Enterprise Imaging Workflows: Challenges & Opportunities


Medical imaging isn’t always concentrated in traditional imaging departments anymore. Health systems are collecting images at various points in their patients’ journeys, and they need to store those images along with their associated data in a location that’s accessible to everyone.

To make these images useful to all clinicians in the health system, we must tackle the issue of incompatible workflows between different departments.

Here is a brief overview of the conflicting workflows that exist, and considerations for making images and their associated data more consistent.

Order-Based Workflow

Traditional imaging departments have workflows that suit the way they capture and use images. For example, most radiology departments have an order-based workflow: A physician orders a study, the imaging department performs the procedure, and the resulting report is completed and associated with the order number. Images are organized, tracked and retrieved based on a specific order.

Order-based workflows make perfect sense when the image is the result of a separate procedure, like an MRI or CAT scan. But it’s hard to adapt this workflow beyond the radiology department. For example, what if a dermatologist takes a picture of a patient’s mole? The resulting image needs to be added to the EMR, but how is that possible without an associated order? When you consider that there are dozens of departments creating hundreds of images, it’s easy to see how quickly things can get out of hand.

Encounter-Based Workflow

In departments outside radiology, physicians don’t always need to create orders, because they’re capturing the images themselves. In these cases, the patient encounter drives the image creation, rather than an outside request.

As digital photography improves and becomes less expensive, departments as diverse as emergency services, pathology, and dermatology are generating images during their patient encounters.

Since most EHRs more readily accommodate order-based workflows, encounter based workflows pose a challenge for issues like adding metadata to images and incorporating them into the patient’s medical record.

Common Goals across Workflows

It’s unlikely that health systems will switch to an entirely order-based or an entirely encounter-based workflow. The challenge, then, is to make sure each process produces an image and accompanying data that is compatible with the other. When attempting to navigate these workflows, here are some things to consider:

  • All images associated with a care event should have a unique study identifier.
  • Images should be readily accessible either within the EHR or from a link in the EHR.
  • It should be easy to identify the type of imaging performed and the anatomical region.
  • There should be an accompanying note or report describing where and how the images were obtained.
  • Image metadata should be consistent to aid in search, retrieval, and reporting.

As health systems evolve under a value-based care model, established workflows will need to adapt. Order-based and encounter-based workflows each suit the unique needs of individual departments, so the solution won’t be one-size-fits-all. The overarching goal should be to give clinicians more relevant information so they can treat patients more effectively, regardless of where the images originate.

To learn more about enterprise imaging, data management, and workflow challenges, see our three-part video interview with Change Healthcare Software Architect Kinson Ho or contact us today.

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