Successful Execution of Enterprise Imaging

A physician at The Cleveland Clinic can now view  photos of a patient’s hand and an X-ray of the same hand side-by-side within the electronic medical record to determine the best treatment plan, according to Louis Lannum, the director of enterprise imaging at the nine hospital health system, during a session at the HIMSS 2015 annual meeting.

This advance was made possible by the organization’s adoption of an enterprise VNA to facilitate access to images and other unstructured patient data throughout the system. The organization is one of a growing number that have adopted an enterprise-wide imaging strategy. It’s the latest step in the evolution of imaging, explained Richard “Skip” Kennedy, MSC, a radiologist and regional technical director of imaging information at Kaiser Permanente Medical Group.

“We adapted to the idea that the EMR is the fundamental [hub] for all imaging, “ Kennedy said.

Lannum said the Cleveland Clinic was motivated to make the switch to an enterprise-wide image solution when they realized that more than 60% of the data physicians need at the point of care-unstructured data such as images-were missing from the medical record. These data were trapped in silos throughout the organization.

To remedy this, the organization opted to pursue an organization-wide strategy for cataloging and storing images, regardless of which department created them.[[{"type":"media","view_mode":"media_crop","fid":"34497","attributes":{"alt":"Louis Lannum","class":"media-image media-image-right","id":"media_crop_8233973144881","media_crop_h":"0","media_crop_image_style":"-1","media_crop_instance":"3671","media_crop_rotate":"0","media_crop_scale_h":"0","media_crop_scale_w":"0","media_crop_w":"0","media_crop_x":"0","media_crop_y":"0","style":"height: 169px; width: 160px; border-width: 0px; border-style: solid; margin: 1px; float: right;","title":"Louis Lannum","typeof":"foaf:Image"}}]]

“It’s more than just storage,” Lannum said. He explained that VNAs initially emerged to extend storage capabilities of radiology departments, however, these systems have evolved to include workflows, central image management, and a single access point.

Previous imaging strategies have been “radiology-centric,” Lannum said, but as more specialties utilize images, it is becoming more important to look at imaging management at the enterprise level. At many organizations, this process has included no longer referring to other specialties using the VNA as  “the ologies.”

“It is time to stop talking about ologies,” Kennedy said. “Now, we have to learn to collaborate (within the enterprise model).”[[{"type":"media","view_mode":"media_crop","fid":"34498","attributes":{"alt":"Richard “Skip” Kennedy, MSC","class":"media-image media-image-right","id":"media_crop_3702769266793","media_crop_h":"0","media_crop_image_style":"-1","media_crop_instance":"3672","media_crop_rotate":"0","media_crop_scale_h":"0","media_crop_scale_w":"0","media_crop_w":"0","media_crop_x":"0","media_crop_y":"0","style":"height: 213px; width: 160px; border-width: 0px; border-style: solid; margin: 1px; float: right;","title":"Richard “Skip” Kennedy, MSC","typeof":"foaf:Image"}}]]

So far, 35 of the 45–50 departments that produce images at the Cleveland Clinic have been integrated into the enterprise-wide system.

In addition to solving some of the storage and access problems associated with siloed image management, Lannum said the new system is giving physicians the opportunity to utilize a wider array of image capture devices and provide more efficient care. For example, if a patient sees a dermatologist for a rash, the dermatologist could ask the patient to take “medical selfies” of the rash during treatment and the physician can incorporate these images into the record to assess treatment results.

One of the keys to a successful enterprise image strategy, according to Lannum, is having strong governance. He explained that the Cleveland Clinic has created a governance body, including the chief information officer and representatives from the departments using imaging, that meets regularly. This body helps set image storage policies and helps to ensure that new systems purchased by various departments are compatible with the enterprise system.

Another key to a successful enterprise imaging strategy is to ensure that communication among specialties doesn’t suffer, said Kennedy. He explained that despite the inefficiencies associated with earlier generations of imaging technologies, these older technologies also required one-on-one discussions among clinicians or even physical handoffs of data. It is critical, he said, for enterprise strategies to include good cross-department communication and collaboration.

“For all the inefficiencies, we had a communication and collaboration process build into that,” he said. “We need to maintain that.”