By John Memarian and Hugh Lyshkow

Contemporary healthcare in the United States is quite disjointed, particularly regarding the retrieval of patient data that extends beyond Protected Health Information (PHI) and basic demographics. This includes essential diagnostic records, both current and historical, from clinical groups, which are crucial for a comprehensive longitudinal care strategy that encompasses various healthcare institutions.

Over last decade, there has been a considerable investment (time, finances, resources) in unifying patient Electronic Medical Records (EMR). Nevertheless, these systems inherently omit vital clinical information produced by the various devices, modalities, and systems utilized by medical professionals for patient diagnosis and treatment. This type of information is often categorized under clinical informatics. Yet, this term fails to encompass additional data with substantial file sizes that carry richer content.

Clinical imaging data, for instance, offers a vast array of diagnostic and informational information that far surpasses other data types created within the EMR framework. Currently, a large portion of global medical imaging data remains isolated within individual healthcare provider’s facilities, and this fragmentation extends across various provider locations and even throughout entire Integrated Delivery Networks (IDN), leading to considerable discontinuities in patient health records.

Healthcare is not a series of isolated events but a continuous journey for patients. Improved access to comprehensive data allows clinicians to understand the full scope of a patient's medical history, which is crucial to enhance decision-making and patient outcomes.

Despite the pivotal importance of medical imaging in diagnosis, treatment planning and ongoing patient management, significant obstacles remain in accessing and leveraging this data effectively. The prevailing misconception within healthcare IT systems and among service providers is that medical imaging serves merely as a single-use resource. This view is a stark contrast to the reality that imaging data, including the visual records of a patient’s condition, are invaluable for providing foundational and historical context to inform current medical assessments. This misapprehension has led to a storage approach, that favors the retention of images and associated data within closed clinical system.

As a result, many patients undergo imaging studies at multiple facilities over time, but healthcare providers do not have access to their historical imaging data. This lack of access typically results in redundant tests, increased radiation exposure, and suboptimal treatment decisions.

Benefits of improved access to imaging data
Improving access to imaging data means making every point of care where a patient was seen by a professional or had imaging done available.
• Enhanced patient outcomes: Improved access benefits healthcare professionals by allowing them to make more accurate and timely diagnoses. The ability to compare current imaging studies to historical ones promotes better identification of changes over time and helps detect disease progression in advance of serious complications.
• Comprehensive imaging data: This also enables healthcare professionals to tailor treatment plans to individual patients' needs. By understanding the precise location, size and characteristics of imaging abnormalities, clinicians can develop personalized treatments, including precision medicine, to optimize effectiveness while minimizing side effects and complications.
• Collaboration within cross-functional teams: Another benefit of enhanced imaging data access is coordination among multidisciplinary teams. Specialists from different departments can collaboratively review and interpret imaging studies, facilitating interdisciplinary communication and planning for complex cases.
• Enhanced patient engagement: Patients benefit from improved imaging access by being able to actively participate in their care decisions. With a clearer understanding of their conditions and treatment options, patients can engage in informed discussions with their healthcare providers, leading to shared decision-making.

So, why is the healthcare industry struggling to improve imaging accessibility? The main problem is that most hospitals still store images and imaging related data in silos within individual services, which leads to very poor interoperability.

Despite the Digital Imaging and Communications in Medicine (DICOM) standard being around for over 30 years, proprietary silos are still impeding access, and the number of CDs still in place means there is still no way to fulfill the idea of a seamless patient record.

If all data were transformed to DICOM, it would be possible to review it or allow machine learning and artificial intelligence to access it for medical research. Many vendors still use proprietary formats inside their systems, even though they might offer DICOM.

Currently, a cloud-based environment is the closest solution for imaging data inaccessibility. Data is collected and scattered across devices worldwide and, in some ways, has even been commoditized. Moving imaging data to the cloud allows information from different sources and systems to be centralized into a single, accessible repository.

In modern healthcare, patients are typically moved around many hospitals and healthcare providers, but the data doesn't always move with them. Data can be locked into hospitals and healthcare chains, meaning that if a patient leaves, they don't have access to it again.
Imaging data is often locked into a department, imaging centre, hospital or healthcare group. Better access means losing the lock-in, providing full access to as much information as needed for healthcare providers to make better diagnoses.

It is crucial to cleanse data that is not secured to ensure it is readily accessible. When integrating data into a fresh system, its cleanliness and uniformity are key to preventing issues and simplifying retrieval. For example, consider a patient whose records are evaluated in one hospital using a different set of medical terms compared to another. Without prior data cleansing, locating, retrieving and contrasting the necessary images in a new system becomes challenging. Additionally, if patient IDs vary between databases or hospitals, it can complicate the process of referencing the same patient in an alternate system. Data cleansing, standardization and harmonization processes must be in place for all systems to ensure imaging data is properly integrated for enhanced accessibility, interoperability and continuity.

Enhancing healthcare through comprehensive imaging data utilization
The enrichment of healthcare delivery through the improved accessibility of both contemporary and archival imaging data is a significant stride towards enabling medical professionals to render more precise diagnoses, tailor treatment regimens, track patient evolution and minimize unnecessary procedures and expenses. This advancement fosters better collaboration, promotes dialogue between patients and providers, and supports the progression of medical research.

By harnessing the entirety of a patient’s imaging history, healthcare practitioners are equipped to offer care that is not only more impactful and efficient but also centered around the patient’s needs, thereby elevating the standard of patient care and their overall health journey.

The adoption of a strategy that involves collaboration with entities and experts who possess the requisite knowledge—free from any bias or obligation to specific vendors of products and technology—serves as a powerful advocacy for healthcare systems and their IT governance. Such an approach ensures an impartial perspective that benefits the healthcare infrastructure at large.

About the authors: John Memarian has over 25 years of clinical and technical experiences with extensive hands-on experiences in both invasive and non-invasive adult and pediatric imaging and surgical procedures. He has held various healthcare executive roles in the provider sector. John has consulting and business development experiences in bioscience, IT Solutions, cloud technologies, enterprise imaging, digital pathology and clinical genomes. He played a leading role in launching new innovative technologies - Thromboelastography (TEG), Vendor Neutral Archive (VNA), DICOMized digital pathology and POC clinical genomics in US and international markets.

Hugh Lyshkow is the co-founder and CEO of DesAcc. He is a visionary leader with over 30 years of experience assisting healthcare organizations and vendors in accessing, managing, and utilizing their health data through software development, data migration, and data management. He is passionate about improving health data continuity worldwide to enhance patient outcomes, care quality, and operational efficiency. Under his guidance, DesAcc has served over 7,000 clients in over 50 countries, including hospitals, clinics, research institutes, and government agencies.