Q&A with KLAS VP of Imaging Informatics & Oncology Monique Rasband: Partnering Key to Making Enterprise Imaging Strides

For the better part of a decade – from 2010 to 2020 – CIOs were busy implementing and optimizing their EMRs. And since 2020, it’s been all about cost cutting via application rationalization, integration and, of course, security. But there’s another massive challenge that stands to benefit from CIO leadership – the journey from a siloed, ology-specific imaging paradigm towards one focused on more seamless sharing across the enterprise. Of course, the topic is nothing new to KLAS’s Monique Rasband, who has been with the company for 15 years and focused on enterprise imaging for much of that time. In this interview with healthsystemCIO Founder & Editor-in-Chief Anthony Guerra, Rasband discusses the value of enterprise imaging, how to get started, and the most effective role for CIOs in the journey.

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Bold Statements

What’s nice about the VNA, if people do decide to go that route, is that a strong VNA will be able to handle multiple PACS, so you get them in one place. They can handle the scopes. They can handle the non-DICOM. So for a lot of people, the reason they like having the VNA is all of the different pieces are able to fit in one solution.

The CIO, what is going to be so critical and important to them is going to be security. And figuring out: are these pieces of equipment; are these machines secure? And very unfortunately, the WannaCry virus was brought in from a modality.

… this is a partnership, not only with the CIO, but with the clinical side, IT, and then, of course, the vendor. If there is not that partnership and people are not all in, one of those teams can’t jump out by themselves and have it be successful.

Anthony: Welcome to healthsystemCIOs interview with Monique Rasband, VP of Imaging Informatics and Oncology with KLAS. I’m Anthony Guerra, founder and editor-in-chief. Monique, thanks for joining me.

Monique: Hi, thank you so much for having me today. I really appreciate it.

Anthony: Excellent, Monique. So we’re going to have a lot of fun today, and we’re going to talk about enterprise imaging, which is one of your specialties, so I’m pretty excited about that. Let’s start off with my usual question. Tell me about your organization and your role.

Monique: I am vice president of our imaging team, imaging informatics, and that does include oncology. Cardiology also falls under my umbrella and then cloud as it’s involved in imaging and then of course, AI. And you said, we’re going to have fun, this is obviously one of my passions, a really fun topic, and it’s fun for KLAS to get to dive into it.

So a bit about KLAS for those that are not familiar. We get all of our data from the healthcare providers. We are on the phone, the good old-fashioned way, or on Teams and we’re having these in-person interviews talking with them about strategy. We get into the solutions, support all of the fun pieces that feed up into the enterprise.

Enterprise imaging is interesting in that it is a bit unique and different case by case. For some organizations, having a PACS and reading for multiple hospitals or other organizations, that is at their enterprise level. We look at others, some of the academics, some of the IDNs, and they may be looking at multiple specialties under the umbrella for enterprise imaging and just within their organization. So we do find the pieces of enterprise imaging and the definition is different case by case, depending on what they need.

At the end of the day, it is so fun to work with both the vendor side and the providers, both those giving care, the IT teams, the C-level, because we all are looking at the patients. So it is the diagnostic backbone of healthcare, and that’s why it’s so exciting, and I’m happy to be a part of this today.

Anthony: Awesome. Thank you for that. So specialties, there’s so much in here. There’s so much to understand in this ecosystem. Let’s talk about first the clinical specialties where you have an imaging component. You want to list them off, maybe from the biggest to the most minor ones?

Monique: Yeah, absolutely. So most people get started with radiology. We have seen a few organizations that certain cardiology can be more complex. Radiology, most individuals have been doing this for quite some time and some are adding in a VNA, for some that’s not the route they’re going, but radiology is a really great place for most people to start and where we have seen people get started. Cardiology, a very natural fit to be a second or as I mentioned, starting out. And right now, what’s been really fun is seeing some of the outside specialties, some of the newer specialties before that were sitting in a silo. Ophthalmology has been popular. We have seen some start to bring dental in. Wound care, if you think about the scopes and some of the surgical images. Dermatology, just to name a few. And one that is very new that we’re seeing a lot of intention is pathology.

Now, digital pathology can mean different things to different people. It has not been something that has been on the radar. Well, it’s been on the radar off and on, but we’ve not seen a lot of adoption. And now we are starting to see very early adoption in the US. We have seen adoption in Europe before the US got started. Something to understand is that these images are incredibly large and complex. So those that struggled with the 3D mammo, the tomosynthesis studies. I’ve had a few radiologists joke that pathology is child’s play compared to those size of files. And then the scanners can also, they’re not the DICOM standards. That’s what’s been so beautiful about radiology is having that DICOM standard which, for the most part, is very neutral. People are able to play with each other. We see some of these vendors integrating within their EMR, and sometimes the providers don’t even know the stop-start. That is a great problem to have when you don’t know what’s the stop-start between your imaging system and your EMR. Pathology has been a little bit different where there are a lot of different standards and some proprietary pieces in there. So that’s something that’s been a bit more complex that we are seeing energy.

