When the Covid-19 pandemic hit and healthcare leaders had to reshuffle priorities, enterprise imaging was one of many areas affected. But as organizations advance toward digital transformation, it has come back into focus.
And the timing couldn’t be better.
“It’s imperative to allow physicians to share information and pull up imaging studies,” said Chuck Christian, CTO and VP of Technology, Franciscan Health, during a recent panel discussion, which also featured Geoff Fallon (VP, Epic & Clinical Applications, MaineHealth) and Chris Jenkins (SVP of Advisory Services, Healthlink Advisors).
If providers can’t access imaging data, it means having to reacquire images, which, along with potentially putting patients at risk, also puts a strain on resources, according to Fallon. “It’s not efficient, and it’s not timely care,” he noted. “That’s a real issue for us.”
And yet, sharing images and creating a solid enterprise imaging strategy remains a significant hurdle due to myriad factors, including administrative and technical challenges, the high cost of applications and storage, and variations in processes. During the discussion, the panelists shared their organization’s journeys and provided best practices.
MaineHealth’s “ideal state”
For MaineHealth, the move to a true enterprise imaging approach — which kicked off about five years ago — was driven by a desire to facilitate information exchange between the cardiology and radiology departments. Unfortunately, “We chose a fairly complex model with different vendors,” Fallon recalled, which became difficult to support and sustain. “It’s been a bit of a growth process for us to realize that our vision had some gaps and to shift that vision and move toward stability.”
Some five years later, the strategy for managing a large amount of specialty referrals (many of which come from non-affiliated health centers) involves a hub model for sharing PACS images. “We’re trying to move toward a more streamlined platform with fewer vendors and a good VNA that is flexible and can accept images from non-core platform solutions,” he said. “That’s the ideal state for us.”
The more systems an organization has in place, the more critical it is to ensure the patient, order, and study are tied closely together. “It makes it cleaner” to decipher the source and ensure it’s the correct patient. “It really takes a lot of work with different vendors and your HIM department to make sure you’re doing a good job managing patients across those platforms,” Fallon stated.
It also means being able to meet the needs of cardiology and radiology staff, which can vary quite a bit in terms of workflow and usability. “They have very different opinions, and there isn’t one clear-cut system that’s best,” he said. For leaders, it means “brokering a governance and a clinical decision to say, what is the best for the most amount of people in this organization?”
It’s why Fallon believes enterprise imaging governance is “inherently more complex than a lot of other areas of governance,” and must be approached thoughtfully. “It’s all about finding the right balance and partnerships to make sure patients are cared for.”
Jenkins concurred, adding that although it’s understandable to want fewer products, the overall goals of the organization can’t be overlooked. “Yes, you can reduce the footprint, but will it enhance the patient experience? Can you increase clinical quality and operational efficiencies if you move to one system? That’s where governance comes in,” he said. For leaders, being able to communicate the negative effects of having multiple systems — including variations in workflow and care delivery, as well as greater support burden on IT — is essential. “If you can streamline that, you can provide better support and have better outcomes.”
Franciscan’s “clear vision”
For Christian, who spent the first 14 years of his career as a lab radiologist, it was all about timing. When he joined Franciscan in 2019, the organization had just acquired a new PACS, which he helped implement throughout the enterprise. “It makes it so much easier” to share images, particularly in an organization that handles referrals from different regions, he noted.
Of course, it’s not always easy to capture an image from an outpatient facility that isn’t part of the system, for example. “Getting images from point A to point B can be a challenge,” according to Jenkins. “We see a variety of workflows and variations in the process, all the way from the outpatient imaging facility to the health system.”
It’s particularly true when CDs are used to transfer images, which is the case for nearly 60 percent of the organizations he has worked with. “There’s a whole process where a patient brings it in, and it has to be adjusted and matched.” Much of the time, the format isn’t compatible, or the CD isn’t readable, which can cause additional delays. “You want to simplify the environment as much as possible, but not to the point where you can’t deliver care,” Jenkins added. “You want to put in a solution that meets the needs of providers while driving the business and enhancing the patient experience.”
At Franciscan Health, it means leveraging a cloud platform for image sharing, rather than letting outside users access their PACS. “We have enough to store on our own,” said Christian, adding that the team already sees more than one million studies per year.
As with so many critical issues, it starts with “having a clear vision of the problem we’re trying to solve” — not finding a solution and then hunting down the right problem to fix. “That’s where the operational partnership comes into play. What are you trying to accomplish?”
It’s also where relationships and trust come into play. Because while image sharing does certainly have a technical underpinning, it’s operational involvement that can make or break an initiative, Christian said. “If it comes across as IT-led, it’s 50 percent destined to fail. You need to bring operational folks to the table.” CIOs and other leaders also need to “put your business case where your mouth is and illustrate that you can deliver on that.”
After all, enterprise image management is by no means a cheap undertaking. While IT certainly doesn’t want to be “the department of no,” as Christian stated, “everybody needs to understand that we have limited resources from a capital standpoint and a human standpoint. We need to make investments appropriately and make sure we’re not getting in the way of patient care.”
To view the archive of this webinar — Enhancing Systemness Through an Enterprise Imaging Approach — please click here.