Not everyone in the medical imaging community is involved with enterprise imaging, but nearly every stakeholder is at least thinking and talking about it. The concept represents an eminently logical next big step in the technology-driven evolution of U.S. healthcare delivery: Imagine a world in which any diagnostic image captured from any image-producing specialty is viewable by any credentialed clinician anywhere and at any time.

What is the state of enterprise imaging right now? To find out, Radiology Business Journal reached out to James Whitfill, MD, co-founder and co-chair of the pioneering HIMSS-SIIM Enterprise Imaging Workgroup.

The intersociety group’s notable success is, in and of itself, a strong indicator of how quickly enterprise imaging is coming along. Launched by a handful of healthcare IT and imaging-informatics thought leaders in 2014, the workgroup now has close to 100 members. It holds meetups at the annual conferences of HIMSS, SIIM and RSNA, and has so far produced seven white papers on the subject of enterprise imaging. The workgroup convenes at HIMSS17 on Tuesday, Feb. 21, in the HIMSS Spot at the Orlando Convention Center.

Whitfill, chief medical officer of Scottsdale Health Partners (now part of an accountable-care entity called Innovation Care Partners), is a clinical associate professor of internal medicine and biomedical informatics at the University of Arizona. He took our questions on enterprise imaging and what RBJ readers should look for if they attend HIMSS17 in Orlando.

What are some of the markers of a sound, well-thought-through enterprise imaging strategy?

Our biggest recommendation for an organization starting down the path of enterprise imaging is to begin not with the technology but rather with the governance. What we have found from organizations leading the way with enterprise imaging is that, when you talk about it, you are no longer saying the radiology department is going to service all the other departments in the enterprise. You’re saying that we need a neutral space that is not beholden to any one department, one that can treat all departments equally but will have to make hard decisions about workflow, about technology, about cost, and about availability.

And of course, that governance process is not easy. As we all know, in complex organizations there are different stakeholders who have different opinions on how things should work. But getting that governance process in place, it seems, is one of the key markers separating successful organizations from those that really struggle.

Is having a healthy electronic health record (EHR) up and humming across the enterprise a prerequisite to playing in the enterprise-imaging arena?

I think most people would say it is. One of the sparks for enterprise imaging was the fact that, with the adoption of the electronic health record, clinicians became used to looking at a patient, looking at a patient’s encounter and then, in context with that, having the radiology images immediately available. And they said, “Wow, that’s pretty powerful. I used to log into the PACS, but now I’m looking at a patient’s care and, in context, I get the patient’s images.” It wasn’t a big leap for some of those clinicians to say, “I am creating my own images. Maybe other clinicians would like to see these images, in context, when they’re looking at the patient.”

The EHR really does provide that early convening place or a common starting point, where an enterprise viewer now makes a lot more sense as opposed to a tool that is just sort of standing alone out there.

What technical hurdles are causing the most trouble and slowing enterprise imaging from attaining widespread adoption?

There are some issues around standards that need to be refined. If you look at DICOM and IHE, there is a lot there. Probably a lot more education needs to be done. The HIMSS-SIIM Enterprise Imaging Workgroup white papers have done a lot to help identify many issues that people may not know about. And the production of non-DICOM images by a number of different entities continues to be a challenge.

I would say the two biggest technical challenges are managing non-DICOM images and then adopting encounters-based workflows or identifying workflows that ensure patient safety—workflows that match the image to the patient but don’t interfere with the clinician’s workflow.

A third would be image exchange. This is a fascinating area where, today, we have the beginnings of radiology, DICOM image exchanges and a number of vendors serving that space. RSNA itself has an image sharing project. And so we are starting to kind of break ground in terms of what it means to exchange images among and between different

institutions. What does that mean in an EI world? Does that mean that every [skin] mole, every eye picture, every wound picture, every chest x-ray—what should be sent? How should it be sent? How do you move it across different organizations?

It’s hard enough to do in a pure radiology space. The image exchange across organizations is probably another technical area where we, in our workgroup, are spending a lot of effort to try to help hammer that out.

What kinds of things does the HIMSS-SIIM Enterprise Imaging Workgroup plan on working on as it becomes more mature?