Anthony: So let’s talk about the non-enterprise imaging state that most health systems live in today. Would you say that’s the reality; that most health systems do not have an enterprise approach to imaging. And therefore, each one of these, and you tell me if I’m wrong, each one of these ologies have their own imaging capabilities. There is a modality, which is the machine,

and there are different machines that take different types of images. And then there are viewers, workstations, PACS, RIS things like that. So you have your modality, you have your system that manages the image, and all those things, you can have silos of those, capabilities for those in each ology, correct? And so, a dermatology doctor who sees someone who was at the ophthalmologist within the same health system may not have a way to easily see that image, even though they might like to or they might not. Sometimes they don’t want to, sometimes it’s totally irrelevant, but sometimes it’s relevant.

So the idea here is that we want to get to a world where instead of all these imaging silos, we have an ability for anyone to see any image taken anywhere in the health system at the start. Before we talk about between health systems, we’re talking about within a health system, right?

Monique: Correct, yes. And even in radiology, there are issues. I have a friend that had imaging done all within the same organization, but it was at more of a remote imaging center. And even when this person went to look at the history, all of that was not, even for radiology, all of the appointments and all of the images were not tied to the EMR. So sometimes people understand the disparity of different PAC systems and specialties, but we do see it even within radiology. If you think about third-party imaging centers that contract, there are oftentimes acquisitions. It’s really interesting, a handful of years ago, everyone was talking about consolidation. And sometimes I talk to those same organizations that did consolidate their PACS and their cardiology, and somehow they have acquired more sites or other healthcare systems, so they brought new PACS and new cardiology systems back under the fold. So it does seem like even within the core specialties, that still can be an issue.

So you’re right, at the end of the day, from a patient standpoint, and for the person treating that patient, it is so helpful to see all of the images under one umbrella when that is possible. And obviously that takes a lot of work on the IT side, and that’s something that is definitely going to keep a CIO up at night.

And then we’ve talked a lot recently about security because these are in all different systems. So that is also part of what everyone’s hoping to get together. What is the best way to consolidate? What is the easiest way for all of the clinicians and the providers to see all those patient images? And then if they do need to view them, is there a way that they’re able to go in and do that without a lot of work and without a lot of hunting down? So most people don’t want these specialists having to go out and hunt down the image. It’s really nice for it to be there.

And then viewing, I think it’s helpful to talk a bit about the different types. There is diagnostic viewing. That’s where the clinician is going to literally be reading and having the radiology report, but then there’s also the referential viewing. So not everyone needs to see the diagnostic view. Quite frankly, most people, unless they are the reading, the radiologist or the reading physician, they don’t want to go through all that. They just need to see that quick and easy referential viewing. And so oftentimes I get asked, what do you mean by referential? And it is either the referring physician or just a referential view into that patient image.

Anthony: And that has to do with how you’re going to view the image and the file size and the monitor and all that. For that diagnostic viewing, you’re going to need that ultra high-level stuff.

Monique: Yes.

Anthony: And there’s probably even legal ramifications there. You can’t officially read an image on a cheap monitor.

Monique: That’s right.

Anthony: And if it’s something, there’s got to be liability there, right?

Monique: That’s right.

Anthony: So that’s what comes in.

Monique: Yeah, yeah, absolutely. It’s all the fun stuff.

Anthony: Yeah, it’s a lot of stuff. It’s a lot of stuff. Let’s just pick on some of the stuff that you mentioned or dig into it a little bit. I’ve done a few things in this area. It seems like because of DICOM, if you go to a VNA model, being able to purely see an image in many areas in many ways is possible. But you may lose some of the context, the tagging, the notes, the information that make it valuable in that instance. I guess when it leaves its core, the core vendor system, some of that is stripped off. And so, you may see the image, but you may not have the context. Is that a correct dynamic that I’m understanding?

Monique: Yes, that’s a correct dynamic. Again, another scenario, I have a personal story. I got a friend who had an image read. They found a tumor. it was in the report, and it was marked, but it was very deep, and the top of the report was just labeled something very basic like CT pelvis. And then that was put into the report, but there were no follow-ups. There was nothing that was shared. Unfortunately, the ED doctor sent this individual home and said, ‘you’re fine. There’s nothing in there’ and it was right in the report, again buried in the report.

