involved.

Looking at where things are now, I wish more people had a deeper adoption of EI systems, which would make it easier for the physicians and patients. Although I believe we’re moving in the right direction, the technology is still somewhat immature.

 

Gamble:  What are some of the factors that make it challenging to implement an enterprise imaging strategy?

Rasband:  There has to be a lot of coordination among departments, which has always been difficult. The way images are stored and workflow is designed in radiology doesn’t always match up with cardiology, even though they’re considered cousins – or even siblings. Then you move into the some of the other spaces like pathology, wound care, and dermatology, and it’s a whole different animal. It was hard enough for radiology to get everything in sync. But I believe they’re at a decent momentum now.

Another important consideration when we’re talking about imaging and radiology is the existence of standards. When you start moving to point-of-care ultrasounds, it adds a layer of complexity. And the question becomes, who should tackle that?

In the study KLAS is currently working on, which is a follow-up to the 2018 Enterprise Imaging report, we’re trying to shed some light on what the governance structure should look like. We’re also asking providers to rate their vendors in areas like VNA (vendor neutral archiving) and even PACS. Surprisingly, we’re seeing that a lot of people aren’t rating the vendors particularly high — but they’re not rating themselves high either.

They’re telling us, ‘We’ve done a lot of work, but we start to lose momentum because we have full-time jobs and department priorities that we need to focus on, and this type of work requires a full-time team.’ The problem is that although most organizations might have a dedicated person, they lack the resources for an entire team.

Cost is an issue as well. We’re finding organizations that are either on dated PACS systems or need a VNA refresh, so they start looking and ask: ‘what comes first, the chicken or the egg? Do we refresh systems or do we start over? If our cardiology system is dated, do we focus on that first?’

If money and resources were not an object, this would be much easier. But unfortunately in healthcare, that’s not the case.

 

Gamble:  What are you hearing in terms of ROI? Are providers able to demonstrate it?

Rasband:  That’s been really challenging. A lot of the people we speak with believe there’s an ROI, but it’s not easy to attach an exact dollar amount to it. And some of them are trying to track ROI and find a way to show it. Although some are succeeded, for the most part it’s been difficult.

 

Gamble:  What do you think has prevented EI from becoming a higher priority? Were a lot of organizations zeroed in on the EHR component?

Rasband:  That’s certainly a factor. There are so many competing priorities, and for most organizations, there’s only so much money and resources to go around. So yes, I believe EHRs were the first thing to put imaging on the backburner – or at least delay it.

When I first started at KLAS 10 years ago, I remember being really excited about VNA. I thought it would be adopted quickly and the problem would be solved. Fast forward to today, and we’re still working on it. And honestly, I think it’s more complex now than when VNA was first introduced.

Some of the people I started speaking with back then are still having issues. They may have put things on hold, and now they’re going back and refreshing their EI strategy. But now it’s even more expensive because it’s bigger and their product is outdated. That’s why some people rate themselves lower than or equal to the vendor. They’re telling us, ‘It’s not the vendor’s fault; they’ve been trying to push us along. We just didn’t have the resources, the focus, or the finances.’ So providers are definitely taking ownership, and acknowledging that they haven’t done as well as they could’ve in pushing this along.

It started with the EMR, and then other things trickled in.

 

Gamble:  What about artificial intelligence – how does that factor in?

Rasband:  AI has certainly been a buzzword, but in some ways, it’s confusing. A lot of people ask us about AI and what data we have, and my question to them is ‘what do you need to know? What does AI mean to you?’ Sadly, the description is all over the road.

There are, however, some very cool things happening around AI. And for some providers we’ve spoken with, it’s starting to become much more of a reality. There are some tangible case studies going on.

At the same time, it’s still really early. Several providers have said, ‘AI is great, but until we can clean up and organize the data — which many are struggling to do even with the VNA — how do we expect it to really help us?’ The answer is that it can’t.

Hopefully with AI coming — and in some cases, already here — that will be a motivating factor and potentially put more focus on bringing everything together for an EI strategy.

The other thing that can make an impact is risk. As organizations take on more risk, we’re seeing more focus on preventing duplicate imaging. We’re seeing different reimbursement requirements that force people to say, ‘We need to know if this person has already had images. We can’t be doing repeats.’ Whereas before, there wasn’t much accountability. That will also potentially help move the focus back to EI; or at least put a stronger emphasis on it.

 

Gamble:  When leaders are asking for funding for EI, what are some of the hurdles they can face?

