Looking beyond radiology and cardiology to build a system to collect, index, manage and communicate images of all types throughout the enterprise is a large and complex undertaking. Key steps in developing a plan are to size the project, establish a governance structure, and lay out a roadmap. Determining the magnitude of the Enterprise Imaging Project provides information that will aid in developing the strategy, the governance structure, and the roadmap.
To size the project first identify the image generating departments in the enterprise such as respiratory care, otolaryngology, ophthalmology, pathology, dermatology, wound care, sleep labs, and many others. One institution identified 60 image generating departments, some at the out set of the project, and others during the course of the project. Even now, years into the project, and with half of the departments on the enterprise system, they report that new requests keep coming in.
For each of these departments, basic information about the images needs to be collected.
• Image type: monochromatic/color; still; motion; motion with audio; motion with waveforms
• Image sizes and frame rates (if motion)
• Acquisition device: Technology; manufacturer, model
• Where images are acquired: location; mobile
• Current storage technique and device: digital, paper, thermal printer, analog video, film, or none
• Image formats: standards employed
• Study sizes
• Study volumes
• Associated meta data: currently acquired; needed to be acquired
• Archive requirements: medical and legal; all images or key images; how long
• Viewing needs: identify the users; specialized processing needs; mobile needs
In addition, the needs of each area for image sharing should be identified, both import and export of images, to and from the enterprise.
Once the generators and consumers of the images have been identified, a governance structure can be proposed. This step can be delicate since it is moving imaging beyond cardiology and radiology to encompass the enterprise and may involve silos of image storage in other departments as well. To succeed, the governance structure needs to be broader than a single, image-generating department. Many organizations have established an Enterprise Imaging department and pulled in personnel from existing PACS support teams to staff it. A multi-disciplinary physician advisory group is important to provide guidance to the program and to help communicate the program to the enterprise before and during roll-outs.
Criteria for an implementation roadmap should be established and reviewed with the governing body. Consideration needs to be given to the enterprise strategic goals, the volume and nature of the requests for enterprise image access, and plans to replace existing PACS equipment. Often a first step in the roadmap is to bring in the established enterprise disciplines of radiology and cardiology.
The next departments to be added to the Enterprise Imaging system, may be the low-hanging fruit, that is those that are already digital, interfaced with ADT, and maybe even DICOM compatible. Some enterprises have also required a physician champion in a department before adding that department to the roadmap. The roadmap is not usually complete at the outset of the project and evolves as the project progresses. One large healthcare system which has been developing its enterprise image system for several years has reported that no one can say when they will be done. As the project progresses, new places emerge with image storage and communication needs.
Once the strategy is in place, the size of the project estimated, and a roadmap in place, work flow analyses can be examined, indexing strategies started, system architectures proposed and analyzed, schedules and budgets developed for the initial phase. Communication and promotion of the Enterprise Imaging System can proceed. Integration of the Enterprise Image system with the EMR broadens access to all images and will benefit providers and quality of care both inside and outside the enterprise.