So that is obviously now a challenge because a year later that tumor has unfortunately tripled in size and now were at a very different spot. And so how can we tag, how can we get that back easier to that emergency physician who should have found it buried, but also was there something that person could have done to label the report differently or had a note in there for follow up? So even just simple things like that, and that all goes more into processes by organization, not necessarily from the vendor side or on the software side, but even just understanding when those things happen, how is that brought to the attention and how is that for the organization helpful to make sure that there is a standard of care. And I think that absolutely will be something, and is something, that CIOs are working closely with the departments to make sure all of that is brought up and heightened so that does not get missed and does not happen in the future.

Anthony: You mentioned the tie to the EMR. Can you tell me more about that? Whether there’s a tie or no tie? Obviously, that’s about workflow, right? We always say we want it easy in the workflow. And the EMR is the core place where the physicians are working. So ideally, you want to be able to see that, ‘oh, there was a scan taken. Oh, click here. Boom, I see it right where I am. I don’t have to log into another system or go to another workstation.’ Tell me more about that.

Monique: Yes, and being able to see the patient record, the patient history, and again, as we mentioned before, understanding and having all of that information for a health system in one spot. One thing that makes me so happy, when I’m on the phone and I’m talking with someone and they will call out the Cerner viewer or the Epic viewer, that is such a compliment. And I’ve heard that also for Meditech. They’ll say, “we just use the Meditech viewer.” That is a true compliment to the EMR vendors. Whenever you have a link and it is that simple that the end user – now, obviously, that’s not what the radiologists are saying. It would be the other specialists in other departments. But if it is that easy to go into your EMR and you are clicking on a link and you are able to see the referential viewing, kudos to both the imaging vendors and the EMR vendors for making that work.

When I started at KLAS, that was not the case. They did not integrate well, and it is a compliment that providers don’t always know when they’re switching back and forth. Now, imaging will know, and IT will know, where that starts and stops, but it is so nice and easy for someone to have that in the tool, in the system they use the most. Obviously for radiologists, they are using their PACS the most, that’s the diagnostic. And all of that information does not need to be in the EMR, but as we mentioned, the record, the report for that patient, as well as a thumbnail or the way to click back for referential viewing, is nice and very convenient for everybody. Also, for the patient to be able to go back. As I mentioned the story before, it was a patient that was looking and went to go get imaging and said, “wow, a lot of my imaging is missing, and I’ve always gone to the same health system.” So how can we figure that out?

And also something that gets brought up quite a bit is point-of-care ultrasound, often referred to as POCUS and earlier, the old school days, people came out with a stethoscope. The joke now is everyone comes out with a point-of-care ultrasound, and it’s so small, it’s similar to the stethoscope. So you can take a quick peek, you can look. Well, what happens when someone takes a quick peek and they’re looking at something completely different? And all of a sudden, now a patient down the road has a problem, and the patient said, “well, I thought I was fine, I had a scan. I had an ultrasound a few months ago or six months ago, and nothing was documented.” And remember, that would not have been a diagnostic ultrasound. Maybe they were just looking for something quick.

But that has been brought up over and over. How do we focus in? How do we document point-of-care ultrasound? Where should that be stored? How is that labeled? Is that ordered? Or what is also the revenue, even more importantly, to healthcare organization? How are they getting the revenue for that if it was something that should be billed? So that is still early, but it comes up quite a bit. At our previous enterprise imaging summit, we had a whole discussion around point-of-care ultrasound or POCUS.

So obviously, as more people are more and more savvy with that, it’s going to be an area of growth. And I’m personally very excited for it. I love ultrasound. It is the little sweetheart of healthcare. There is no dose. It’s quick and easy. It’s very comfortable for the patient for the most part. So it’s really nice to see that expand. But with the expansion, there also has to be governance. It has to fit in within the workflow. And better yet, it needs to be documented and the healthcare organizations need to be getting that revenue if that is something that should be revenue generating. Obviously, the right image at the right time and the right payment. So that’s what we’re all focused on.

Anthony: Very good. It seems to me like health systems would have an infinite variety of imaging setups. And you have multiple hospitals, some you’ve acquired through M&A, many physician practices, maybe you bought some imaging, standalone imaging clinics or whatever you want to call them, and your modalities, your vendors, everyone’s going to have a different flavor, a different setup. So, how do we begin to give people information about thinking through this when there can be so much variety out there? Is there a basic, ‘okay, take a deep breath, here’s what you want to start. Here’s maybe what you want to start thinking about. Here’s some low hanging fruit, if there is such a thing here.’

