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How a health system made an enterprise-wide impact with enterprise imaging

The MetroHealth System’s chief health informatics officer shares best practices and lessons learned.

A woman in a doctor's coat looking at brain image scans.
Introduction Best practices Lessons learned and business benefits

The Healthcare Information and Management Systems Society (HIMSS) defines enterprise imaging as “a set of strategies, initiatives and workflows implemented across a healthcare enterprise to consistently and optimally capture, index, manage, store, distribute, view, exchange and analyze all clinical imaging and multimedia content to enhance the electronic health record.”

For Dr. David Kaelber, the chief health informatics officer at The MetroHealth System, the “implemented across a healthcare enterprise” part is critical.

“You need to take the concept of an enterprise imaging strategy and weave it into the system’s goals to get buy-in from other executives and make sure that when you’re driving outcomes with enterprise imaging, they’re touching one or more of the entire health system’s goals,” Kaelber said.

MetroHealth, based in Cleveland, has 1.5 million patient visits per year at its three hospitals and 30 health centers. As it devised its enterprise imaging strategy, the health system, a longtime user of Hyland’s OnBase, deployed Hyland’s PACSgear and Acuo VNA to capture, share and manage its imaging content. A few years later, MetroHealth implemented NilRead, Hyland’s universal diagnostic viewer.

The project had its share of challenges — from staff alignment to needing to do more with less and “a major cultural shift” that had to take place. Despite the initial headwinds, Kaelber and the health system have been pleased with the results.

The MetroHealth chief health informatics officer has a few pointers for health systems that hope to develop an enterprise imaging strategy that drives better patient engagement and produces results across the enterprise.

You need to take the concept of an enterprise imaging strategy and weave it into the system’s goals to get buy-in from other executives.

— Dr. David Kaelber, Chief Health Informatics Officer, The MetroHealth System 

Enterprise imaging best practices

Pick core vendors and develop deep relationships with them

This is a winning strategy that helps MetroHealth “maximize how we’re leveraging all of the technologies that those core vendors can provide,” Kaelber said.

Have an overarching goal and additional goals to support that vision

MetroHealth’s primary objective was to “develop and implement a true enterprise imaging strategy to complement existing PACS (picture archiving and communication system) and provide capture, visualization and management of all patient imaging throughout all service lines.”

The supporting goals all tied into the overall health system priorities, Kaelber said. Those were:

  • Give all stakeholders input into medical imaging
  • Centralize image storage for all of the departments in the vendor neutral archive to create “one source of truth” for imaging
  • Standardize processes (credentialing, ordering, results, billing, etc.) across all imaging modalities and settings
  • Provide clinicians access to all patient images via the electronic health record (EHR)
  • Provide patients access to their medical images via the patient portal
  • Provide anywhere, anytime access to images through an enterprise viewer
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Radiology isn’t the only stakeholder

Many departments — including dermatology, endoscopy, OB/GYN, pathology — perform imaging at health systems. Here’s how MetroHealth drove that cultural change:

  • Someone has to take the lead. The chief health informatics officer or chief medical information officer can be a good choice, Kaelber said.
  • The EHR isn’t optimized if you have to look for content in multiple silos. “If we want to make our electronic health record better, we’ve got to solve this imaging silo issue,” Kaelber said. “And, of course, the answer to that is enterprise imaging.”
  • The EHR isn’t optimized until everything is in the VNA.

Establish an enterprise imaging steering committee

Kaelber led a group that developed and standardized processes for all types of imaging throughout the system. The group included reps from many different departments, including cardiology, dermatology, emergency, OB/GYN, ophthalmology and pathology.

A picture can be worth 1,000 words

Showing a patient what you’re talking about can be “a huge motivator for behavioral change,” Kaelber said.

33,000

MetroHealth patients who viewed images via NilRead in the first seven months after rollout 

4.7 million

Images that 8,000 MetroHealth staff members viewed in the first three years after rollout 

5.5 million

Images MetroHealth already has in its Acuo VNA 

Lessons learned and business benefits

Two of Kaelber’s main takeaways after MetroHealth deployed an effective enterprise imaging strategy:

  • Imaging is an enterprise-wide, interdisciplinary activity in healthcare today.
  • To be successful in EI, a system needs committed leadership, an interdisciplinary team (imaging is everywhere), a guiding strategy and principles, and a core vendor strategy.

An effective EI strategy brings plenty of benefits, including:

  • It’s easier to manage requirements for regulations such as HIPAA and the 21st Century Cures Act.
  • It’s easier to manage security risks.
  • You can get volume discounts on hardware, software and imaging equipment.
  • Systems can centralize and consolidate technical staff who work with imaging.

In the first seven months after MetroHealth rolled out its enterprise imaging strategy, almost 33,000 patients viewed images via NilRead. Just as impressive to Kaelber was physicians who previously showed no interest now asked when their patients’ images would be available in the enterprise system.

In the first three years after rollout, 8,000 MetroHealth staff members viewed more than 4.7 million images. At that point, the health system already had more than 5.5 million images in its Acuo VNA.

“I would really credit Hyland for getting us to start thinking about this,” Kaelber said.

The chief health informatics officer said Hyland helped MetroHealth evaluate its clinical imaging environment, better understand its imaging needs, identify key stakeholders, establish a governance process, and define solution requirements and standards.

“Do you know of any technology that achieves near-complete adoption within two months of being rolled out?” Kaelber said.

For MetroHealth, that was the case when it devised an enterprise imaging strategy that touched almost every aspect of the health system.

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