Imaging isn't what it used to be

Vendor neutral archive project allows HCA Group to offer more complete patient records
By Mike Miliard
11:09 AM

This past summer, HCA Group launched a project to offer clinicians easier, enterprise-wide access to advanced digital images. Once all but impossible thanks to proprietary platforms and enormous file sizes, vendor-neutral archive technology now enables effective management of an "increasing amount of data," says Kaye Bonython, the health system's head of imaging informatics.

[See also: Is VNA the future of image delivery?]

"Image management now extends beyond traditional radiology DICOM imaging," says Bonython. "Demands for all images relating to a given patient being available from a single point of entry to the patient record means that holding images in a system that is perceived as 'separate,' which may need a separate log-in or an additional mouse click is becoming a key requirement for users."

HCA Group deploys a Meditech EHR and a PACS system from McKesson across all its hospitals, diagnostic treatment centers and labs – a total of a total of 26 sites across London, Surrey and Manchester in the U.K., says Bonython.

[See also: Imaging IT heads toward new phase]

"My team manages all clinical imaging systems across the enterprise," she says. "This initially was a PACS team, but now encompasses CV, other 'ologies' and soon will add digital pathology to the increasing number of image types to be acquired, stored and distributed across the enterprise."

Add to this complexity HCA Group's project to implement a number of breast tomosynthesis modalities to enhance its breast imaging capability.

"HCA offer both symptomatic and screening breast imaging services across multiple sites and the requirement to add tomosynthesis imaging posed some challenges due to the size of images and the requirement for studies to be made available across multiple sites for both diagnostic reading and MDT purposes," says Bonython.

HCA Group recognized that VNA technology from Perceptive Software could help offer a single point of entry for clinicians to access many different types of patient images, enabling, in Bonython's words, "more holistic view of patients."

"The role of clinical imaging in patient care has changed dramatically over the past few years," says Mark O'Herlihy, Perceptive's healthcare director for Europe, Middle East and Africa, in a statement. "Imaging is no longer used solely for diagnosis but also to assist in surgeries and to record treatments. Imaging has become a core part of all patient records."

Indeed, recent years have seen enormous growth of image capture modalities and software analysis packages that are fast becoming "part of standard patient care," says Bonython. She points to clinical photography, gait analysis video and digital pathology as just a few of the new image types clinicians now rely on.

As as "new proprietary image file types enter the market, the challenges of storage and distribution continue to grow," she says.

"Given my imaging background, I naturally see this from an imaging perspective but, as an organization, we also are aware of the need for a more streamlined approach to document management," she adds. "We see image management as the first step to the bigger program of work to implement a large scale architecture change for our organization."

Given that breast tomosynthesis imaging requires file sizes 20 times larger than routine digital mammograms – and are in a proprietary format to boot – "viewing on non-modality workstations posed a significant challenge," says Bonython.

The first step was to ask several questions:

"Was there a confirmed need for tomosynthesis imaging to be available across the enterprise, or would 2D images suffice? How many studies did we expect per annum, and therefore the storage capacity required? How could we move images and the network requirement to ensure no impact on other operations? Could we utilize current storage capability, and what would be required to ensure capacity was sufficient?"

The assessment showed that "we did have some infrastructure that could be re-purposed in a cost effective manner to enable a small scale VNA deployment as a first step to prove the value of the technology," says Bonython.

"We needed to work closely with the modality vendor and required them to adjust their implementation to fit an architecture which was new to them," she adds. "This required significant communication to ensure all the vendors in the process were fully engaged and understood the requirement. We had a very short timeframe and all worked together to ensure we were ready prior to the modality go-live with a fully tested, safe solution."

The benefit of VNA for image management – in terms of storage and cost efficiency – is "very clear," says Bonython.

"Added to this is the opportunity to have horizontal data management rather than separate silos means that the end user experience is seamless as the end user has a single objective – to use less mouse clicks to gain maximum information, be it an image or document," she says. "Smart use of VNA technology enables the IT department to maximize resources and make significant savings over time."

Any advice for other providers looking to enable more widespread access to all image types by deploying VNA?

"Planning is vital," says Bonython. "Look at several vendors and ensure that you understand your business so that you can communicate it well so that your vendor can understand your needs. There will be need for multiple workshops to be sure you are all on the same page and be sure to involve all areas so that they understand their role in the program of work.

"In essence, you need diligent project management with a highly committed core team who fully understand the brief," she adds. "We were fortunate to achieve our project in a remarkably short time due to the commitment of a small key group who spent the time upfront to ensure all aspects were fully understood and communicated."