Monique: Yes. Great, great question. And we hear this all the time. We hear about consolidation. And my very first question when I hear consolidation and when I hear enterprise imaging, I always ask the same simple question – what do you have now? What’s working really well? What is not working well? What are the age of the contracts? What seems to be a nice workflow? I think that’s what is so complex, but also so beautiful about imaging. There’s not a standard answer, but the low hanging fruit would be: what is working well? What are the physicians comfortable with? Is it something that is for them to be productive? And then, of course, thinking about long-term storage.

So cloud comes up quite a bit, and I have found cloud is very fuzzy. What is the definition? For some organizations, they want the long-term storage in cloud. Others are small, and they want that to be hosted – shortage of staff, shortage of IT, as well as clinician shortage. So cloud can be an answer for a couple of those things, but it is not one-size-fits all. And the definition of cloud is definitely very broad. So just a few things to think through there, but definitely having a standard setup. So some people have tackled that with a vendor neutral archive. Others have said we don’t necessarily need a vendor neutral archive. I’ve talked to people very successful that are very happy with their strategy. So we have absolutely seen that work both ways. The other way people can tackle it is with a very strong universal viewer that has the diagnostic capabilities. And in some cases, they could have a different viewer for referential.

Now, most providers would like to stick with one solution. At the same time, it does not seem like there is a silver bullet as we dove into our report. There’s not one silver bullet that people just say, this works for every single person, every department, and it’s all perfect. There are some things that are still melting together for most of the vendors. They’re all keenly aware of that, and everyone is striving to get to a better place. Our CEO, Adam Gale, he said, “we keep having this enterprise imaging summit, is anything changing? What’s progressing?” So it may seem like that, because we’re talking about different challenges. But honestly, we’ve seen so much progression in imaging. And that truly is a thank you back to the providers that work so hard on it. All of the people that have these enterprise imaging committees, the CIOs that see the vision and get behind it, but also to the vendor partners that go out and listen, and they figure out workflow. If you even think about imaging today versus pre-COVID, a lot more people are remote. So things that they’ve had to tackle and switch up are different from what we were looking at even five to three years ago. The shortages are different from what we were looking at five to three years ago.

So there is an infinity of work to do, endless challenges, but we are actually making progress. The vendors work very well and are truly very neutral, but a diagnostic viewer overlaying on multiple PAC systems and/or VNA, is absolutely possible. So this is very fun to talk about and to see the progression.

Anthony: I’m glad you’re having fun, I am too. So, VNA versus universal viewer, a VNA sounds like it’s not absolutely the one way everyone needs to go.

Monique: Not the absolute way. A lot of people really like that direction and we’ve seen a lot of people be successful. Now, what can be different from the VNA, and again, people approach it differently, but that can be their backup archives. That can be from the same vendor or there are vendors out there that have really good standalones. So again, we’ve seen successful people on both routes. What’s nice about the VNA, if people do decide to go that route, is that a strong VNA will be able to handle multiple PACS, so you get them in one place. They can handle the scopes. They can handle the non-DICOM. So for a lot of people, the reason they like having the VNA is all of the different pieces are able to fit in one solution.

Now we’ve had people that say, ‘we just don’t want to go that route. We would rather find a really strong viewer that will go across multiple specialties.’ To date, we have seen examples of things going okay, but most providers say, ‘we think this is the strategy. It’s the right vision,’ but vendors need to continue to work on X, Y, Z. And when I say X, Y, Z, I’m careful to not say one particular specialty because it depends on how deep the provider is within that specialty. Obviously, when you start getting to some of the newer ones with ophthalmology, with pathology as an example, vendors have work to do because it’s something that is new and being developed. When it comes to radiology and cardiology, most vendors diagnostically do a great job because that’s where we started. They’ve developed. They have had time to get those tools together, but obviously more and more things come out. I’ve joked that one of my first reports at KLAS, we were talking about 64-slice CT. And that was mind blowing back then. We are so far beyond that now.

You think about 3D tomosynthesis, as we mentioned with the pathology. So the vendors have their work cut out for them. There is never a rest. There’s always something to develop and also new technology coming forward. And you mentioned at the beginning of the interview that this starts with the modality. It starts with capturing an image and all the vendors are coming up with stronger technology to capture that image and equipment that does a better job that’s going to be a higher resolution, which is again, you got to go back to the complexity of storing it. And the amount of data just continues to grow.

