Approaching Interoperability: Taking the Next Step in Realizing the Full Promise of Digital Diagnostic Imaging


Dan Trott, Healthcare Strategist for the Healthcare & Life Sciences division of Dell EMCBack in the day, when part of my job in radiology was hand developing x-ray film, no one could have imagined the impact of digitization on medical imaging — including all of the new kinds of diagnostic imaging and the tremendous savings in time, money, and space.

Now that more than a quarter century has passed since the first PACS systems were introduced, we are approaching another transformation: fully realizing the promise of digitization, with the ability to easily access and share a patient’s medical images across disciplines, accountable care organizations, and healthcare systems.

The end-goal vision is ambitious: a 360-degree, continuously updated, longitudinal patient health record, including all of the patient’s medical history and diagnostic images, which can be securely accessed and amended by authorized patient caregivers (as well as patients themselves) anywhere and anytime.

The benefits are clear. One only has to imagine the scenario of a medical emergency while traveling and the comfort of knowing that the ER team where you are will be able to instantly pull up and scan your complete health record, including medical history, diagnostic images, practitioners’ notes, and so on.

The challenges are also clear—and must not be minimized. Data system silos are a tremendous issue, where separations still exist between EHR, RIS and PACS. ‘Unintelligent’ networks across the healthcare system prevent access to patient information by all who need it, and a patient’s imaging history is kept locked away in departmental databases, or in paper/film format. Nevertheless, healthcare organizations and technologies are moving steadily forward, step-by-step, toward simpler, more transparent access and interoperability for medical images. Equally important, they are realizing tangible, incremental benefits as they move forward on the journey—in quality of care, patient experience, efficiency, and professional satisfaction.

Using Intelligent Archiving to Facilitate Clinical Collaboration

One way that healthcare systems are achieving greater interoperability today is through the intelligent, unified archiving of diagnostic images. Unified clinical archives leverage advances in both the storage capacity required to centrally store medical images, and intelligent, centrally applied software that strengthens security, protects privacy, facilitates image sharing, and simplifies integration with EHR applications.

Unified clinical archives break down the silos of diagnostic data created by different PACS solutions, which makes the data essentially inaccessible to EHRs and other applications. That’s because, although medical images, whether generated by X-ray, CT scan, ultrasound, or other modalities, are captured in a standard DICOM (Digital Imaging and Communications in Medicine) format, different PACS solutions alter the format to facilitate differentiation in their viewing platforms—and then store the data in proprietary, non-standard formats. Unified clinical archives use software to pull different types of PACS data back into a flat standard DICOM format so it can be more easily shared. Thereby enabling an EHR, for instance, to then use its own viewer to open the image.

Additional layers of software help mask complexity. For example, a vendor-neutral data management layer can aggregate and standardize patient data from all PACS, HIS, and specialized imaging applications, eliminating the need for expensive data migrations or the need to open multiple applications, disrupting workflow. A clinical collaboration portal layer can help manage access and secure sharing using a wide variety of devices, to clinical data from a wide variety of sources in a patient-centric repository, thus simplifying both image integration in the medical record and image sharing.

Other software, such as customizable, enterprise viewer and clinical workflow solutions, enables healthcare organizations to add yet another layer of control to enhance efficiency and simplify compliance with regulatory and institutional standards.

In addition to residing on-premises, unified clinical archives can reside and be managed in the cloud (as well as in hybrid configurations), to meet business continuity, disaster recovery, and scalability challenges.

Many health organizations are using unified clinical archives today to improve care and productivity, for example, by eliminating the need for radiologists and others to have to mail CDs within or beyond their own health network. Instead, a referring physician can gain immediate access to a patient’s scan and the radiologist’s report as soon as it is completed.

On top of bringing all the pertinent information together for a longitudinal view of the patient’s record, unified archives also make it much simpler to apply predictive clinical analysis to the unified data. This provides the clinical team a much improved view of the trends, variances from established benchmarks, and true ability to predict.

While we recognize tremendous challenges of interoperability, workflow, and compliance that must be addressed to enable the vision of a single, real-time 360-degree longitudinal health record for each patient, healthcare organizations and their partners can take a significant step toward interoperable healthcare by eliminating silos of diagnostic image data and realizing the full promise of digitization through faster, simpler, less costly, and less risky sharing of medical images today.

For more information, register for Dell EMC World on October 18 or visit Change Healthcare (North Hall B, Booth 7313) and Dell Technologies (North Hall B, Booth 6152) at RSNA November 27 – December 2 in Chicago.

Dan Trott is a Healthcare Strategist for the Healthcare & Life Sciences division of Dell EMC. Dan has more than 30 years of experience in medical imaging related fields, including clinical radiology, ultrasound and PACS.

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