Application development is not the typical hospital's strong suit. Chang cites two government agencies—the Air Force and the Veterans Administration—that have built metadata-at-image-capture applications. The rest of healthcare is still waiting for imaging system vendors to offer mature solutions of their own. It doesn't help, Chang says, that some vendors are still trying to get providers to buy bundled archive systems, even as those providers have invested heavily in their own storage solutions.
"One of the problems with non-DICOM images is it was too easy for us to just throw them into a PACS without really associating with metadata or orchestrated work flow to be useful," Chang says. "You've got all these pictures, but they're not as discoverable, they're not as useful to us as radiology images, because of the lack of association with metadata.
"You might, if you ever get around to it, tag [or] associate with some metadata post-hoc. That's very dangerous. We would never do that in radiology."
At the University of Chicago, Chang is building an iPad app that integrates work flow into the act of taking a picture. A nurse opening the app will be able to obtain a patient list, select the patient being photographed, and use drop-down menus to indicate the target, such as a skin lesion. Then the application will give the nurse pointers for how to take the picture.
But a total solution takes a lot more than building one iPad app. The University of Chicago first built a sophisticated service-oriented architecture infrastructure, and could rely upon Chang's earlier experience at the University of Pittsburgh, where he helped build the Air Force's system that was under contract at the time.
All of which indicates that solving the enterprise imaging puzzle requires expertise, years of time, and money. It's more appropriate to think of enterprise imaging's potential to create value than it is to think of it simply as a potential return on investment, says Eric Yablonka, vice president and chief information officer at University of Chicago Medicine.