HIT Think

Why enterprise imaging is entering a new stage of maturity

The annual HIMSS conference is viewed as a challenging proposition for vendors with an imaging IT focus, given the scale and breadth of healthcare IT solutions on show. It is also a difficult place to launch new products because of the barrage of press releases and media that accompanies the conference.

It was no surprise, then, that big new-product releases were relatively thin on the ground for imaging IT. This may be a consequence also of the proximity of HIMSS, sandwiched between the premier radiology conferences of RSNA and ECR.

But it might also be an indication of something more important—a sign that finally providers and vendors alike have settled on enterprise imaging as the clear next step in market evolution. Here’s our view as to why this is an important development.

The concept of enterprise imaging is not new. For some time, it has been emblazoned across vendor product marketing literature and conference booths. It has offered health providers the suggestion that consolidation of imaging across hospital networks is a simple task; however, in reality, enterprise imaging products have fallen short to this point.

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iSite Radiology Software application

Many have been based on a legacy framework of multi-site PACS systems, an evolution of multi-site PACS with additional features or partnerships with third parties to support remote viewing (universal viewers) or centralized archiving (usually a DICOM archive or VNA). Rarely has the promise of enterprise imaging lived up to its claims.

Arguably, not a lot has changed since we wrote about this in our RSNA 2018 round-up. Yet in the broader context of HIMSS, enterprise imaging seemed more assured than we have observed before. The audience of health IT professionals, administrators and hospital leadership perhaps better understand the problem that enterprise imaging is trying to solve.

At more clinically focused shows such as RSNA and ECR, vendors must be ready to debate and discuss the most nuanced and complex clinical and diagnostic needs of users. At HIMSS, the broader focus of attendees is looking at the bigger picture. Many of these health provider leaders have already identified that in the wake of rapid EHR adoption, myriad clinical departments have been left by the wayside, creating a fragmented puzzle of legacy applications and software that is a costly and complex problem to deal with.

It is doubtful if any vendor on the show floor this year could solve these challenges with a single offering. Yet it was notable that, in recent times, many vendors have taken significant action in evolving their products and services to better address this need and have pinned their future strategy on enterprise imaging.

Further, there was more evidence than before of real-world implementation of enterprise imaging. Many of these examples were some way from the depth and maturity promised by glossy marketing campaigns of the past, but it was heartening to observe that providers and vendors alike are taking the initial steps towards making enterprise imaging a tangible reality.

Above all, it was evident that vendors and providers are now thinking outside of the radiology department in terms of the role that enterprise imaging can play—point-of-care ultrasound (POCUS), surgical, dermatology, pathology and genomics all have been identified as areas that should play a role in the near-term future of enterprise imaging. A handful of case studies even showed examples of providers using centralized clinical content management platforms across a number of these areas, supporting “multimedia” diagnostic reporting, a far cry from the old adage that enterprise imaging is just “radiology at scale.”

Also, very prominent was the focus on operational, workflow and performance tools from imaging IT vendors. Because most vendors come from a legacy of diagnostic software, analytics and business intelligence are still relatively new concepts. However, given that medical imaging takes up a sizeable chunk of healthcare spending, it is perhaps surprising that it’s taken so long for providers and vendors to focus on using IT to improve the efficiency and quality of imaging operations.

Most progress so far has focused on a few key areas from an operational perspective. For example, staff audit and training, especially relating to dose awareness and compliance, are now increasingly integrated and expected; integration to financial and revenue cycle management has also become more prominent. Analytics and dashboarding from basic patient admission information, in order to find patterns or reasons for missed appointments and potentially missed revenue, was also a significant talking point.

These are also being paired with smart scheduling for appointments and follow-ups to minimize downtime and reduce patient no-shows. As with broader enterprise imaging, it is still early in terms of the adoption of these tools. Yet focus in this area signals an important point—that is not only EHR vendors have a role to play in supporting hospital operations, especially in complex clinical departments, like radiology. In light of the fact that EHR has long dominated the agenda of hospital executives, imaging IT vendors likely see operations and performance tools as an opportunity to prove their value and return on investment credentials and raise their standing.

The confluence of the two trends above, combined with the changing demands of the market, is also changing the role leading imaging IT vendors see themselves playing in the future of healthcare IT. While many providers have only just begun (or have yet to start) their journey towards clinical data consolidation with enterprise imaging, it is becoming obvious that the demands of modern healthcare require a more expansive model for clinical content management.

Thus, imaging IT vendors see this as an opportunity to provide the core clinical platform that can act as a central hub for integration of non-EHR clinical and diagnostic applications. In our research, we call these Agnostic Clinical Enterprise (ACE) platforms.

However, becoming established as the central ACE platform provider will only be part of the broader strategy for leading imaging IT vendors. ACE platforms also will change the paradigm of the vendor-provider relationship. Healthcare providers are today under pressure to improve care outcomes and manage spending better, while also simplifying supply chains. This will put more focus on long-term partnerships, resulting in fewer suppliers across a broader product range.

Imaging IT vendors see this as an opportunity, especially considering clinical operational budgets far exceed clinical software budgets. If imaging IT vendors can forge a prominent role as a partner for operational support with a combination of software, analytics and professional services, they will be better positioned to tap into this far richer budget source. Those with medical device and imaging equipment businesses will also be able to leverage their position to ensure long-term deals under a managed service model.

The lack of glitzy new product releases and ongoing messaging around enterprise imaging at HIMSS could be viewed as stagnating market; we’d argue the opposite. In fact, the lack of change suggests that the market has settled on a concept that will, over time, benefit providers in tackling some of their complex clinical IT issues, while providing a new business opportunity for vendors. Therefore, enterprise imaging looks to be here to stay, and perhaps, might start to deliver on its initial promise.

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