There is a tremendous amount of interesting dialogue around the adoption of standards, as we touched on earlier. And I think that is something we are just starting to get involved in and will continue to mature in.

Another area is the choice of the image viewer, and this is a fascinating area. There are two extremes to consider. One extreme would be the adoption of a universal viewer or a single viewer for all departments viewing all images across the enterprise. Or do you need specific viewers for specific areas? Radiology cannot interpret complex axial CT images on a generic universal viewer; for this, radiologists need a department-specific viewer. Gastroenterology with endoscopic images, [it’s the] same thing. So at a certain point, the question becomes … could there be a one-size-fits-all solution? Or is there some best practice in terms of a generic universal viewer for most things, but then specific areas where specialized viewers are implemented in order to maximize departmental workflows?

The image exchange piece will continue to be a big area for which we will want to partner with groups like RSNA and others by way of providing the roadmap to allow better interoperability of these datasets and help people realize that we are about to create massive amounts of image-based information. That will be phase 1 of success in the image-exchange piece. Phase 2 will be: How do we know what to share and how to share it?

Is the meetup open to anyone attending HIMSS, or do you have to be a member of the workgroup?

The meetup is open to all, and we encourage people to come by and learn more.  Anyone can become a member of the workgroup. The only requirement to join the workgroup is that you need to be a member of either HIMSS or SIIM; we do ask that people join one of those two associations in order to participate in the workgroup.

What specialties and job titles are you seeing join the workgroup?

Typically what we see is a combination of chairs of clinical departments, chairs of imaging informatics, vendors—we have a lot of vendor participants. And this is a very collaborative space for everyone in this workgroup community. And then we have oftentimes imaging informatics professionals and PACS administrators. It’s a wide spectrum of participants.

Has the workgroup considered spinning off as its own professional society?

There has been some thinking around the possibility of starting an enterprise imaging society. But, as part of our governance, the leaders of the workgroup meet on a regular basis. We ask strategically where we need to go to continue to mature and grow this group, and we feel that what we have today is incredibly powerful. It brings the strengths of two great societies together.

At our meeting at the last RSNA, our sense was that, if we were to spin off the HIMSS-SIIM Enterprise Imaging Workgroup as its own society, we would really lose so much of the support and infrastructure that has made us strong to this point. So we are really committed to keeping this as one of the best examples of two societies cooperating together to do something neither could do so well on its own.

I wanted to end with a few specific questions about HIMSS17. First, what are you most excited about seeing or doing at the show? Are there any must-see speakers, sessions or demonstrations?

Well, I’m co-presenter of a talk on value-based care, enterprise imaging and the future of artificial intelligence and deep learning. I would recommend this to any attendee because AI and machine learning are rapidly changing the face of healthcare. It won’t be human versus machine but human with machine that allows us to revolutionize patient care. And value-based care will need analytics and machine learning to fulfill its promise. The talk is a lunch session on Wednesday sponsored by Fujifilm, and it’s part of a program called C-Suite—Information Technology. And, of course, we hope to have a good turnout for the EI workgroup meetup on Monday at 2 o’clock in the HIMSS Spot.

What should the imaging community be looking for at HIMSS17 in terms of enterprise imaging in general or the HIMSS-SIIM Enterprise Imaging Workgroup meetup in particular?

What we are looking to do is really continue to extend our outreach to those specialties that produce images that aren’t in the traditional cardiology/radiology realm, and we see HIMMS as a key place to do that. At SIIM and at RSNA, it’s obvious that you are going to get a lot of vendors who are very much focused on the radiology space. And we love our radiology vendor partners. But HIMSS is a special opportunity where we know we have the whole enterprise represented, and we know we won’t be successful if we don’t have participation and input from all entities producing medical images.

That means including the vendor community on the governance side within the provider enterprise. So you will see us continue to push for having broader inclusion, trying to get the word out to a wider spectrum of both IT leaders and vendors to help make the effort successful.

Editor’s notes: To access all seven white papers, and to learn how to join the HIMSS-SIMM Enterprise Imaging Workgroup, go to SIIM.org, scroll over the “Journal-JDI” tab and select “Enterprise Imaging White Papers.”

This text was edited for space and clarity.