Don Dennison

IT Matters – Image access strategies

March 25, 2016
By: Don Dennison

In part one of this two-part series, I discussed the increasingly common consolidated enterprise environment, driven by facility acquisition and affiliation. I also covered the motivation and benefits for consolidating the PACS at different facilities within the enterprise into a shared, multi-facility PACS for diagnostic users. In the second and final part, I will explore the needs and strategies for imaging consumers.

Enterprise viewer in the EMR for imaging consumers
With Web-based access and single sign-on (SSO), users can review both clinical and imaging records without having to leave the EMR. As users shift from needing to log in to the PACS to look up a patient’s study data, to relying on the enterprise viewer in the EMR, resources (such as databases, servers, storage and network) on the PACS are freed up, providing more power to diagnostic users. To provide a complete patient imaging record, the enterprise viewer needs to provide access to images acquired at all facilities in the enterprise, as well as across different specialties, like radiology and cardiology. If it can’t, then multiple specialty viewers will often need to be provided and integrated separately into the EMR, resulting in access challenges and frustration by users.

Connecting the enterprise viewer to the VNA, PACS or both
Enterprise viewers typically connect to image managers, like PACS and VNA, through standard DICOM communication, but a more direct data access method may also be available. While PACS often contain diagnostic images for a specific domain, like radiology or cardiology, VNA typically store images from all domains, making them the usual best source of records. However, some PACS operators may delay when images are stored to the VNA, so to provide immediate access to recently acquired images, a connection from the enterprise viewer server(s) to the PACS may be required. Some enterprise viewers can connect to more than one image data source and may contain logic to determine the system(s) from which to retrieve the necessary data.

What to look for in a system
It is important to be able to provide access from within the EMR. Therefore, how the enterprise viewer is launched, embedded in the EMR, and told what study or studies to present to the user is very important. A method of SSO user authentication that is supported by the EMR is critical to prevent users from having to log in to the viewer separately, while meeting security requirements. The ability to display all image types acquired across departments and facilities within the enterprise is crucial to prevent the need to launch multiple specialty viewers from the EMR. Ensure that all the necessary navigation, measurement and analysis tools are available. If imaging consumers are going to access images from mobile devices, such as tablets, support for this is also important.

Change management: getting adoption
If the integration within the EMR is effective, the presentation and navigation of the image data is good, and the speed of display is acceptable, users will typically accept the enterprise viewer without much effort. As users are dispersed throughout the enterprise (and beyond), traditional classroom training is typically not practical. Online training, such as videos and FAQs, are normally sufficient. Tracking study access by user type and facility can help identify where further engagement can lead to increased adoption.

Access from outside the Enterprise
Even with a shared PACS archive or VNA across the consolidated enterprise, images will need to be accessed by authorized users outside of the enterprise. Effective methods for providing viewing (such as an enterprise viewer in a referring physician or personal health record portal) and exchanging images (for instance, through an image-enabled health information exchange or cloud-based service) are also an important part of a complete plan.

Providing direct enterprise viewer access (outside the EMR)
Most enterprise viewers provide an optional interface to allow users to log in directly to the application and then search for a patient or study before viewing the images. Some provider organizations limit access to the enterprise viewer from within the EMR and similar portals. This allows the EMR to apply data access controls, preventing the user from searching through image records. Often, it also helps increase use of, and satisfaction with, the EMR, if the diagnostic and clinical images are made available along with the patient’s clinical data. If direct access is desired, user authentication via lightweight directory access protocol (LDAP) is often sought, and features related to searching and filtering of imaging records also need to be considered.

About the author: Don Dennison has worked in the medical imaging informatics industry for over 14 years. Currently serving as a consultant, he is a speaker and panelist on topics ranging from medical imaging record interoperability, integration of imaging data within the EMR, multi-facility integration and others. He has published articles and eBooks on patient identity management, VNAs, PACS, and enterprise viewers.