Anthony: So much there. When you talk about all the imaging vendors, I think of the EHR space, and I think of what Epic’s done. And the reason that Epic has become what it is, it was to get away from a best of breed with all these modules, all these independent applications, data not flowing across especially inpatient/outpatient, but a whole bunch of stuff. So Epic’s model was, we’re going to take care of all of it. It’s going to be homegrown. All integrated at its core, no acquisition and all that stuff, and look what happened. Is there anyone like that on the imaging side or any potential for someone to become the Epic of imaging?

Monique: Yes, and a lot of vendors have the end-to-end, but it still goes back to, if you’re working with an imaging center that has a different PACS, you’re not going to be able to force that person to replace theirs and go to the same PACS you are on. So what’s more important is that vendor neutral archive, if that’s the way you decide to go, they can bring those images in and have that stored long-term. So it is very different between EMR patient data and the record. And then again, bringing in images, let’s say someone goes between a few states, which nowadays is very common, you’re needing to get your images back and forth or you’re being treated at two health systems. So those images, every time a person, a patient goes, they’re going to be stored there, but they also are going to want to have availability. And we haven’t even touched on image exchange, but that is definitely one that has been going for some time, but we see a lot of potential for organizations being able to exchange images back and forth. Again, that diagnostic quality and being able to be stored in the PACS.

So while vendors offer that with the consolidation and with the data migration and the amount of storage, it is not so easy just to rip and replace a PACS just so everyone can be standard. And that is definitely the difference between EMR. So if you think about going to a new PACS today and you are a patient that’s had images done, you are going to want all of those priors. So even when someone goes live and has a go-live on the PACS or the VNA, even going into the viewer, they’re going to want to make sure they’re able to go back and pull those priors while that data is being migrated. And in some cases, obviously data migration comes and then the go live.

So we’ve seen people tackle that a few different ways as well, but it’s not just so easy as standard text in an EMR. We’re talking about images with motion and sound and video and photographs, so it definitely gets a little bit complex.

Anthony: We talked about this at the beginning, but does it start with, what do we want our clinicians to be able to do? Let’s throw out some use cases – The physician wants to do this. This physician has this patient who has had this happen and wants to do this. We would really like to be able to do that. Okay, what do we need to do to make that happen? Well, you need to do X, Y, Z, and this means you’re moving towards enterprise imaging. Because a lot of things, I guess the idea is a lot of use cases we come up with today are going to involve enterprise imaging when they’re around images. When they’re around what we would love for physicians to be able to do, that’s going to entail moving towards an enterprise imaging environment. Is that correct?

Monique: Yes, correct, correct. And most people are moving in that direction and have been for some time, especially when PACS comes up or it’s time for a contract. Often, I get on the phone with a healthcare organization, they’re coming to KLAS for data, they want to get the last report, and they’re saying, ‘our PACS contract is up. It’s either aging or legacy, or it’s just time to look at if we go with this vendor or do we change, but what should we do with VNA? What’s our strategy? Is it time to look at it? Maybe we have an aging VNA.’

For many of the early adopters for VNA, it was never intended, nor they did not purchase it, with the thought of putting all these different images in. Honestly, back then, I don’t think people even thought about bringing over dental, ophthalmology. It never came up to me. Maybe someone had the vision, but it was more, let’s get radiology in here. So in some cases, they need to upgrade or they need to figure out what is the strategy. What’s the committee? How do we do that moving forward? And if you think about workflow from any physician, it is going to be different. It was fascinating to hear our experts from UNC talk about pathology and what they are doing, and people were clamoring, taking notes on what are they doing in pathology. And that is awesome, but that is not the same as putting radiology in the VNA as an example. There are going to be nuances to cardiology. When you talk to the surgeons and what they need for their scopes, that is a completely different workflow. As we mentioned, point-of-care ultrasound, how is that captured? When is the order? Is there an order? How is that getting billed?

So it is definitely a case-by-case, by workflow, by organization, and then of course the volume. The volume’s going to be different as well. If you just have a few things here and there that are going in, that’s going to be different from someone that has a large pathology program, or they’re putting a large amount of data in, which is back to it is not so one-size-fits all, but what is important to the organization, what departments are they working on? And then I like to start to go from there and then go backwards of, ‘okay, what’s the low hanging fruit? What steps do you need to take? What solutions are you going to need to add? Also, is there something you really like from the vendor that you can add from that same vendor that you have the relationship with?’ In some cases, that’s not going to work. They’re going to want to go standalone. But there are a lot of options and flavors. So it’s not so easy as saying we’re making one EMR decision and we’re going to go end to end. It gets a little more complex and chopped up.

