Enterprise Imaging: The now and future king of medical image management

As recently as three to five years ago, clinicians diagnosing disorders could not afford to dismiss the possible presence of “stumble-across” imaging studies.

Don’t confuse the term with incidental findings. These are anatomic abnormalities that pop up in imaging exams looking for something else. By contrast, stumble-across imaging is typically a prior exam that’s relevant to care but hidden from view. The only way a clinician can find it is to stumble across it.

Helpful as they can be when they turn up, stumble-across imaging was always destined for demolition. Its days became numbered as soon as healthcare entered the digital age. It was just too obviously unreliable as any sort of go-to diagnostic strategy to survive the transformation. After all, it was no secret that priors often went poorly remembered by patients and completely undiscovered by clinicians. The result often was repeat imaging, and the safety risks and monetary costs that it carries.

What replaced poking around for clues and making do with whatever turns up? The one-two punch of uniting the EMR with enterprise imaging (EI).


Adam Brand photo for EI Article.“The physicians and staff in our imaging department were progressive enough in their thinking that they didn’t want to simply replicate what we’d been using through the state’s direction. They wanted to look at whatever technologies were out there. And they wanted a product family that would meet our needs well into the future.”

– Adam Brand, MBBS, MPH, Emergency Medicine Specialist, Gold Coast Hospital and Health Service, Queensland, Australia

A defining moment in healthcare history

So suggests Adam Brand, MBBS, MPH, an emergency medicine specialist at Gold Coast Hospital and Health Service in Queensland, Australia. As a physician staffing one of medicine’s busiest branches since 2007, he’s had enough experience with stumble-across diagnostics in the past to recognize the vast superiority of EI in the present.

An example might be “something as simple as a prior exam of, say, a nodule you’re looking at on an emergency chest X-ray,” Brand tells Radiology Business. “Today the prior imaging comes right up on your screen with the patient’s identifying info, and you can compare the nodule’s appearance then with how it looks now. You check the prior report along with the side-by-side imaging, and you immediately know exactly what to do for the patient.”

Brand, who also serves the four-hospital Gold Coast system as medical director of digital and information—the equivalent of a CMIO in the U.S.—isn’t shy about expressing his zeal for EI and other emerging technologies.

“When you look at how substantially artificial intelligence has matured over the past year or so, especially with generative and large-language models, we’re really at a rich and exciting inflection point in healthcare,” he says. “We’re trying to be at the forefront of that evolution. It’s a great place to be.”


Efficiency, productivity, innovation

Gold Coast Hospital and Health Service began fully embracing the concept of enterprise imaging, which Brand interchangeably calls “enterprise PACS,” between 2016 and 2018. The health system is funded by the government and at the time its leadership felt pressured to, take on more duties, responsibilities—and volumes.

At the same time, however, Gold Coast radiologists were “struggling to get the reporting efficiencies that they knew were possible within the private sector,” Brand explains. “They were not the controllers of their own destiny.”

In internal meetings, radiologists and radiology administrators identified the crux of the problem: the hospital’s reliance on a team of centralized decision-makers representing the entire state of Queensland (pop. 5.2 million). The solution would be placing enough trust in Gold Coast’s maturity to let the radiology department acquire and run its own RIS, PACS and VNA packages.

The goal of the project would be realizing a substantial boost in not only efficiency and productivity but also innovation.

“The physicians and staff in our imaging department were progressive enough in their thinking that they didn’t want to simply replicate what we’d been using through the state’s direction,” Brand says. “They wanted to look at whatever technologies were out there. And they wanted a product family that would meet our needs well into the future.”

A technology selection team formed. Members knew before even starting to shop around that image storage requires a significant investment, Brand notes. They knew that many PACS platforms are not readily interoperable with other technologies. And they knew their selection would have to fairly easily accommodate other specialties (aka “ologies”) into the EI environment.

Meanwhile Gold Coast was already well into the installation and implementation of a new EMR. The new enterprise PACS and/or VNA would have to seamlessly piggyback on that project.


From Exhaustive Whiteboard Notes to Optimized Patient Outcomes

The particulars of enterprise imaging vary from one health system to the next, but the principles guiding EI adoption remain the same.

At Canon Medical, Jim Litterer, president and CEO of the informatics operation, believes every successful implementation starts with an EI supplier listening to a prospective EI client.

That’s how it went with Gold Coast Hospital and Health Service in Queensland, Australia, he notes. The same went with the other two Canon Medical customers in this series, Ochsner Health in Louisiana and Aalborg University Hospital in Northern Denmark.

“We call it whiteboarding,” Litterer explains to Radiology Business. “The process may or may not involve an actual whiteboard. Either way, every potential partnership starts with a hospital team talking and Canon Medical taking notes.”

