Don Dennison

IT Matters - Image access strategies

February 20, 2016
By: Don Dennison

This is the first of a two-part series in which we will explore trends for optimizing imaging systems for two distinctly different user communities.

The consolidated enterprise

As organizations acquire, merge, or affiliate with others, consolidated enterprises are becoming the norm. The facilities within these blended organizations seek efficiencies and standardized clinical information access, such as a shared Electronic Medical Record (EMR), to gain the benefits of their combined size and abilities.

Having a strategy that works for all imaging users in a consolidated enterprise is important. While order placement for imaging procedures and scheduling and acquisition workflows are also important, we are going to focus on image access.

There are many types of imaging users, with different needs, but this series will explore two high-level types: diagnostic users and imaging consumers. Understanding your users and knowing their needs is critical to developing a successful strategy.

Diagnostic users
These users’ primary need for image access is to provide or support the review, interpretation, and reporting of imaging exams. They often need advanced toolsets and multiple monitors, and require non-imaging applications, such as voice recognition and reporting, to perform their tasks. The most common platform for their daily work is a PACS. They typically have powerful, dedicated workstations with special monitors and devices, such as speech microphones.

Imaging consumers
These users have general needs, often using imaging as just one type of information, along with clinical data from the EMR, to perform their primary tasks. They use images to support their treatment planning and delivery. They may be mobile, performing work at different locations, including remotely. They typically do their work on standard computers with one or two monitors. While these users have used PACS for image access for many years, it has proved to be costly to deploy and maintain across the enterprise. Many of them find PACS complex to use. Increasingly, many of these users are shifting to an enterprise viewer, embedded right in the EMR.

PACS consolidation
The benefits of sharing a PACS across an enterprise are both economic and clinical. In addition to saving costs through economies of scale, having only one system to support and maintain reduces complexity and allows support staff to better service and optimize the system. Any built-in or integrated communication tools provide important collaboration methods within a facility (such as tech to rad) and across facilities (for instance, rad to rad or rad to clinician).

PACS consolidation and a VNA
While consolidation on a common PACS platform (the same type but perhaps multiple server clusters) or instance (the same server cluster) provides several benefits, sometimes it is impractical or time-consuming to complete the data migration and system replacement required. Also, where organizational autonomy prevents consolidation, a shared VNA connected to each PACS can provide a longitudinal patient imaging record, even with different PACS. If an enterprise is very large, PACS consolidation may occur regionally (within common patient referral patterns)
and still be connected nationally through a VNA. Finally, even with a shared Radiology PACS, a VNA may be necessary to provide a shared repository for a longitudinal patient imaging record across clinical domains, such as cardiology, dermatology, and other enterprise image-generating departments.

What to look for in a system
In addition to meeting the needs of the radiologists, the consolidating PACS should have features to support multi-facility workflows, different patient identities (MRNs) along with a Master Patient Index (MPI) value, support for different procedure information originating from a variety of facilities’ RIS, and a shared long-term archive (within the PACS, or a connected VNA).

If the PACS can discover patient and study information on demand from external image sources, such as a VNA, without requiring a data migration, the PACS can provide its users a longitudinal record for the patient, allowing comparison of any of their studies, regardless of acquiring facility. It should also offer multiple deployment options (for example, on-site or central servers and storage, or a combination), and demonstrate the ability to scale to very large transactional volumes with performance. Providers should consider user role and permission management and the ability to set different configurations (such as DICOM attribute mappings, display protocols, and so on) to accommodate different group or facility needs.

The ability to allow staff from each site to perform quality control functions on data acquired locally is often desirable. A system that provides High Availability (HA) and Disaster Recovery (DR), along with real-time system monitoring with alerts, is even more important when supporting many facilities. Getting clinical, system admin, and IT infrastructure staff to work together, reach consensus on workflows, and accept a shared PACS is not a simple task. To get buy-in, leadership should be sure to be able to explain not only the operational benefits, but also the clinical ones.

About the author: Don Dennison has worked in the medical imaging informatics industry for over 14 years.