Radiology and cardiology departments have long produced significant imaging volumes, but the volumes of imaging exams performed in other specialties are now easily surpassing that amount. “Scopes, cameras and smartphones are routinely used within various service lines for evaluating and documenting medical disorders and pathologies,” says Dawn Cram, University of Miami Health System (UHealth)’s IT application systems development manager for enterprise imaging. “Attempts to integrate these images with the EMR and archive them have created cumbersome clinician workflows, often with limited identifiable information and questionable data security. The image data is often left stored on the acquiring device, external storage media, PC drives, or network shared folders.”

All of these issues drove change for UHealth, a large academic medical institution and medical school with three hospitals, over 30 satellite locations and more to come. The various locations use different PACS solutions, often presented as siloes of information, which can impact clinician workflow and continuity of care. To address its concerns, UHealth developed a strategy to effectively collect, manage, archive, and facilitate permitted access to patients’ images across the health system. The variety of equipment used in various areas of the organization led to frequently changing workflows, so the university also wanted the system to simplify workflows and establish a more centralized management system.

“We were looking to solve multiple challenges,” says Cram. “We weren’t looking for just a radiology/cardiology solution because we wanted to bring various –ologies into the system, including surgical services, endoscopy, gastrointestinal, otolaryngology—anywhere there is scoping, audio and camera images. Departments were uploading images and copying and pasting them into the EMR. We needed to streamline and centralize our workflows.”

A baseline survey conducted before the go-live found that 90 percent of physicians said it took them more than five minutes to find prior dermatology photos on a patient, if they’re even available. Frequently, studies conducted with a scope are stored on that scope’s capture device, or maybe burned onto a CD and stored in a locked cabinet somewhere. In those instances, someone has to find the right device or cabinet. Dermatology, for example, has multiple clinics and sites. If patient images are taken in Miami and the patient then sees a clinician in Coral Gables for follow up, the images aren’t available.

A New Imaging Data Management Strategy

The university’s Information Technology Clinical Applications team was interested in bringing in a best-in-class vendor-neutral archive (VNA) solution as part of a new imaging data management strategy. When Cram joined UHealth, she was tasked with conducting the VNA evaluation process. She also faced the challenge of DICOM v. non-DICOM studies. “Our strategy was to find a solution that could handle being the primary image management solution for some of the –ologies that didn’t need a departmental-type viewer.”

The university wanted to maintain support for the requirements of radiology and cardiology, while expanding these capabilities to encompass each additional specialty. “We wanted to ensure the flexibility to store to the system as a primary archive and image management solution, store to a departmental PACS and have Copy 2 as part of enterprise archive, or maintain a small cache for a PACS with long-term archive in the selected VNA,” she says.

Merge’s VNA solution, iConnect® Enterprise Archive, was selected to do the job. Its ability to archive and present all enterprise-wide images from disparate PACS, specialties, and sites for a complete image management solution was compelling. A consolidated patient view allows physicians to access current and historical images at the point of care. The IT Clinical Applications approach at UHealth was to first move everyone without a departmental PACS into Merge’s iConnect Enterprise Archive, and then focus on the areas with an existing solution to achieve economies of scale.

As standards are developed and refined, Cram says UHealth also will have the ability to plug in a viewer in any setting. Merge’s iConnect® Access image viewing and sharing solution allows UHealth to view DICOM or XDS documents, depending on each department’s specific needs.

To date, UHealth has brought dermatology live on the iConnect® Enterprise Archive fairly quickly, and has a specialty-by-specialty strategy that will take the university through the next five years.

One key component UHealth was seeking is real-world XDS workflows which include handling the ability to resolve image management issues and encounters-based imaging support. Methods for applying the IHE profiles and workflows in a practical environment are important to the university. Cram said the organization wanted XDS since many devices aren’t DICOM-compliant and for future interoperability plans. “We wanted to make sure we had a cost-effective solution that wouldn’t require us to go out and buy DICOM modules for some of the –ologies if they become available. XDS was a big reason behind going with Merge—Merge’s commitment to work with us to develop product functionality supporting XDS workflows for images which can be applied to a real-world healthcare environment. It’s actually going very well.”

First Mission Accomplished—the Dermatology Workflow

To create a new dermatology workflow, UHealth combined Merge technology with a standards-based mobile camera app that sends images directly into iConnect® Enterprise Archive. “The feedback has been just unbelievable. It’s a very nice workflow for clinicians because it prevents them from having to place orders.” They also can either launch iConnect® Access through the EMR or login directly. Clinicians are happy to have the ability to see what they performed on the patient as opposed to just a “photo” label or general description, Cram reported.

Some of the dermatologists were initially skeptical of the new Merge-based solution, but found the system very user-friendly and intuitive with minimal training. They could pick it up with five-minute training sessions or, in some cases, just by using a tip sheet. “They can also pick up these cameras, take images, send them into the archive and retrieve them, and it’s instantaneous,” she says.

UHealth chose Merge because the university wanted to work with an innovative company “that would partner with us to create new, effective solutions. We’re following a strategy our organization needs,” says Cram, of bringing on various –ologies currently without an image management system. “We are very happy with the direction we’re going in—we are on the cusp of breaking new ground in the industry. It’s a very exciting time at the university and for enterprise imaging.”