Ubiquitous smartphones are responsible for a number of cultural changes, from the rise of texting to the demise of paper maps. One of their most visible impacts in healthcare may be to force adoption of enterprise-wide image management.

While the radiology department is still the most prolific producer of medical images, they're starting to show up from all quarters--the ICU, the OR, the primary care office, even directly from patients--in volumes that need to be managed, archived, and made accessible to clinicians, said Cheryl Petersilge, M.D., vice chair of regional radiology at the Cleveland Clinic. Also medical director at MyPractice Imaging, the clinic's imaging consulting arm, she spoke at RSNA 2014.  

At the Cleveland Clinic, images outside the radiology department are proliferating  from point of care ultrasound, endoscopy, and cameras everywhere. Photo volume alone has increased 20-fold in the past year, with ophthalmology contributing a significant share.

Petersilge described the clinic's migration, now in progress, to a single archive for all images, which will be indexed, searchable and accessible through the EHR. "If an image is just cut and pasted into a note, who even knows it's there?" she said.  Physicians will be able to preserve any images they used in making a diagnosis, even if they come from a patient's iPhone. Currently those images are often deleted, creating a potential legal hazard.

All imaging modalities are being incorporated into the archive. The clinic has integrated 78 point of care ultrasound units and 38 cameras, and is currently conducting a pilot to capture images during surgical procedures, which Petersilge says is a first.

Cleveland Clinic also is working toward a uniform imaging access experience for its patients, referring physicians and other outside sources, so that they can easily submit images to the archive and get access to them. Easy access will discourage physicians from hoarding their own image archives and will confer HIPAA security advantages as well.

"We won't have images wandering around on a USB drive," Petersilge said.  Trauma services will improve as well, because images will be available in the archive before patients arrive in a helicopter, rather than traveling with them on a CD and possibly being lost in transit.

She also expects the enterprise archive to be a significant boon as imaging moves from a profit center to a cost center. All clinicians, whether within the clinic or referring from elsewhere, will have access to each patient's complete imaging history and will be less likely to order costly duplicate scans.

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