The profession of radiology has largely supported the basic notion behind enterprise imaging, aka EI: All medical images should be readily available to healthcare providers and patients across the care continuum.
Other specialties haven’t been so sure. Some specialties have embraced the EI evolution in theory while working to gain buy-in from change-resistant physicians. A few holdouts in image-dependent sub-specialties believe clinical images are best “owned” by the specialist who created and interpreted the images.
To Enterprise Imaging pioneer Cheryl Petersilge, MD, it’s time for this shortsighted perception to meet its end. Only then, she says, will patients and caregivers fully benefit by the comprehensive image-management strategies that visionary EI adopters have been modeling for years.
“Creating an imaging ecosystem—and it really is an ecosystem, not a one-off project or a VNA implementation or a storage strategy—means you are going to consolidate all forms of visual data throughout the organization into a single system,” Petersilge, a radiologist, explained in a recent interview with Radiology Business. “And this single system must be accessible by patients, providers and all other stakeholders engaged in the care of the patient.”
Petersilge, a leading member of the HIMSS-SIIM Enterprise Imaging Community, now runs the EI consultancy she founded in 2019, Vidagos. She emphasizes that to constitute the foundation of any enterprise imaging endeavor deserving of the name, such an ecosystem must be paired with an institution’s EMR. (“Some people use EMR and EHR interchangeably,” she adds as an aside. “I don’t.”)
She also counts a few components as foundational to a true EI system. Among these are a VNA, a series of diagnostic viewers such as for radiology and cardiology, tools to support encounters-based workflows and an enterprise viewer.
“I prefer the more precise term enterprise viewer to the term universal viewer,” she says, adding that the best of these have dual FDA approval: They’re diagnostic viewers for radiology and cardiology, and they’re informational viewers for referring providers across the enterprise. “Some products require separate software and separate deployments for diagnostic vs. enterprise viewing.”
Definitions set, Radiology Business acknowledges three provider organizations that are exemplars of excellence in enterprise imaging. What they all have in common is the EI technology they’re using: AGFA HealthCare Enterprise Imaging.
1. Zuckerberg San Francisco General Hospital (known locally as ZSFG)
By the time the ZSFG radiology department knew it had outgrown its PACS, the institution was well into planning for a new electronic medical record. Any new image-management system would have to integrate with the single new EMR that was soon to replace multiple EMRs. Equally important would be meeting the imaging needs of cardiology, pathology and, in the longer term, clinical departments relying on non-DICOM images—ophthalmology, dermatology, wound care and others. Also wanting in, at least eventually, would be endoscopy operators (such as gastroenterologists) and clinicians with all manner of ultrasound stills and cine loops.
As ZSFG Neuroradiologist Jared Narvid, MD, saw it, high on the list of medical colleagues to keep in mind at EI selection time were the institution’s surgeons, including those staffing the busy trauma center.
“Enterprise imaging facilitates close collaboration with other clinical departments and medical professions. For radiologists here, it has become an integral source of our job fsatisfaction.”
- Cardiac and pulmonary subspecialist Brian Haas, MD, Zuckerberg San Francisco General Hospital
“Surgeons might want to look at images in the context of call situations in which they’re offsite,” says Narvid, who also teaches and researches for the University of California San Francisco. “Making images available to doctors wherever they might be located at any given moment has always been a good thing. This became all the more apparent during the COVID pandemic.”
Narvid’s ZSFG colleague Brian Haas, MD, a cardiac and pulmonary subspecialist who likewise has a teaching and research appointment at UCSF, recalls AGFA HealthCare’s Enterprise Imaging platform was a frontrunner largely due its blend of leading-edge innovation with long-term reputation. ZSFG could attest to the latter firsthand, having been an AGFA HealthCare PACS client for years.
Shopping is one thing. Using is another. Having gone live with AGFA HealthCare Enterprise Imaging in 2017 to coincide with the Epic EMR consolidation, ZSFG can take the measure of EI based on more than five years of EI experience with AGFA HealthCare’s rendering of the technology.
ZSFG being a public hospital under the purview of the city’s Department of Public Health, is an urban resource serving many individuals who have no insurance, Haas notes. “Today we take great pride in providing these members of our community with advanced technologies like enterprise imaging,” he says.
EI technology in particular, he adds, “makes it easier than ever before to provide great radiology services. Enterprise imaging facilitates close collaboration with other clinical departments and medical professions. For radiologists here, it has become an integral source of our job satisfaction.”
