By Dawn Cram

Enterprise imaging has become a rapidly growing movement within the medical imaging community.

Following the advent of the electronic health record (EHR), now commonplace in health care organizations, enterprise imaging needs and challenges became evident. As departments acquiring visible light images such as ophthalmology transitioned to electronic charting, the image storage, indexing, management and retrieval workflows previously used in a paper chart environment were quickly identified as being too cumbersome to be incorporated in concert with electronic processes and ultimately demanded better methods. Our IT departments and C-suite executives were additionally enlightened to the risks and accessibility issues implied by the acquisition and storage methods being employed within visible light imaging areas, including the extensive use of smart devices and multiple silos of image content.



Enterprise imaging has become so relevant that seven white papers were released in 2016 by the Journal of Digital Imaging (JDI) as a joint effort between the Healthcare Information and Management Systems Society (HIMSS) and the Society for Imaging Informatics in Medicine (SIIM). During this year’s SIIM annual meeting, attendees will have an opportunity to discuss these white papers in depth with the thought leader authors, in subject-specific roundtable sessions.

Enterprise imaging extends the imaging informatics domain beyond radiology and cardiology, encompassing imaging performed across the spectrum of specialties and including diagnostic imaging, visible light imaging, graphical representations of data, waveforms and clinical multimedia such as those acquired within neurology sleep labs or audiology departments.

Radiology and cardiology departments are often combining efforts and leading the forefront of an organization’s decision to move toward an enterprise imaging strategy in an effort to enhance clinical decisions attained from greater multidisciplinary relativity, improve continuity of care through the availability of a holistic image record and achieve enriched analytics capabilities through centralized storage of imaging performed in departments such as pathology. These benefits and the inherent challenges of pathology imaging informatics will be discussed in sessions, led by pathologists, and are being introduced at SIIM 2017 as a new Society initiative to attract expertise from all enterprise imaging specialties and in unity with this year’s theme of “bridging the transformation to a new era in medicine.”

Implementing an enterprise imaging strategy continues to be discussed and sometimes passionately debated with increased vigor. Defining and determining how to develop a strategy has been detailed in various journal and media articles. While reading information-rich articles and white papers is helpful, implementing a strategy is not a plug-and-play endeavor. Imaging informatics professionals newly progressing toward an enterprise imaging model should find opportunities for networking with industry leaders who can advise on determining how your organizational drivers can adjust the needed approach.

It is necessary to understand the steps toward guiding your organization as its imaging informatics expert, including identifying the current state, engaging stakeholders, establishing organizational vision, planning, quantifying value for your imaging initiatives and evaluating vendor products that can move your organization’s medical imaging to the enterprise level.

Various technical challenges exist and continue to be identified, requiring innovative methods of acquiring, managing, storing and distributing clinical multimedia in cohort with diagnostic imaging. Learning the basics of IHE profiles such as cross-enterprise document exchange (XDS) and standards like DICOMweb and FHIR can assist when working with vendors toward meeting the technical challenges. In addition to traditional DICOM imaging, advances in predictive analytics and deep learning are developing rapidly across visible light specialties such as ophthalmology and dermatology.

Health care organizations are facing an ever-growing need to address workflow, image management and image life cycle challenges presented by incorporating non-DICOM images alongside DICOM imaging. Pointof- care diagnostic imaging adds additional complexities by combining encounters-based clinical workflows as most intuitive and efficient, with the need for resulting and billing to be processed through more traditional orders-based diagnostic imaging workflows.

Software architecture and delivery methods offered by our imaging system vendors must begin to maximize the hardware technologies available. Retrofitting legacy architecture with newer delivery methods, rather than new development, can no longer suffice. Meeting the challenges of enterprise imaging requires the ability to consume image data from many potential sources and in many image, video and clinical multimedia formats. Extracting, preserving and utilizing the metadata behind non-DICOM images is essential.

Conformance to DICOM standards is not a realistic expectation for modalities in some enterprise imaging specialties. It is crucial our vendors begin identifying and applying creative ways to leverage standard photo, video, audio and document standards to incorporate this content, while applying more traditional and automated image validation and management methods. Both diagnostic and clinical imaging modalities are becoming more portable. Smart devices are increasingly utilized as the conduit for acquisition and transmission of visible light clinical imaging, and most recently for diagnostic imaging such as ultrasound and ECG. Other mobile diagnostic imaging smart device apps are in development, including one mimicking the diagnostic capabilities of X-ray by using the terahertz frequency of the electromagnetic spectrum.

Whether a veteran or newly embarking on this journey, we will all continue to learn, grow and adapt. In doing so, innovation will be the primary key for moving forward through this era of enterprise medical imaging, and succeeding. As you plan to attend the SIIM 2017 annual meeting, take time to visit the exhibition hall and innovation pavilion. Explore some of the imaging systems built on newer information technologies, which are widely used by other industries to meet the increasing demands for handling big data, scalability, performance, disparate workflows and analytics. In HER fashion, several imaging system vendors now offer enterprise image repository solutions with modular viewers to address workflow-specific needs. Others harmoniously support encounters-based and orders-based imaging workflows, deliver enterprise work-lists and offer multidisciplinary relativity capabilities. Mobile imaging and image exchange applications, which tightly integrate with EHRs, are enabling organizations to achieve greater patient engagement across a wide gamut of imaging specialties.

Today’s imaging informatics professionals are entering a new era and evolution in medical imaging, which is both exciting and challenging. It is our responsibility to learn from and apply our experiences over the past three decades, while expanding our perspective and embracing the new challenges and advances in medical imaging. We look forward to seeing you at the SIIM 2017 annual meeting!

About the author: Dawn Cram is the IS director of enterprise imaging at Ochsner Health System.