As healthcare providers work to develop and implement enterprise imaging strategies, they often run into the same roadblocks again and again. A new white paper published in the Journal of Digital Imaging examined many of these issues, providing insight into what specialists can do to get past such problems and move forward.
According to the white paper, which was a collaborative effort from members of the Healthcare Information and Management Systems Society and Society for Imaging Informatics in Medicine, these are four of the biggest challenges providers face when trying to implement a successful enterprise imaging strategy:
1. Patient Identification
“Correct patient identification is imperative,” wrote lead author Alexander J. Towbin, MD, department of radiology at Cincinnati Children’s Hospital in Cincinnati, Ohio, and colleagues. “The correct images must be placed within the correct patient’s medical record every time. As such, all images must include patient identification.”
This is fairly straightforward when it comes to DICOM imaging, the authors noted, but can get more complex with non-DICOM imaging. In those instances, an automated solution is needed to make sure patients are always identified correctly. Towbin and colleagues suggested four potential solutions: using workflow reminders, adding patient information to every single image, creating a new modality worklist or simply waiting to apply demographic information until after the image has been obtained.
“It is likely that a number of these scenarios may be used to upload data,” the authors wrote. “If that occurs, it may be useful to develop a confidence score for the reliability of the data. System-entered data (such as data generated from a modality worklist) would have a higher confidence score compared to manually entered data.”
2. Reporting
The authors noted that reports can play different roles in different specialties. In radiology and cardiology, for instance, it’s used to provide an interpretation of the study. In dermatology, however, the report will detail an entire visit. In addition to playing different roles, reports also live in different locations in the electronic medical record (EMR), adding even more variety to the situation. For this reason, Towbin et al. wrote that each report should reside in only one specific location instead of being copied or moved to several locations within the EMR.
Another issue related to reporting is that some imaging studies could be associated with more than one report.
“In cardiac catheterization, for example, the report may be both the operative note and the detailed functional data,” the authors wrote. “In these instances, both reports give the image context and should be associated with the images. In current electronic medical record systems and enterprise viewing systems, there is no method for assigning multiple reports to one imaging study.”
To keep this from getting out of hand, the authors suggested that viewers treat one or both reports as additional images. This means reports don’t get lost in the EMR and a patient’s data is all available in one place.
3. Legal Concerns
“There are unique privacy concerns that exist with certain types of photographs,” the authors wrote. “It is recognized that institutions may choose to limit access to certain types of images such as images related to sexual assault or child abuse. In these scenarios, there are several options vendors may choose to allow institutions to manage permission to view these images.”
One option imaging leaders could consider is managing permissions required to view images within the EMR—permissions could be applied only to certain departments, for example. Another option involves allowing access on a case-by-case basis and making the user “select a reason why he or she needs to view the restricted images.”
Enterprise imaging strategies must also address how long images should be maintained. Should they be kept forever? Kept until a certain, predetermined amount of time has passed? And what about, say, an image that is rejected and leads to a retake? This is something that should be discussed ahead of time instead of a system just making a frantic decision one day with considering the ramifications.
4. Mobile Devices
Towbin et al. noted that providers are already using their own personal devices to capture patient images and videos, which raises some red flags of its own when it comes to patient privacy.
“While using a personal mobile device is not ideal for patient care in the current setting, there are important reasons providers use their device, including multifactor authentication, review and creation of documents within a mobile electronic medical record application, and consultation via text message,” the authors wrote. “Thus, it is important that hospital and vendors enable providers to use their devices in a manner that protects patients and meets clinical needs.”
Image data should never be stored on the device’s photo, they added, and patient demographics can’t be stored to a local device. In addition, systems should have a way to recognize, and remember, if the mobile device in question meets minimum image quality standards.
Michael has more than 16 years of experience as a professional writer and editor. He has written at length about cardiology, radiology, artificial intelligence and other key healthcare topics.