At Mount Sinai, the strategy to achieve all these aims is, of necessity, an incremental one. "Right now in many places, electronic medical records are eating up all the dollars for IT projects, which means vendor-neutral archive only gets a middling priority, and that may be very appropriate if you're functional right now," Mendelson says.
"Some places are in the process of replacing PACS systems," Mendelson says. "That might be the moment to begin to entertain moving toward a vendor-neutral archive instead of going to a traditional PACS model."
Mount Sinai is evaluating migrating to a vendor-neutral archive, which would also lay the groundwork to allow the organization to provide images to health information exchanges without increasing the vulnerability of its primary imaging applications, he says.
The vendor-neutral archive may serve double-duty as an upgraded business continuity and disaster recovery system, replacing a cumbersome magneto-optical disk backup system, he says. Planning, and lots of it, is the place to start with enterprise imaging.
"Unless you have a comprehensive enterprise strategic plan for enterprise images, you will waste a lot of money," says Paul Chang, MD, FSIIM, professor and vice chairman of radiology informatics and medical director of enterprise imaging at the University of Chicago School of Medicine. "You're going to consume a lot of cycles, because it is unsustainable having this menagerie of various mini-PACS without a comprehensive management plan. And unless you have optimized work flow, you won't leverage and achieve the efficiencies."
Chang says the often-heard goal of integrating DICOM and non-DICOM images into a single image archive is a solved problem at scores of medical centers. The real need, he says, is for mature work flow technology that allows those capturing the image to enter necessary metadata about the image at the time of acquisition.
One such application, built at the University of Texas MD Anderson Cancer Center, which conducted more than 10 million diagnostic imaging procedures in fiscal year 2011 at its 594-bed hospital, was demonstrated at the 2012 HealthData Initiative Forum's Health Datapalooza event in Washington, D.C. The application, ViSion, was described at the event by David J. Vining, MD, medical director of MD Anderson's Image Processing and Visualization Laboratory. "What we've tried to do, though, is capture the natural work flow of a radiologist, and that is simply sticking our finger on the film and saying, 'Where is it and what is it? Like, lung cancer? Colon polyps? Gall bladder? Gallstones?' And that's the essence of what we have done with this app."