Canon Medical asks a lot of questions in those sessions, he adds. This preliminary step is critical because it lets everyone around the table see whether or not the two teams are a good fit as partners. If participants agree they’ve passed that hurdle, the whiteboarding session turns to tailoring Canon Medical’s EI capabilities with the health system’s needs.

“Hospitals often start with the sense that they already know how to solve their issues,” Litterer says. “Then they engage us. One of my favorite things in the whiteboarding sessions is watching their mental light bulbs come on. They see that they might be able to do things they hadn’t even thought of—or do things better than they imagined possible.”

Kevin Paulazzo, a Canon Medical EI specialist serving Australia and New Zealand, notes that Gold Coast Health is “a uniquely forward-thinking institution. They’ve put forth a clear strategic vision for treating patients and supporting clinicians. A crucial part of that vision is making all clinical information available to clinicians in real time across the enterprise. That makes our partnership a natural fit.”

It’s rewarding, Litterer adds, to help healthcare providers devise their own best strategies.

“The basic promise of enterprise imaging is the same everywhere, but the fulfillment of the promise is unique to each customer,” he explains. “How can this hospital optimize imaging workflows and streamline the delivery of clinical information across the enterprise?”

“It’s fulfilling to help professional caregivers find the answers to those questions,” Litterer says. “We love knowing that many clinicians around the world are using our innovations and technologies to treat not just the patient but the whole person.”


All this and cost savings too

For the image-management piece, Gold Coast opted to split the business between two vendors. Canon Medical would supply key enterprise components—VNA, consolidated image storage and unified universal viewer—while Intelerad handled PACS for radiology.

The institution went live with the new PACS and EI setup in 2018 and 2019. Today it’s expanding the capabilities of Canon Medical Enterprise Imaging to maternal-fetal medicine, point-of-care ultrasound, oral health and other specialties eager to share imaging with clinicians across the enterprise.

“We were the first in our state, and I think the first in Australia, that had a fully cloud-hosted RIS, and we had tiered storage with a mixture of on-prem and cloud-hosted storage,” Brand says. “We’ve continued that with Canon Medical Enterprise Imaging. We believe the approach is allowing us to do better lifecycle management of medical images.”

The improvement is especially noticeable, he says, with the massive files produced by ultrasound loops as well as MRIs, CTs, 3D tomosynthesis and so on.

Brand adds that it’s “incredibly useful” to use EI for indexing all imaging. An accompanying visual cue reminds the clinician that the images exist and are readily retrievable. Hence the death of the stumble-across strategy.
Helping to save mightily on cost is a parallel strategy of moving older images to slower but still extant storage platforms.


Heart of the matter

Going forward, any medical specialties Gold Coast onboards into the Canon Medical EI product, including non-DICOM departments, will enjoy a streamlined process for uploading images into a patient portal.

“Patients who’ve been seen just about anywhere will be able to view all their imaging studies and reports,” Brand says. “Whether it’s a video capture of your throat from an ENT endoscopy performed here or an echocardiography study obtained elsewhere, it will be available.”

En route to that destination, Canon Medical EI is going to become “the heart of our interoperability agenda,” Brand offers.
Other points of satisfaction and expectation as articulated by Brand:

  • With the Canon Medical EI product, Gold Coast created a consolidated and comprehensive view of its imaging. “End-user clinicians can now see every relevant image—from radiology and cardiology, for starters—on a single, unified interface,” Brand says. “That’s huge.”
  • For multidisciplinary team reviews of patient cases, Gold Coast is just now dipping its toe into high-resolution clinical photography. “At the moment these images are not stored with the Canon Medical EI software, but they soon will be,” Brand explains. “We believe this will give our tumor boards a very important platform for care coordination and collaboration across medical specialties.”
  • End-users and other stakeholders are quite excited, in Brand’s words, about the EI software’s potential to help manage image data from point-of-care ultrasound with high confidence in data stability and security.
    “Canon Medical has been very open and collaborative as we work out how their product might develop to meet our needs,” he adds. “That’s been incredibly encouraging.”

Words to the wise

Asked how he might advise another health system mulling a leap into the enterprise imaging era, Brand warns against tolerating inertia.

“Until you have a way to easily share and manage medical images from multiple modalities and specialties, you’ll always struggle to get a full picture of what’s happening with the patient,” he says. “Once you move in the direction of enterprise imaging, you’ll quickly see how it can become a cornerstone on which to build a future of technology interoperability and multispecialty collaboration.”

And that, he suggests, should close the book on how far preferable EI is to stumble-across imaging.


To learn about enterprise imaging as envisioned and produced by Canon Medical Healthcare IT. click here