The other standard that we’re seeing that is very common is teleradiology or large organizations who are reading for hospitals. Radiology Partners is one example, and this is just a rough estimate, probably 10 percent of the images in the US are read by them for multiple organizations. So their workflow and what they’re looking at is going to be different. And then if you’re a hospital contracting with them, that strategy obviously would be different because they are your primary radiology arm taking care of those images and taking care of the software side for that particular specialty. So it gets really complex. This is why I have a job for a long time, Anthony.

Anthony: I know. I think I saw 14 years, 15 years with KLAS now. I know Adam’s going to hold on to you for sure.

Monique: I’m their biggest pain, but we’re solving the best problems.

Anthony: Yeah, that’s awesome. So, the modalities, the actual machines that are taking the images, that’s very clinical. Those decisions, those discussions about what actual machine, do we need a new MRI? That’s super clinical. I don’t even know if that’s ever going to come in front of the CIO, but it may. When we talk about the CIO type, it’s going to be more the PACS, the RIS, the VNA. I mean, those are the informatics type things, whereas the modalities, the actual machines are super clinical. Does that make sense?

Monique: It does make sense. And KLAS used to cover equipment. I love equipment. I was very sad to see that move away because of the technical side and just understanding I’m fascinated by what the equipment does. And again, just in my 14, 15 years, it feels like such a short time. I was blown away by the modalities when I started and every single year, I still sneak a peek at RSNA. I am such a nerd on the equipment side. I’m mind blown every single year. Advanced visualization – mind blown. What people are starting to talk about and look for in AI, mind blown. So, it is constantly progressing.

The CIO, what is going to be so critical and important to them is going to be security. And figuring out; are these pieces of equipment; are these machines secure? And very unfortunately, the WannaCry virus was brought in from a modality. So I would not say the purchase as far as understanding the diagnostic tricks and all the bells and whistles that a piece of equipment can do, but absolutely for a CIO making sure that it is really well-integrated and that it is safe and secure is paramount.

And then aging equipment, that is something that should keep people up at night, I’m sure it is. Because obviously as equipment ages, what people don’t always understand – and this is from my old imaging days, or my old equipment days, and I only know enough to be dangerous – is that as it ages, there is just not a patch or something and it gets less and less secure because that’s not going to connect for some of the new systems as it moves forward. Connects, that’s not the best word, but it’s going to start being very, very dated and the hardware gets dated. So that is something just to think about and consider, especially since security is on everyone’s mind right now with the very unfortunate things that has happened over the last few months. It’s always been on the mind, but I feel like in imaging, everyone’s hypersensitive right now. So what does that look like for budgeting and making sure that things are up-to-date and secure from all angles?

Anthony: So the CIOs probably have been, from what you’re saying, and need to be brought into the picture, even when people are thinking about purchasing new modalities because of security, just like every other application, even though these are more biomedical equipment as we get over there, and there’s a lot of understanding that biomed needs to work closely with IT and IT security.

Monique: Yeah, absolutely.

Anthony: Everything needs to be looked at. So we need to also think of the big imaging machines in the same way. So we assume that CIOs and CISOs are being brought in to the discussion at some level for the purchasing for security, if for nothing else. But from what you’re saying, this has to become part of a larger conversation about…

Monique: With the aging equipment, yeah.

Anthony: Because the modality is tied to the RIS, to the PACS, and if we have any intention…

Monique: The VNA.

Anthony: Right, the VNA…

Monique: Universal viewer.

Anthony: …if we have any intention of making this whole thing work, then the CIOs got to be in all these discussions.

Monique: Yes. And I have heard, this depends on the size, obviously, and the depth of the organization. I have heard some people say there’s a biomed person that reports to a CISO, so would every CIO be in for every decision? – Maybe not, and maybe they don’t need to be. But the CIO, if I were CIO, I would want to know who is responsible and making sure about that chain of command. So at some large organizations where they have a CISO and they have someone really strong on the security side for biomed – great. But as you get to be different size organizations, that’s not always the case that you have those layers. I think a CIO, that would just be a great question to ask and look at the chain of command and who is watching that, who’s responsible, just so people know and understand where that falls and who is responsible for that. And again, aging equipment, I think that’s what would keep me up at night. The new purchasing, yes, important, but the aging equipment.

Anthony: Yeah, some security flaws in there is what you’re thinking?

Monique: Yeah, just as it ages and it’s not up-to-date. It was up-to-date at the time it was purchased, but yeah, absolutely keeping that up-to-date.

Anthony: Where do you think enterprise imaging falls on the list of CIO to-dos or priorities?