Among EI’s other top payoffs as described by Narvid and Haas:
- “AGFA EI keeps studies from falling through the cracks. This is especially important when radiologists are changing shifts. A radiologist just starting his or her shift can see exactly which reads need attention first.”
- “We’ve been trialing AGFA’s RUBBE® platform for artificial intelligence. It, too, integrates seamlessly with the EI system, putting AI help right at our fingertips.”
- “Enterprise imaging is a task-based workflow, and AGFA EI lets you customize not just reading lists but also task lists. You can use it to create conference lists, collect good cases and do peer learning in an integrated and efficient manner within our workflow.”
- “When a resident on call gives a wet read, it automatically populates the work list of the attending or subspecialized radiologist for fast overreading by an expert.”
- “Since the pandemic wound down, we’ve been seeing consistent increases in our work volumes. This has strained our technologists as well as our radiologists. The efficiencies we’ve gained from enterprise imaging have allowed us to offset the difficulties.”
2. Quantum Radiology, reading for Wellstar Health System
Wellstar Health System is one of the largest health systems in the eighth most populous state in the U.S. That would be Georgia, where business and healthcare are both booming. With 11 hospitals, 11 cancer centers, 10 emergency departments and 35 imaging centers, Wellstar Health System continues to expand its services and locations with the addition of Wellstar MCG in Augusta, Ga.
At Wellstar Health System, patient volumes have increased over the past two years, translating to a 12% jump in overall imaging.
“Cardiology was a major future focus [during the selection period], because the Southeastern U.S. sees a lot of chronic heart and cardiovascular conditions. We also knew pathology would come aboard early on, orthopedics would gain a lot by image sharing, and surgeons would appreciate seeing 3D images to help plan surgeries.”
- Radiologist Jay P. Patel, MD, Quantum Radiology, reading for Wellstar Health System
As a result of these and other ascending trends, Wellstar Health System’s radiologists at Quantum Radiology in Marietta, Ga., were ready for a new picture archiving and communication system (PACS) — or something to improve upon that tried and true technology — as of three years ago. The radiologists worked with other key stakeholders to form a selection committee. High on this multidisciplinary group’s wish list were intra- and interdepartmental collaboration tools, connectivity with home-based radiology workstations and centralized communications support.
Radiologist Jay P. Patel, MD, remembers planning for the future while solving for the present. “Cardiology was a major future focus [during the selection period], because the Southeastern U.S. sees a lot of chronic heart and cardiovascular conditions,” says Patel, whose own subspecialties are breast and musculoskeletal imaging. “We also knew pathology would come aboard early on, orthopedics would gain a lot by image sharing, and surgeons would appreciate seeing 3D images to help plan surgeries.”
When AGFA HealthCare began phasing out its IMPAX PACS and offering AGFA HealthCare Enterprise Imaging, the decision was all but a no-brainer, Patel suggests. “We could see that AGFA’s EI represented a new generation of image management,” he tells Radiology Business. “It’s highly secure, it’s a robust imaging ecosystem, and it has some great tools to facilitate collaboration.”
The system went live in 2021. Dr. Patel reports numerous gains that Wellstar Health System and Quantum Radiology have realized over the two years since the go-live. These include:
- “The ability to communicate in real-time without using multiple different systems is hugely helpful. When the COVID-19 pandemic was underway, we really learned to appreciate AGFA EI’s Collaborator Tool, which lets you share a screen and chat remotely in real-time. We’ve used that tool a lot—not only with other radiologists but also with clinical referrers, diagnostic colleagues and technologists.”
- “The EI system’s tools for 3D post-processing have been very helpful. I can transform an orthopedic CT like a hip fracture into a rotating bone reconstruction with one click and, again, share it with the referrer in real-time. All I have to do is insert a hyperlink. That’s major when you’re working with an orthopedic surgeon deciding between fracture treatment with screws, plates and rods versus total or partial hip replacement. We could do this in the past, but we needed two separate software packages. It was a lot less efficient.”
- “I don’t have a hard metric to quantify how much AGFA EI has boosted my productivity, but I would feel confident saying my efficiency has risen by a good 20%. I’m about that much faster at working through my work lists, and that’s with the same, if not better, accuracy. Part of this is the better integration we’re seeing between our EMR and our dictation system. With enterprise imaging, I’ve found everything works together to boost efficiency and productivity.”
3. Northern Light Health
Ten-hospital Northern Light Health is the most geographically dispersed healthcare system in Maine. Its imaging expertise is such that it supplies image-management services to numerous provider groups outside its expanse. These include three independent hospitals, two multispecialty centers, an MRI center and a community health center.
