Five years ago, Radiologic Associates, an imaging group serving the Hudson Valley region of New York state, was focused on ensuring that its dedicated workstations had the correct staff for each type of report or imaging scan that was being reviewed.

But fast-forward to today and the issue is resolved.

“We’ve really moved ourselves into more teleradiology,” Andrew Mazzella, CEO of Radiologic Associates, told HealthCare Business News. “Now our radiologists – whether it is PET/CT, 3-D-tomosynthesis, MR or CT – can read scans from any of our workstations.”

This is but one example that reflects the many changes taking place in the imaging IT landscape, with practices and providers driven by the need for the new and evolving features, such as zero footprint viewers, and tapping into the potential for artificial intelligence technology.

For Mazzella, the Clinical Collaboration Platform from Carestream is what has made all the difference. The image management platform provides enterprise imaging and vendor-neutral archiving capabilities to the group’s 28 radiologists, which he says has paved the way for greater productivity.

Getting medical images out of their silos and transferring them more seamlessly throughout the care system has been an ongoing struggle, and Carestream is not the only company working to resolve the problem. Enterprise imaging solutions promise interoperability, scalability and a more seamless workflow, but does that mean an enterprise solution is a one-stop replacement for the conventional components that have historically gone in PACS?

This question is further complicated by the addition of new features and capabilities that previously did not exist, and storage standards and security requirements that may not have previously been a concern, all of which together can create confusion, uncertainty and a state of misinformation around the most important question of all: What is the best imaging solution for my facility?

It starts with knowing what you need
In today’s imaging IT field, few things are as desirable as interoperability. Hospital departments are being asked to engage more completely across the enterprise – and allowing data to be shared and disseminated among different physicians in and out of a given facility is precisely what enterprise imaging aims to do.

This desire is further augmented by technologies, such as zero footprint viewers for reading and interpreting scans and reports off phones and tablets rather than at big, heavy workstations, and the cloud, which centralizes access to – and allows for storage of – large volumes of data.

These capabilities enable providers like Mazzella to work on operational budgets and improve workflow by increasing the frequency and speeds in which they can access and read scans and make diagnoses. They also tie in other goals important to many practices, including the ability to scale up in growth and workflow consistency in tasks such as finding and adding in priors for diagnosis evaluation.

Rasu Shrestha, chief innovation officer at the University of Pittsburgh Medical Center (UPMC) and executive vice president at UPMC enterprises, says combing through his hospital’s PACS systems for patient priors in the past was exhausting and time-consuming.


Now, since the implementation of GE Healthcare’s Centricity Solutions for Enterprise Imaging – which includes a RIS-IC, PACS, universal viewer and clinical archive – the improvements to workflow at UPMC have been significant.

“Previously, we would have to search across multiple different vaults, as we call them. Hospitals that have different PACS systems that may or may not have had those patient’s studies,” he says. “Today, with one click, we’re able to have true enterprise view across the long regional care record of the patient, regardless of which hospital system or which health system the patient’s studies actually reside in.”

But experts warn that no solution is perfect, and although a product may have impressive capabilities, there are still limitations to enterprise imaging technology and misconceptions regarding the capabilities of these evolving tools.

For instance, though zero footprint viewers may enhance the technological capabilities of radiologists, they are not changing the day-to-day tasks of radiologists. They are merely improving the speed at which these tasks are carried out by decreasing installations and eliminating complex software deployment for potentially tens of thousands of PCs in large enterprises.

It should also be noted that periphery workflow tools do not have excellent zero footprint technologies and require desktop applications.

Also, not every facility is suited for a particular solution. In the case of zero footprint offerings, one consideration is that they may not provide high performance efficiency in certain locations where poor bandwidth may result in more delays.

“You need a system that’s able to adapt to those different environments,” says Laurie Lafleur, director of product marketing at Intelerad Medical Systems. “Maybe a hybrid solution to do some local caching or local processing to remove the burden from the network infrastructure.”

What should providers be asking themselves?
The first question that a provider or practice should ask is “What are my goals,” says Eitan Aschner, Carestream product line manager for Healthcare Information Solutions in the U.S. and Canada. “What are you actually trying to achieve in terms of this new system?”

The answer to that question will depend on a range of factors, including: future endeavors; size of the facility; cost of the solution; and who is involved in the decision. In an era where interoperability is king, the burden of imaging IT decision-making has been partially lifted from the radiology department’s shoulders and is shared among all department heads and hospital decision-makers.

“What they should ask is, ‘How can the system or solution I’m looking for benefit outside of our specific department?’ ” says Harold Welch, vice president of technical solutions worldwide at Novarad. “How can this benefit us as a whole?”

