[vc_column width=”1/2″]This post was written by Mark Watts, CRA. He has studied at the Harvard School of Public Health and Portland State University. He co-authored the textbook “Communication and Information in Radiology.”
Lately I have been focused on understanding the concept of the enterprise imaging archive (EIA), sometimes referred to as a vendor neutral archive (or VNA), and now, I’ve been thinking about the role it plays in the future of the connected healthcare system.
When I think of the connected healthcare system, I think of pure connectivity. I think of a radiologist at her son’s soccer game being able to bring up an x-ray on her mobile device for a quick look. I think of healthcare facilities being able to get images exactly where they need to be, exactly when they need it. The first step for us to achieve this future, right now at least, is an EIA. Following are my guidelines for taking that step, or choosing your EIA.
(To learn more about why an EIA is potentially the most efficient option, read this post about EMR integration and its inefficiencies in the healthcare setting.)
When selecting an EIA, you should look for a product that provides:
- Internal DICOM compliance for all DICOM objects and at least the following services: store, storage commit, query/retrieve, and echo
- HIPAA-compliant security features including encryption, data integrity validation, and intrusion detection notification
- Native-format data preservation, so that the image source can recognize and use it
- Support for IHE integration profiles for an image archive and image manager
- Validation services on incoming data–both at the patient level (against the ADT system) and exam level (against a department system scheduler/order filler)
- Support for multiple patient ID types and formats to relate to different patient ID types for the same patient via a master patient identifier, and to keep the demographic information current
- Organization into different storage groups, based on the source devices, source departments, and/or source locations with separate access controls and data management behaviors for each storage group
- A set of administrative tools for authorized users to maintain their image information (view, update, delete). These tools should include at least a rudimentary image viewer for QA operations. There should also be a utility to search for stands, select the desired exams, and send them to a particular destination
- The ability to scale to meet your enterprise needs
Challenges in Implementing an EIA
The benefits of an EIA and enterprise viewer are clear, but challenges come with it. Following are a few examples.[vc_column width=”1/2″]Integration with PACS. Many vendors view their PACS as the “enterprise image archive” with an “enterprise web viewer” that provides viewing of the “enterprise data.” However, usually a PACS system serves one or two departments. Also, there are frequently multiple PACS in an organization, and one PACS doesn’t know what’s in the others, requiring users to search multiple systems for all comparisons.
From the viewpoint of an EIA, a particular PACS is one of several source systems. To effectively integrate PACS with an EIA requires PACS to:
- Send a copy of each exam to the archive promptly after the exam has been “finalized”
- Include the PACS presentation state (window/level, flip/rotate, annotations, etc.) in a standards-based way
- Not send images that were marked as “deleted”
- Correct that information in the EIA if any changes are made to the data on the PACS after it has been archived
Integration with other source systems. There are many other digital image sources from departments that typically do not have a PACS. The sources can directly send to the EIA, and have their exams accessible on the enterprise image viewer. To do this requires that the sources department workflow ensure that exams are successfully archived, and correct those that did not pass validation.
Migration of historical data. Creating a complete set of imaging data in the EIA requires migration of historical data from older mini-archives. A migration process needs to manage correction of misidentified exams confirmation that all exams migrated successfully, and preservation of the original presentation state information (window/level, annotations, etc.).
Funding. One business concern of the EIA is how it will be funded. Will the institution pay for all users (clinical, research, etc.)? Or will departments/users be asked to fund their pro-rated allotments? It is helpful to answer this question early in the planning process–with which I wish you the best of luck!