Monique: I would not say at this point in time it is up on the top. We definitely see it moving up. I love getting on calls when one of my colleagues who works with the C-suite at a healthcare organization reaches out to me and say, “hey, they’re making a large decision.” This is, it’s incredible amount of money and commitment. I love getting on those calls. And that has definitely been happening a lot more in the last two to three years, even in the last 12 months, where I’m getting on calls, and I’m involved in speaking with the C-level people on those large decisions. Prior to that, Adam Gale, our CEO, was not tapping me on the shoulder very often inviting me to talk with those CIOs about this. Not to say they weren’t involved; they knew about it. PACS has always been important to organizations, but it was not always involved in the strategy, involved in the long-term. But also, you think about moving from PACS and a cardiology system into a full-blown enterprise imaging strategy, which again, some of these systems are aging, and so they’re trying to figure out what do we do even with the current vendor as they talk about AI, as they talk about cloud.

One thing that is fascinating to me, we see a lot of use cases starting to come forward in AI, that we hear it in one-off algorithms. I have not yet talked to someone that blew my mind on every single thing they have laid out. One organization that did present at our KLAS conference, Dr. Nina Kottler from Rad Partners, very, very involved, very involved in AI and in algorithms and the infrastructure and the governance. But again, they are an imaging organization; that is, they are reading so many images for so many hospitals and imaging centers. They are very different from being a traditional healthcare system that is looking at end-to-end AI. And we just see AI popping up in all these different pockets, but it still seems like it’s fragmented. And when it comes to imaging, it’s definitely fragmented. I’ve talked with a provider that says, ‘we’re not doing a lot in AI.’ And then a few weeks later, talk to someone that happens to be a chief of mammography and they’re talking all these things they are doing. So even at their own organization, it seems like it’s a bit in hidden pockets.

But at the end of the day, if we’re really moving forward and going all in on AI, and it definitely seems it’s moving that way, due to resources constraints and burnout and workflow for these physicians that are working so hard, there’s got to be some help and some workflow that helps boost up their productivity. And not because they’re not productive, but they are just overwhelmed, but it’s got to be clean data.

Anthony: Very good. Very good. Do you think CIOs need to be doing more leading, and less just reacting to requests, in the enterprise imaging space?

Monique: Yes, leading and also partnering. So if an organization, as an example, reads something and they’re gung ho with pathology, but that pathology team is not ready or maybe that’s not a need – just because there’s energy does not mean that’s where the CIO would want to lead and go partner and that’s the best use. And that is something we often see – imaging committees that the CIO, the CMIO are on. I have heard of a few CISOs being on that committee, which I think is fantastic from a security standpoint, but just knowing and understanding the why. And there are going to be a lot of problems in imaging. So what is the low hanging fruit? What do you already have that you could be utilizing? What could you be tweaking that could offer better support for clinicians, for patients?

In some cases, I’ve talked with organizations, again, because the call comes to me, they’re looking at PACS, and they have a VNA, and I’ve asked them, what are your goals? What are you working on? They haven’t even thought beyond radiology because there are so many projects on the table. That’s not a bad thing. At the same time, though, what small tweak could they do or could they utilize to start getting all those cardiology images into the VNA since that’s already something that is right there in place in front of them? That could be long-hanging fruit. Talking to another CIO that needs to implement and put all of rad, cardiology, that definitely could be valuable to them, but might not be quite as easy or it’s not going to be the same lift as the person that already has a humming VNA right there in front of them.

Same with a universal viewer, and we have heard this with universal viewers, someone will start talking about how it’s amazing in radiology. They tried to roll it to cardiology, and it just was not as robust, and it was not as helpful for that organization. Then you talk to someone else that they have rolled that out and they have training, and they have some nice personalization. And another organization just says, our physicians love this for cardiology. So that’s another part KLAS is trying to help organizations understand what solutions can work or what does the organization need to do? Because this is a partnership, not only with the CIO, but with the clinical side, IT, and then, of course, the vendor. If there is not that partnership and people are not all in, one of those teams can’t jump out by themselves and have it be successful. Then it’s time and time again what we’ve seen in a successful strategy: everyone rowing the same boat, rowing in sync, being on the same page and partnership. It is so interesting that the word partnership comes up over and over about people that are really happy and working well at enterprise imaging. When that’s not mentioned, we hear people calling out a vendor or the clinicians or different pieces of that puzzle. So everyone working together as partners really will help the strategy. And at the end of the day, it all goes back to helping the patients and having better care.

Anthony: Awesome. So this is something that’s definitely worth a CIO’s time.