Rasband:  Healthcare is so complex, and what’s making it even more complex is the consolidation we’re seeing with provider organizations. I recently spoke with someone who’s been trying for some time to get an EI strategy off the ground, but keeps running into challenges. Just to give you some context, when I first started talking to him, the organization had a small number of hospitals. Now they have more than 25 hospitals, and have gone from two cardiology systems to seven. They could either start trying to get all those on the same page, or they can get the VNA in place and start getting all the data together. I think that’s helping to drive this — through consolidation, there are more people using more solutions. If they have a good VNA with strong governance, they can start to migrate the data to one spot.

There’s also the universal viewer. Based on calls we’ve had, it’s still early in the game, but some organizations are realizing the benefits of having a universal viewer with strong workflow that can attach and dip into other systems for the storage side, either PACS and/or VNA. This way, physicians can have one view of data and won’t have to switch in and out of different systems, which dramatically helps with workflow.

 

Gamble:  What’s some of the feedback you’ve been hearing about how vendors are performing?

Rasband:  Based on our discussions, my impression is that there are vendors that are strong and those that aren’t as strong. A lot of providers give kudos for Epic for image-enabling the EMR. We’re often asked which imaging vendors can do that. There’s a good amount of vendors that enable you to pull images through Epic — not for diagnostic viewing, but to enable physicians to be able to see images across the board. That’s a step in the right direction.

Of course, we always want solutions to be more robust. The expectations are so high. And although it may not seem like it, we are advancing in technology. I believe providers will continue to push for imaging-enabled EMRs. That’s becoming the expectation, and I think it needs to happen.

 

Gamble:  Are you seeing a shift in the amount of providers who are looking at EI systems?

Rasband:  We are seeing a shift. Many people we speak with who don’t yet have a strategy or aren’t in the process of making a purchase, are saying it’s the next step. It’s definitely on most peoples’ radars, whereas before it was more of a ‘nice to have.’ Now, where that will actually go in terms of purchasing and adoption I’m not sure, because we’ve heard this for a long time. But it feels like people are really looking at solutions, not just kicking tires. It feels like there’s more energy and focus.

 

Gamble:  Who are the key decision makers, and how do you think that might change?

Rasband:  Many organizations have added a new role for Chief of Imaging Informatics, or something similar, which is very positive. They tend to be physicians, often with a background in radiology or cardiology; they have imaging expertise and a strong understanding of the clinical, workflow, and informatics component. They work arm-in-arm with the IT team, which is so important.

We’re seeing some fun things happen where chief imaging informatics officers can act as a liaison and go to other departments and explain things more clearly, because they have that clinical background. The organizations that have placed someone in that role have been successful.

At some organizations, it’s the CMIO. Having that clinical and IT experience is huge; they’re able to communicate between the two and figure out which workflows need to happen within the different departments to feed up to enterprise imaging. Those two roles have been incredibly helpful in moving the needle.

 

Gamble:  What about organizations who don’t have the resources for a chief imaging informatics officer, or even a CMIO? I imagine it’s pretty siloed.

Rasband:  It’s still siloed quite a bit. I’ll talk to a provider in radiology who says the organization is working on one strategy, and then I’ll speak with the leader of cardiology, and it’ll turn out their strategies aren’t aligned; sometimes they don’t even overlap. It’s very complex, which is why it’s great to have someone who can represent all clinicians and be that voice.

Of course, you still need department heads. You need department heads feeding up to a voice that can be a liaison between clinicians and IT. That’s where we’ve seen the most success so far.

 

Gamble:  Great. Thanks so much for your time, Monique. It’s a really fascinating area, and one that’s quickly evolving. I hope we can catch up down the road to see where things go.

Rasband:  I’d love that. Thank you, Kate.

Two years ago, KLAS hosted around 60 thought leaders in enterprise imaging (EI)in an effort to determine where organizations stand, and identify key functionalities and best practices to help propel the industry forward. What they found, according to Monique Rasband, was that best practices are still in short supply, especially with something that hasn’t been considered a top priority by many organizations — and yet, comes with high expectations.

Recently, we spoke with Monique Rasband, VP, Imaging Informatics & Oncology, KLAS, about the trends they’re seeing when it comes to creating an EI strategy and purchasing solutions, why imaging was on the backburner for so long, and the importance of having a dedicated leader in the space. She also talks about why imaging is “near and dear” to her heart, the lofty expectations users have, and the importance of collaboration across departments.