Many of these organizations were counting on Northern Light’s PACS to be reliable, recalls Enterprise Imaging Director Randy Bacon. However, the PACS was aging out of support. By the end of its life cycle, it was slow increasingly prone to downtimes and could not meet the organization’s growth plan objective.
Meanwhile requests were coming in for image-management help outside of radiology and cardiology. As elsewhere, this meant non-DICOM departments such as ophthalmology, dermatology, wound care, point-of-care ultrasound, and endoscopy.
With enterprise imaging coming into its own, a selection committee sent out a request for EI proposals. Physicians who tried out the proposed products included not just radiologists and cardiologists but also emergency-medicine physicians, surgeons and others.
“…the most important factor is not bells or whistles. It’s not features or ‘value-adds.’ It’s speed and reliability, both of which AGFA HealthCare EI demonstrated to our total satisfaction. Ultimately, those two factors make up the main performance measures that people are going to rely on—or complain about—something like 99% of the time.”
- Radiologist Yeang Chng, MD, PhD, for Northern Light Health
Radiologist Yeang Chng, MD, PhD, a lead physician on the selection team, remembers the process that ultimately led the group to choose—and unanimously embrace—AGFA HealthCare Enterprise Imaging.
“One thing that I personally came away with after the selection rounds is that it’s very hard to get a handle on what is most important in a demo,” says Chng, a neuro subspecialist by training who just as often works as a generalist. “That’s because the most important factor is not bells or whistles. It’s not features or ‘value-adds.’ It’s speed and reliability, both of which AGFA HealthCare EI demonstrated to our total satisfaction. Ultimately, those two factors make up the main performance measures that people are going to rely on—or complain about—something like 99% of the time.”
Chng serves Northern Light through his role at Spectrum Healthcare Partners, a multispecialty services group based in Bangor and Portland, Maine. An IT power user, he was the selection team’s go-to person for teasing out the technical aspects of enterprise imaging.
Here are some edifying comments on the technology from Chng and Bacon just one month into their AGFA HealthCare Enterprise Imaging journey.
- “The EI system is way faster than our prior PACS. We have not seen a single freeze or delay. This is why the teleradiologists we work with—including those who were loudest to complain about our old PACS—are uniformly saying they love the new system.”
- “Everything about the AGFA HealthCare EI system adds up to better delivery of clinical care. You’re able to swiftly and responsively pull up any comparison studies. You can easily collaborate with colleagues. All of this works to benefit the patient.”
- “For neuro in particular, one big thing that EI does that our old PACS never did is perfectly align current and prior brain images on CT and MRI. In the past, you could miss a lesion due to imperfect image alignments.”
- “We’ve got a ton of small, independent hospitals in Maine that are not part of a large network but from which we receive a ton of patients. The more of those hospitals we can help get into our EI system, the better it’s going to be for them, for their patients and for their communities.”
Petersilge: ‘AGFA HealthCare Gets It’
Six years ago, Petersilge published a think piece on enterprise imaging in the American Journal of Roentgenology.
“Radiologists have tremendous value to offer in support of the new concept of enterprise imaging, which extends outside the radiology department to encompass all image producers in a healthcare enterprise,” she wrote. “Reducing the chaos of the current fragmentation of imaging data is a key foundation for successfully achieving [EI’s promise of care coordination with few limits]. Costs need to be reduced and efficiency increased. Connectivity is the future.”
An “EI system constitutes a solid foundation on which all the -ologies, without exception, will be able to build. It’s here now, but in a sense it’s all about the future.”
- Cheryl Petersilge, CEO, Vidagos
Today Petersilge is even more excited about EI’s potential to transform patient care on a broad scale. She’s especially sanguine about AGFA HealthCare’s take on the technology.
“Based on her previous experience implementing AGFA HealthCare’s solution, Petersilge knows AGFA HealthCare understands enterprise imaging. “They get it, and they’re putting their focus on creating a solid core of services to define it,” she says. “Their EI system constitutes a solid foundation on which all the -ologies, without exception, will be able to build. It’s here now, but in a sense it’s all about the future.”
To learn more about AGFA HealthCare Enterprise Imaging, click here.
To read Petersilge’s 2017 commentary, click here.
Dave P. has worked in journalism, marketing and public relations for more than 30 years, frequently concentrating on hospitals, healthcare technology and Catholic communications. He has also specialized in fundraising communications, ghostwriting for CEOs of local, national and global charities, nonprofits and foundations.