Medical Imaging Options: No Single Vendor Will Do

8 Health Information Exchanges Lead The Way

As health IT managers look for an enterprise-wide medical imaging strategy that stores and archives images in a way that enables clinicians to remotely access X-rays, CT scans, and the like, they're realizing that no one vendor can provide all the technology to support such a strategy. So says a recent KLAS report.

"Enterprise Imaging 2012: Provider's Strategies and Insights" examines the challenges that providers face as they plan a medical imaging strategy. KLAS researchers interviewed 134 healthcare providers and found that most are in the early stages of developing an imaging strategy that aligns with the current push toward increasing the electronic exchange of patient information.

To do this, researchers found that providers are considering one of two main approaches: a vendor-neutral archive (VNA) -centric approach, or a picture archiving and communication system (PACS) enterprise archive system. But when comparing the adoption rates of both strategies, the report notes that there is no clear winner.

When compared to a PACS enterprise archive system, KLAS researchers said there is more evidence to suggest that VNA tools provide greater interoperability with other systems, and have the ability to archive and distribute images "regardless of vendor, device origin, or content format." While many are still undecided about what approach to take, the report noted that 27% of providers said a VNA would be essential to their organization's imaging strategy, and hospitals with more than 500 beds were particularly keen on VNAs.

The report cited Acuo and TeraMedica as the primary vendors that offer VNA functionality without having a PACS platform, and said their products work well with many different imaging systems.

Twenty-five percent of providers said a PACS-centric archive strategy is their preference, which is more popular with health organizations that have less than 500 beds. GE Healthcare and Philips are the leading players that offer a PACS-centric archive strategy, but Siemens, DR Systems, and Fuji also offer this functionality.

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To improve interoperability among systems, providers who are leaning toward a PACS-centric approach are focused on getting multiple facilities--such as the wound care, dermatology, or orthopedics departments--on the same radiology PACS system. The report noted that to advance these efforts, GE recently announced an interoperable suite of advanced visualization and image management applications that will pull images from multiple sites from across several hospital departments.

But Ben Brown, imaging research director at KLAS, said there is a "big question mark" about how companies like GE and Philips will manage medical images that use different technologies and different image file formats.

Interoperability among systems, Brown observed, is a key requirement and one of several considerations for health providers. The proposed requirement in Meaningful Use stage 2 that calls for medical images to be made accessible in electronic health records and cloud computing are other considerations, but that's just the tip of the iceberg.

In an interview with InformationWeek Healthcare, Brown, the report's author, said health IT managers will have to design an IT infrastructure that can manage and store PACS, maintain a master patient index to ensure patients are properly identified and matched with their images, and establish rules that dictate how long they intend to store medical images.

"Health providers have to ask many questions including: 'Do I store my pediatric images until the child is 18 or until they are 21? If my office is in California, do I keep mammograms for 10 years or if I'm in Nebraska, is the time limit eight years based on state laws? When a patient dies do I delete those images from the archives,'" Brown said. "There are quite a few questions that providers have to think about as they go through this."

Whatever course of action health providers decide to take, Brown said, the need for storage technology will increase, and providers that decide to expand their data centers will turn to companies like EMC, IBM, HP, NetApp, Dell, and Hitachi Data Systems.

With regard to the use of cloud computing, 18% of providers said they use the cloud for managing their medical images, and another 35% said they are planning to incorporate the cloud into their imaging strategy.

Whatever healthcare organizations decide to do, however, the consensus is that providers are seeking an interoperable imaging system--whether it's a PACS or VNA--that accepts data from a variety of hospital departments.

"Some are learning how to leverage the cloud for imaging, exchange images electronically, and image-enable the [electronic health record]. Also, many are still looking for the best plan for storage and disaster recovery backup. As Meaningful Use stage 2 rules are rolled out, providers will see that enterprise imaging is an area that has just started to gain momentum," the report concludes.

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