Industry players have matured from a proprietary don’t-share-anything approach to embrace interoperability.
I’ve worked in medical imaging for over 25 years, and in that time, I’ve seen the industry take amazing strides forward on the road to better patient care. When I compare today’s technology stack, clinical breakthroughs, image quality and support for interoperability to where they were when I first began my career, it’s remarkable how far we’ve come. Industry players have matured from a proprietary don’t-share-anything approach to embracing standards and interoperability focused on improving patient care and cutting healthcare spending.
Silos Upon Silos
In the early 1990s, there were separate and distinct technologies for radiology functions and tasks. PACS was a separate application from RIS, and multi-planar reformat and 3D were add-on imaging applications or plug-ins. In addition, multiple vendors offered products within each of these areas. In practical terms, this meant you needed to log into each one of these systems, remember a patient identifier in order to extract data or search for the same patient in another system. Each vendor had its own proprietary closed formats and protocols, and clinics and hospitals often dedicated their radiology operations to a single vendor to ensure some level of interoperability.
In this siloed environment, manual patient entry into every system often introduced errors. Radiologists also typically had to move not only between systems, but also between rooms to go from a PACS reading room to a 3D imaging lab.
Vendors were so protective of their proprietary technology that, at trade shows, I needed permission to enter competitors’ booths. Customers were frequently required to sign NDAs to get a product demo, and any group presentation happened behind closed doors.
Market Trends Push Vendors
Fast-forward a decade or two and this closed, proprietary environment has completely transformed into an open, standards-based world. A number of market factors, including healthcare reform, widespread adoption of electronic health records (EHRs) and hospital and clinic consolidation, have pushed information sharing and integration to the top of providers’ must have lists.
One can’t help draw parallels between how PACS used to interoperate with other radiology IT and the current state of EHRs, VNAs and enterprise-image viewer interoperability. Today, the full integration of RIS and 3D technologies with PACS allows radiologists to read images, diagnose, write reports and share them all from one workstation. On the horizon, we can extrapolate seamlessly driven workflows from the EHR that bring in any content from the VNA and leverage enterprise-image viewers to visualize not just radiology images, but images from all departments. These technologies offer enterprise health IT departments zero footprint tools and native mobile apps that scale as needed to quickly bring rich content together from any source and make clinicians’ desired workflow a reality in the near future.
In a recent survey from the U.S. Office of the National Coordinator of Health Information Technology, most hospitals can now send and receive all manner of patient data both inside and outside their networks. At the same time, however, only 18% of providers actually access and use exchanged and shared patient data for patient care because they cannot access it from their EHR.1
Providers are eager for the ability to sign into their EHR and be able to view, analyze and report on any content, including images, lab reports and other patient data, without leaving their EHR. While the bad news is that this level of integration is still in its infancy, the good news is that modern web and mobile application technologies can make it happen safely, securely and, most importantly, quickly. New working groups such as the HIMSS-SIIM Enterprise Imaging workgroup will help pave the road and teach important lessons from those institutions that have blazed the path forward with enterprise-image adoption.
Platforms Need to Integrate
In my vision, an enterprise-image viewer needs to transition from a tool that can view content in all formats to a true interoperability platform. While most enterprise viewers can launch from the EHR, view most data, federate across repositories from different vendors, view DICOM and non-DICOM files, support XDS and virtualization, they may not interoperate within and outside a hospital’s enterprise network.
With real-time collaboration features now tightly integrated into the enterprise-image viewers, it is possible for multiple caregivers to view the same medical data from any location on any device. Adding integrated audio and video communication further enhances this real-time collaboration experience. If the enterprise-image viewing platform includes these types of built-in collaboration features, does it always make sense to move the data from one location to another and will we see more use cases where the data is left in place?
With the allure of the cloud, new DICOM web standards, FHIR, web technologies and mobile applications, I see more integration opportunities on the horizon pointing to whole new paradigm of what interoperability really means. Once again, we have what innovators call “blue sky” and incredible opportunities. It’s a great time to be in the industry.