road_endless_webImplementing an enterprise imaging strategy is an ongoing process. Success is all about reaching the milestones rather than a final destination.

By Aine Cryts

Your flight arrives at Boston’s Logan Airport, and all you want to see—with your own eyes—is the Impressionist collection at the Museum of Fine Arts. You’re not hustling across the city to read about these masterpieces by Cézanne, Van Gogh, and Renoir; you want to experience them for yourself. For the very same reason, Trent Conwell, director of IT and clinical technical services at Sentara Healthcare (Norfolk, Va), likens an electronic health record (EHR) without images to a museum without paintings and sculptures. “A museum without paintings and sculptures isn’t much of a museum; and an EHR without access to images isn’t much of an EHR,” he said.

This needs to be about patients, says Conwell, who believes that providing access to both the text and the images in the patient record helps patients see the whole picture of their health. Even if a patient can’t make “heads or tails” of what the doctor says, the images tell their own story. For example, a patient who is nervous about their knee surgery can be much more at ease when they can see with their own eyes what their knee looks like.

Patient engagement is vital during the drive to achieve Meaningful Use, but there’s often a motivating event—such as the need to switch out a hospital’s radiology PACS or to figure out how to get a handle on its image storage costs, which continue to increase month after month.

Sentara’s Enterprise Imaging Journey

Trent Conwell, Sentara Healthcare

Trent Conwell, Sentara Healthcare

“The major driving force that got us off the couch was the rapidly increasing cost of storing images,” said Conwell. “Clinicians want to keep everything. We’ve been completely digital since 2002, and we have never eliminated images. You can compound the number of radiology images with images you’ll find in other ’ologies and see your storage costs increase at a rapid pace.”

Sentara’s journey started in 2010 and, after two unsuccessful and stressful attempts to figure out their enterprise imaging strategy, they began work with Roseville, Calif-based Ascendian Healthcare Consulting. Through a process that involved 6 months of education about enterprise imaging for Conwell’s team, then 6 months on RFPs and vendor selection, Sentara chose the Mach7 Enterprise Imaging Platform. This solution from South Burlington, Vt-based Mach7 includes a vendor-neutral archive (VNA) and a communications workflow engine.

According to Mach7, the VNA enables Sentara to consolidate their storage across PACS, and sites and specialties, in addition to implementing a more effective image lifecycle management (ILM) policy; and that supports an overall reduction in storage costs. With the ILM strategy in place, certain image files will be compressed and moved into backup storage, while others will be removed. With Mach7’s solution, Sentara can do this for both DICOM and non-DICOM images.

With Mach7’s communication workflow engine, the various systems at Sentara can “talk” to each other. This is a particularly good fit for Sentara, given the increased number of partnerships with local healthcare organizations. As new partners are welcomed into the Sentara fold, Conwell’s team can “translate, transform, and integrate their imaging data across new and existing sites and across ’ologies within and across those sites,” according to a Mach7 spokesperson.

Acknowledging that his hospital’s enterprise imaging strategy has no end date, Conwell’s team achieved their first milestone at 7 months in the spring of 2014. Sentara’s cardiology department was the first to implement this new enterprise imaging strategy.

The timing was perfect for cardiology for three key reasons:

  • Cardiology was facing the purchase of additional storage to maintain their legacy system
  • The department voiced an interest in being an early adopter for the enterprise imaging solution
  • Cardiology had fewer imaging studies than the radiology department

The nuts and bolts of that deployment involved evaluating the department’s workflow requirements and setting up specific workflow and ILM rules, while migrating studies onto storage servers. A Mach7 spokesperson says that once the analysis was done and the storage servers were in place, the actual install was “straightforward and relatively quick.”

Sentara’s radiology department, which is next on the list to deploy this solution, presents more challenges—mostly those that require the attention of the radiology PACS vendor. While the initial implementation with the cardiology department took 7 months—much of that time taken up working initially with the radiology department—Conwell expects future rollouts to take much less time.

No Easy Feat

Conwell says that, had it not been for competing priorities, his team could have implemented the VNA part of the project in half that time. This particular project involved “significant design complexities,” he said. “While not on the same scale as an EMR implementation, it was in many ways just as challenging.”

Conwell’s advice for any healthcare organization embarking on their enterprise imaging journey includes:

  • Take the opportunity to save money on storage costs. Sentara’s strategy was a PACS-agnostic one, largely because Conwell wanted to have more ownership of the healthcare organization’s images.
  •  Show viewing tools to clinicians. This can be a very powerful group to have supporting your project. Conwell figured out early that what clinicians really cared about was having intuitive, robust tools to read their patients’ images.
  •  Have a strong IT team in place, but be willing to learn. Conwell considers himself lucky to have such an experienced IT staff. Still, with all of that experience, they still had to seek out help.
  • Develop a solid relationship with your partners and vendors. His team needed a vendor that could move with Sentara and their road map and would be available to provide advice and help along the way. “If you take out the technology, the real success in this entire process was that we selected a vendor that we can build a solid relationship with and can help make us successful,” said Conwell.

“It’s a situation where if you don’t align yourself with the right vendor, you’ll be frustrated. You need someone to talk through the process,” said Conwell, who’s worked with the same team members at Mach7 since day one; he considers them an augmented part of his staff.

No Quick Fix

Kimberly Garriott, MyPractice Imaging Solutions at Cleveland Clinic

Kimberly Garriott, MyPractice Imaging Solutions at Cleveland Clinic

There’s no quick fix when it comes to devising your healthcare organization’s enterprise imaging strategy, says Kim Garriott, program manager with MyPractice Imaging Solutions at Cleveland Clinic, where she consults with healthcare organizations about enterprise imaging strategies. All healthcare organizations need to take a hard look at how they’re optimizing the EHR and the types of images and video being captured, says Garriott, who notes that as many as 40 different service lines across a hospital may be capturing various kinds of imaging data.

Her key advice for healthcare organizations:

  • Understand the imaging landscape across the enterprise.This will help you understand the problem you need to solve. If you’re focused just on radiology or image exchange, you’re missing the entire picture (no pun intended). You need to figure out who’s acquiring images, where they’re doing it, and how the images are managed and protected.
  • Look at your enterprise imaging strategy as an ongoing program.It’s not a project; there’s no definite end date. This is a program that will live on as long as we have the EHR. Treat it with thoughtfulness.
  • Understand how to make those images accessible within the EHR and how to display them. Often, images are made available within the EHR without a meaningful study name or description. When a doctor is looking for a specific photo of a laceration, he’ll need to find it quickly and intuitively. Images need to be relevantly named and easily found within the EHR.
  • Get organizational buy-in. Garriott says that this is a “top-down process,” one where you need the support of the CIO, the CMIO, the CMO, and the COO in order to get it off the ground. It’s also important at the departmental level to voice the need for a solution that meets their clinical needs.


Aine Cryts is a contributing writer for AXIS.


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