This is the seventh blog in a series looking at different aspects of implementing Enterprise Imaging (EI). Find links to blogs one through six – which cover everything from what is EI to data quality, migration, and management – at the bottom of the page.
Enterprise Imaging moves an organization from a departmental focus to an enterprise-encompassing approach and enables making all images available to all users when and where they need the information. Ensuring a successful start to launching the EI program requires assembling data and a good understanding of the individuals, functional structure and processes of the organization involved. As this a significant undertaking, ensure that the required budget has been reviewed and approved for the duration of the implementation.
Process Not a Project
To summarize the previous blogs, the introduction of EI in an organization is a process, not a project. Communication and inclusion should be established as the process gets underway. Assessing who is willing to start and who chooses to assess and/or adopt later is part of identifying the stakeholders.
Particular attention should be given to individuals who have opposing views, as they often provide excellent pointers on what should be included in the adoption. Early adopters are typically those who have been using a PACS system, are accustomed to a structured means of capturing images, and understand the value of quickly and easily accessing prior images.
Understanding the need for capturing data for non-ordered images may appear foreign and unnecessarily time-consuming to some specialty areas. Typically, once the utility of having your images available any time on demand and sharable with others will draw new groups into the Enterprise Imaging concept.
Put together a multidisciplinary governance committee that can ensure that all contributors to EI have a say in creating the overarching strategy and associated processes and procedures. Besides having a strategy, early decisions should address who manages the data and how the systems should be purchased and maintained.
Data going into the vendor neutral archive (VNA), the storage system for the images, needs to be of the highest quality to ensure smooth operation. The quality standards may affect what older data can be imported for legacy systems and which older data should be retained outside the VNA. Teamwork between operations, physicians, clinicians, compliance, and information technology, including networking, storage architecture, application architecture, and security should be established at the outset of the implementation.
Develop a high-level understanding of how much image data each specialty generates each year, what retention periods apply and how much they have in accrued storage. Also ensure that the program manager has documented performance metrics required by some specialties (e.g., radiologists typically need to load images including priors in less than three to five seconds).
Typically, traditional orders-based imaging (radiology, cardiology, ophthalmology) are the first to be incorporated in a VNA. When the focus of EI moves to non-ordered images such as point-of-care ultrasounds, photographs, or videos, determining what tags and identifiers these images require is particularly important if highly specific access to image categories is required by business or research.
Workflows and Data Management
The more precise an organization is in knowing its current workflows and data management techniques, the more specific the desired requirements for the VNA will be. It is particularly important to have existing image acquisition and processing workflows documented in order to determine what training will be required when new systems and workflows are introduced. When looking at storage scalability, it should be determined if genomics, digital pathology or extensive intra-operative video will become part of EI, as these specialties tend to generate very large image files.
On Premise vs. Cloud
Another aspect that should be explored early on is whether the organization is hosting the VNA at their facilities or in the cloud (e.g., Microsoft Azure, Google, Amazon, etc.). Existing vendor contracts should be reviewed to ensure that no conflicts arise from the introduction of the VNA as the long-term archive. Many legacy systems are not designed to sync with an archive other than their own.
Identify Time Expectations
Implementing an EI will also require substantial time commitments from IT and clinical and operational staff. Making sure these individuals have time to commit to the project ensures that the project can proceed smoothly. Working with department leaders to identify individuals who can commit the needed time will be of great assistance. Many systems interact with other software applications; every group joining the EI needs to understand the how or whether their legacy systems can continue to be used.
Many thanks to my teammate Diana Alberts for reviewing and enhancing my series of EI blogs. She has added clarity and scope, for which I am very grateful. The eighth and final installment of the series will review potential challenges that can arise in setting up EI.
1. Enterprise Imaging: What is It and Why have It?
2. Enterprise Imaging: Answers to Fundamental Questions
3. Enterprise Imaging: Governance, Strategy and Resources
4. Enterprise Imaging: Vendor Neutral Archives
5. Enterprise Imaging: Data Quality, Migration and Management
6. Enterprise Imaging: Enterprise Viewers and Image Sharing