Monique: Yeah, and I think understanding the business case and the use case. I have to just throw in a pitch for KLAS. We love this stuff and we’re happy to help. I’ve been on many calls with department leads and the CIO and we’re hashing out general questions. It does get really political and you have to be very respectful with budgets and financial, imaging is not inexpensive, and it comes with a long-term commitment of storage. So I think investigating the request, absolutely understanding the business case, understanding the need, and then what is going to benefit the patient, what’s going to keep you secure, and then what’s going to keep you out of trouble. So there are a lot of irons in the fire on imaging, but we truly are happy to help jump in and help any organization that would like us to help on the imaging side. We’ve seen a lot of things work. We’ve seen a lot of things not work. I’m not a clinician, I’m not an IT expert, but I have talked to so many organizations over the years and would love to help in that way. And then we can always connect people with other organizations that have done well.

Imaging is one of those things. It takes a village and those that have been through it love helping and they also know someday they’re going to have something they need to come back and ask for that favor in return. So I love being part of a community where we are nice healthcare neighbors. We get along really well in imaging. Our summit is like a family reunion.

Anthony: That’s wonderful.

Monique: And also, for CIOs coming to some of the KLAS summits on enterprise imaging, we had a few CIOs that came this past year when we held it, and they said, “why have we not been coming to these in the past,” and how do we get more CIOs involved? It’s a very safe environment because it’s not your team, and even if someone from your team is there, we mix it up and we allow people to ask those questions and talk. It takes the politics, and it takes the budget and the financial away, and you can really have those deep discussions with each other from multiple angles, from cardiology, pathology, radiology, IT, CIO, CMIO. We’d love the CISOs to come, but it gives you a really healthy space to hash it out where it’s not the politic environment where people feel like they’re making a decision and other people may or may not like that. It’s just a safe environment to hash out strategy and bounce your ideas, for CIOs to bounce ideas off of others and get feedback.

Anthony: This is the final question, then I’m going to let you go. My guess is that in the past CIOs have not felt really tied to imaging, but that they should really start now.

Monique: Yeah, and at least be aware, absolutely. Put it on the plate, be aware. There are some that have told me, ‘we have the best team,’ and then, all of a sudden, one or two of those best team members leave and go somewhere else, and we just see things start to unravel. So even if you have a solid team, by the way, there are so many solid teams in the US, that is another reason I feel like we are so lucky. We have learned from amazing organizations, all of these discussions and the things I’m able to talk about, I learned from my providers, and literally watching them step-by-step. But it is definitely something to be on the plate and be aware of, especially with turnover as things change, just so the momentum, the strategy, keeps moving in the right direction.

Anthony: I mean, to your point, we talk about a lack of, or challenging, workforce, around healthcare security, cybersecurity. I mean, I’m sure you’re not going on Monster.com finding somebody you need in this space.

Monique: Something with experience, right.

Anthony: These folks are skilled, unique, valuable. If you lose a key person, your momentum’s gone.

Monique: Absolutely. Your momentum stops. We’ve seen that with some of the aging VNAs where they were on a roll and a few people left or things changed, and now we come back and say, ‘so what are you guys doing? Well, we haven’t done a whole lot in the last year or two. Now it’s aging, and now we’re trying to figure this out, and we never got the scopes in, and now we’re starting from scratch.’ So it is a true, true journey, which is why I joke, I am going to be at KLAS’ a lot longer, and I am aging, so I need everyone to figure this out. I am not getting younger, people.

Anthony: Yeah, me too. Trust me, I used to have a lot of hair.

Monique: I think another reason I get so passionate is thinking about when you are the one that is getting the treatment or a family member or a friend, or you’re at a facility and you’re watching all this happen, I have been in a facility when the PACS goes down. I am there where they’re diverting patients to another facility. I have been there when something goes down and there’s a critical stroke patient that is not able to get that image. You really start to feel and figure out and understand why we are this crazy team, the imaging providers, and we get so passionate about what we do. And if you don’t understand it, you haven’t had the situation, and I’m happy for that person, but go back to the backbone of the diagnosis of the patient. And everyone can get really excited about this. Everyone can get on board.

Anthony: I’m not the brightest bulb, but I know that imaging is a cornerstone of diagnosing illness. So, we’re in agreement.

Monique: Yes.

Anthony: Good, Monique, wonderful to chat with you today. I look forward to chatting with you again in the future. There’s probably a billion things we didn’t get to, but I appreciate the discussion and I’m sure this is going to be helpful. So thank you.

Monique: I appreciate it. Thank you so much for your time. And I’m so sincere when I say reach out if you need help. Happy to help in any way.

Anthony: Thank you.