Before the dam bursts: 4 challenges in the era of enterprise imaging

Due to improvements in both technology and the quality of patient care, there are currently more images being used in the healthcare industry than ever before.

However, according to Alexander Towbin, MD, associate chair of the department of radiology at Cincinnati Children’s Hospital, providers need a systematic method for obtaining, storing, and distributing these images throughout the hospital.

In a webinar presented by the Society for Imaging Informatics in Medicine (SIIM), Towbin compared the situation to a dam holding back roaring waters.

“We’ve been doing a pretty good job, but it’s sort of like this dam ... images are piling up and they’re coming from multiple departments and divisions throughout the hospital,” Towbin said. “We’re not always doing a great job, and that dam is about to burst.”

This new era of enterprise imaging has introduced numerous challenges to imaging departments and hospitals. In his presentation, Towbin discussed many of those hurdles and said each one must be addressed to keep that dam from bursting.

Mobile device use

There are over seven billion mobile devices in the world today, and this has had a substantial impact on the healthcare industry. Mobile device use in medicine is ubiquitous, Towbin said, and physicians turn to their smartphones and tablets several times throughout the day to help provide care to their patients.

“We can access the electronic medical record there, we can view images there, we even have devices we can take straight to our patients and allow them to take things like blood pressure and then deliver that information to us,” Towbin said. “These are everywhere, and people are using them.”

Towbin noted that this has led to healthcare providers’ personal photo libraries being filled with patient images. Radiologists may want to quickly consult with a peer, for example, so they do it through a text message.

“This is big challenge in security for hospitals, and it’s also a challenge in us doing the right thing,” Towbin said. “Hospitals are sticking their heads in the sand if they don’t think people are doing this, whether there are policies that say they shouldn’t be doing this or not.”

Physicians often do a thorough job of removing identifiable information about the patient from these images and messages, Towbin added, but that does not make it any less of a security issue.

The solution to this challenge, Towbin said, is using special phone applications that allow providers to take images without the images ever appearing on their phone’s photo library.

Towbin listed several things the ideal phone application should be able to do, including: query the electronic medical records for patient demographics, capture images, edit the images, tag the images, upload the images to a separate archive instead of the user’s phone, and communicate with peers about the images as needed.

Tagging the photos in a standardized way would be especially helpful, Towbin added, making it much easier to identify and compare images in the future.

Phone applications do exist for this purpose (SIIM members can go to the organization’s website for more information) but Towbin called for more and said many of them do not provide key features such as the ability to tag and classify the images.

Patient identification

With so many images being captured on a daily basis, identifying the patient is also becoming increasingly difficult. It often causes confusion, for example, when a provider photographs a patient for reference and then has identify the patient later on.

“The challenge with many of the traditional digital cameras is transferring the image from the memory card to the information systems and then making sure the patient is identified correctly,” Towbin said.

Towbin suggests that providers using a sticker or machine-readable barcode in images as a solution. He also said bracketing or bookending the images with a control sheet can be effective.

Modality worklists can also help with patient identification, and Towbin said those have the advantage of being less susceptible to human error. But most digital cameras don’t allow this capability, and other cameras can get expensive quickly.

Image quality

Establishing consistent image quality in all photographs is another challenge faced by healthcare providers.

“We have to figure out ways to standardize image acquisition so these images can be compared at a later time,” Towbin said.

The quality of an image goes beyond its resolution; details such as the color, lighting and size are equally as important. Towbin suggested including a ruler in each image as an effective way to reflect the size of the object being photographed. He also said including a color wheel is the easiest way help with color consistency.

Using standardized cameras across the board was something else Towbin suggested. If you can get everyone in a given hospital system to all use the same basic digital camera, he said, it will be that much easier to make comparisons of photos taken by different cameras.

Image identification

When discussing enterprise imaging, Towbin said one has to consider the challenge of finding a specific image among so many others.

“How do you find a dermatology image in the middle of 150 chest x-rays?” Towbin asked.

The best solution in this instance went back to something he had already discussed in his presentation: image tags.

Tagging each image by the specialty, study type, and body part, for example, makes finding it later down the line much easier, Towbin said.