More hospitals are transitioning from radiology department-based image management to an enterprise-wide, centralized archive that houses both radiology and non-radiology imaging datasets.
Centralized image management is a positive move for most clinicians but there are obstacles. Mony Weschler, MA, director of clinical ancillary systems and emerging health IT at Montefiore Medical Center in New York City, says there are sometimes cultural and workflow issues in departments that need to be overcome. The solution must be fully integrated to the core system and function seamlessly for clinicians. Montefiore modified its initial strategy of a single enterprise-wide archive after introducing the model in cardiology.
After the cardiology rollout, Montefiore maintained its initial goal of an enterprise-wide archive but determined a hybrid approach was best. To preserve functionality, some departments are required to have their own "integrated" imaging system, customized workstations and short-term storage space, with images also sent for long-term archiving on the enterprise PACS. Surgeons and referring physicians still can access all images, while departments can retain their required toolsets.
Weschler says the hybrid approach will be the model for integrating ophthalmology, nuclear medicine, pathology and other departments. Even though some archive systems claim they can meet the needs of multiple departments, at Montefiore, the integrated hybrid approach was the only way to meet every department's needs.
Similar to Montefiore, departmental workflow is a major concern at Massachusetts General Hospital (MGH) in Boston, says David S. McClintock, MD, a pathology informatics fellow.
"Radiologists have the best clinical image management model to date. For departments that have not transitioned to digital management, it would be nice to leverage what radiology has done and use what they've already proven to work rather than trying to reinvent the wheel," says McClintock.
But workflow is a key difference between radiology and pathology. While radiology image management can be digital from image acquisition to archival to display, McClintock says that pathology requires physical specimens and involves a lengthy chain of custody with multiple possibilities for human error. There can be anywhere from 20 to more than 100 handoffs in the pathology specimen chain of custody and a single mistake in container labeling or slide creation would be perpetuated into the archive.
To prevent errors, MGH utilizes barcodes instead of handwritten notes for every part, block and slide generated.
Another hurdle for integrating pathology images into the digital archive is the sheer size of whole-slide images captured by a virtual slide scanning robot. These devices reproduce glass slides at high magnification that can be zoomed in for more detail, says McClintock. Size often reaches 4GB, compressed, per slide (uncompressed they can be 40GB each), which is a huge strain on enterprise archives as most pathology labs produce thousands of slides per day and one or two petabytes of data per year.
These challenges could be worth overcoming to realize the potential benefits of an enterprise model. McClintock says the most prevalent model today is to manage pathology images by storing files on a HIPAA-compliant server using a simple folder structure.
Majors hopes to eventually have a set of common clinical viewers that provide access to data and images, regardless of its origin. In the meantime, the transition to an enterprise archive serves as a solid stepping stone, not only for a universal viewer but also improved clinical access and cost savings.