For healthcare organizations around the world, the COVID-19 pandemic has served as a wake-up call in countless aspects, and has forced leaders to assess their readiness to operate during a crisis.
One area of need that has been brought to light, so to speak, is imaging — or more specifically, the ability to share and view images among different facilities to enable providers to diagnose and treat patients. What the outbreak has revealed is that many organizations are lacking in this area, according to Chris Magyar, Senior Product Manager of Enterprise Medical Imaging with Hyland.
When it comes to enterprise imaging (EI), “some organizations get it; they have a defined enterprise imaging strategy. They’re executing on it. They have a defined governance structure. They have a budgeting model. They have identified specialties that are going to be leaders in this space,” he said during a recent webinar. Others, meanwhile, “are just kicking that can down the road, milking out their existing imaging solutions, continuing to invest in point-specialty solutions and just thinking the whole thing is going to go away.”
It’s not, and in fact, COVID-19 has only amplified the need for a comprehensive EI strategy, noted co-panelists Joe Marion, Principal with Healthcare Integration Strategies, and Brandon Taggart, Founder and Principal Consultant with Kondifi Healthcare IT Consulting. During the discussion, they identified the benefits of having an EI strategy and the drawbacks of not having one — particularly in the current environment, and offered advice on how to address these challenges.
“The key is going to be widespread accessibility,” said Marion, who has amassed 40 years of healthcare experience. But as telehealth use increases, it becomes increasingly difficult to ensure patient information is available to the clinical staff, regardless of their location. “It’s going to tax hospital systems, particularly in terms of interoperability.”
Whereas traditional imaging models tend to be specialty-focused and “don’t necessarily scale well outside of radiology,” according to Magyar, EI spans departments and facilities, and integrates with the EHR to provide a single view of the patient record. For that reason, organizations that have invested in this approach are “better positioned to quickly deal with unpredictable demands.”
It doesn’t get more unpredictable than what we’re seeing with COVID-19. Organizations with a strong imaging strategy have either “migrated or federated the data, and everything they need to diagnose appropriately in terms of pertinent priors is there,” said Taggart. For those still relying on antiquated methods of transmitting images, COVID-19 has wreaked havoc, and will continue to do so. “These basic things can either set up an organization well or set them up for some major deficits.”
Three key areas of concern, according to panelists, are as follows:
- The “wild west” of imaging. In the absence of an EI strategy, questions abound as to how images are being used and shared, said Magyar. Individuals are using imaging, ultrasound, video capture, and other tools, “but are they associating that with the patient data? Are they storing it? Are they managing it? How are they exchanging it?” These issues, he noted, need to be addressed. “We joked for years about it being the Wild, Wild West outside of radiology and cardiology. I think situations like [COVID-19] shine a light on things in a way that you can’t just sweep it under the covers.”
- Avoiding workarounds. Leaders need to realize that workarounds are inevitable, especially during a pandemic. “If clinicians need to do something to treat their patients, they’re going to get very creative,” said Taggart, including accessing images. “And if an organization is not adapting and providing them with viable solutions, they will find a way to work around that and get what they need.”
- Securing unknown devices. With the remote workforce growing (exponentially, in some cases), CISOs and other security leaders are becoming increasingly hesitant to allow VPN access from unknown devices. When they do, it’s critical to ensure VPNs aren’t open to the entire network, as “that could introduce other vulnerabilities from an information security perspective,” he noted. “That’s probably the most important thing to be concerned with right now.”
The bottom line? Enterprise imaging has become a necessity. “If you think about the cost benefit analysis, it’s a slam dunk,” said Taggart.
But no matter how smart an investment it may be, the reality is that now is not the ideal time to implement an EI strategy — at least, not if you want to do it right. “Can it be done in a hurry? Yes,” he noted. “Can it be done in a hurry and be done well? Probably not. If you don’t already have an enterprise imaging strategy that you’ve deployed with remote capabilities, you still need to go through that process in order to establish these things. Just because we have an emergency situation, doesn’t mean that you’re magically going to be able to stand up an enterprise imaging system faster.”
The good news is that there are some solutions that can be applied in the interim. And while the workflows aren’t ideal, it’s better than nothing.
What it boils down to, according to Magyar, is changing the rules. The vast majority of diagnostic medical imaging solutions are using a model in which both a full DICOM study and relevant priors must be pushed to a workstation. “That whole architecture makes this problem of a remote read really hard to solve.”
Fortunately, there are alternate architectures. In environments in which the server-side rendering work can be done in the data center, Hyland has a solution that can push those images to a virtual machine and do the rendering work that would have happened on the radiologist’s desktop, then send it to a browser using an http-stream to whatever device the radiologist is using, he said, adding that it makes the problem “vastly easier to solve.”
Of course, with any change being made to a system, one area that must be addressed is infrastructure. For organizations that are on the path toward a real enterprise scale solution, leaders need to understand how imaging will interoperate with the EHR, said Marion. “That’s a key aspect in the sense that if you have an image-enabled EHR, you have a mechanism to present some level of imaging to a broad range of clinicians. That’s more of a true enterprise issue than allowing a radiologist or a cardiologist to view images in their home.”
The last — and perhaps most important — piece of the EI puzzle involves governance, noted Marion. He advises putting together a governing committee that addresses all imaging needs and is properly represented to ensure no areas are being overlooked. Organizations that have this type of structure in place and can address IT issues in that context “are going to be far better positioned to deal with an emergency such as COVID,” said Marion.
Magyar took it a step further, adding that organizations that don’t have an EI strategy “really need to rethink this. We’re all affected by this. We need to work together, and think hard about what we can do to make this a better situation.”
To view the archive of this webinar — Optimizing Your Imaging Approach for the COVID-19 Fight (Sponsored by Hyland) — click here.