That conversation should be had with one eye on the future. Instead of figuring out what kind of technology will improve workflow efficiency and patient outcomes right now, planning ahead means leaving room for the integration of complementary tools and solutions, such as artificial intelligence, for example.


The size of an imaging facility, hospital or health system will also play a significant role in finding the right imaging IT solution to meet its needs. While a smaller facility might have the disadvantage of an extremely tight budget, limited size and comparative simplicity are advantages that make its needs easier to be met at a price point that won’t break the bank for such a facility.

Bigger facilities, conversely, tend to have more complex systems, particularly those with sites that are regionally diverse. Providers like this might see greater advantages in zero footprint solutions as a way to minimize troubleshooting at individual workstations – especially those that are acquiring other providers and practices, reflecting an ongoing trend of consolidation.

With many organizations working together to develop and integrate new standards for interoperability, a standards-based solution is best.

“We’re seeing a lot of the more innovative vendors play friendly because they can more easily adjust their products to support datasets that may not be entirely compliant with standards such as HL7 or DICOM,” Steve Deaton, president of Healthcare IT at Konica Minolta HealthCare Americas, Inc., told HCB News regarding his company’s imaging IT technology. “I think a lot of legacy vendors out there have not updated their platforms’ core technology in years, and they often do not even support any standard for exporting data such as prior radiology reports. We’re playing friendly just by overly accommodating people that are nowhere close to meeting standards such as HL7 or DICOM.”

All of these considerations take their toll on the bottom line, but experts agree that cost is a more dynamic issue than the number on the sticker. Factors such as the scalability that the organization wishes to achieve, what innovations and maintenance will be required for a solution, how long are they feasibly hoping to use their system and what return on investment they hope to gain are all essential to properly crunching the numbers.

Shifting markets and considerations for tomorrow’s imaging department
The question of whether an enterprise imaging system is a solution for all needs and a replacement of other modalities continues to set off debates on the present and future state of imaging IT technologies.

Although the introduction of enterprise imaging, coupled with the abundance of PACS systems already installed, has taken some of the air out of the conventional PACS/RIS market, a 2016 Transparency Market Research report found those markets will grow from $2.2 billion in 2015 to $3.9 billion by 2024 at a compound annual growth rate of 7 percent, and the Asia Pacific region is leading the way.

One possible reason for this is that developing a RIS requires time and money as well as a large base to sell to in order to justify the investment for one.

“Outside the U.S., it’s still very much a joint RIS/PACS market. RIS and EMRs tend to have a lot of geographic dependencies such as billing, how things are processed, one payor versus multiple payors. The lead EMR in any given country tends to be a local EMR player. That also means, though, that their main geographic scope is that country, so creating a big enough business to also be able to invest in building a RIS in addition to an EMR is challenging. The scale of the US is obviously different and that gives you enough revenue and income to be able to invest in periphery areas around the core EMR, like RIS,” said David Hale, leader of enterprise imaging, cardiology IT, high acuity care and perinatal software businesses globally at GE Healthcare.”

A topic on the rise in discussions of imaging IT and the capabilities of emerging technology is artificial intelligence. Anyone who attended the RSNA annual meeting last November can attest that AI has stimulated interest and fear as well as excitement over the changes it will bring to workflow in day-to-day tasks, but caution over whether or not it will become a replacement for radiologists.

Manufacturers and experts assert that AI will most likely function as an assistant to the radiologist, who may evolve into something of a data intelligence manager. Still, AI applications are subject to the same approval processes as present-day technology.

“From what I hear, at least from a lot of our customers, is it’s academically interesting and extremely important, but it’s not tomorrow morning that all of these applications are going to suddenly become FDA-regulated for approval,” says Hale.

Intelerad’s Lafleur agrees that by exciting the imagination, AI can sometimes generate more of a fuss than may be warranted.

“I think one of the things that is forgotten with the focus on future tech, such as AI, is the other technologies that can boost workflow intelligence,” she says, referencing workflow intelligence solutions like Intelerad’s SmartLayouts and InteleOne XE products.

Meanwhile, as radiology sheds its silo and joins the enterprise, hospital IT departments have taken on much more responsibility within the imaging department. While skilled for such a task, the result can have some negative aspects.

“What’s happened with IT now in charge of software and image management solutions is that these IT groups are overloaded and all they can do is function in maintenance mode,” says Konica Minolta’s Deaton. “They don’t have time to investigate what efficiencies could be leveraged, or if they can reduce the number of products and consolidate with one or two vendors. IT departments need the time to explore what is needed clinically so providers can do more with less.”

As the industry increasingly warms up to the notion of enterprise imaging, these kinds of growing pains are likely to continue. Debating the right way to bring imaging IT into the modern era is the only way to make the right investments, and the conclusions will be unique to the individual needs of the providers having those discussions.