I came across an interesting publication (https:// medicalis.com/downloads), referred to as a “Glossary of Terms” for Imaging Service Lines. This prompted a telephone conversation with Jordan Halter, VP of Business Development for Medicalis to discuss the basis for their document.
According to Jordan, “We created the Glossary of Terms to facilitate communication between the 3 main stake holders (Strategy, Clinical, and IT) in the creation of Imaging Service Lines within Regional IDNs. We noticed that successful projects had a clear voice and direction on “why” they were constructing the Imaging Service Line from their strategy folks. The Glossary was created to help articulate operating plan concepts of Imaging Service Lines for clinical and IT personnel involved in the project.”
Medicalis has seen that not all organizations have a unified vision for handling Imaging Service Lines in an environment of increasing consolidation. IT personnel sometimes advocate the “boxes and wires” (as they describe it) aspect of the project, but this may not address a strategy for the Imaging Service Lines, nor address the clinical need, let alone enable rapid consolidation of imaging within a growing Regional IDN.
As it pertains to Imaging Service Lines, oftentimes IT feels the need from an infrastructure perspective to start with a VNA (Vendor Neutral Archive), but they don’t always have a clear-cut strategy directive for doing so. IT may be attracted to the VNA as a means for improving image management in conjunction with a recently-finished EMR (Electronic Medical Record). As far as creating an IDN-wide Imaging Service Line though, shared storage may not be the primary issue for an Imaging Service Line. There may be clinical issues that are of greater concern, such enabling sub specialty (Peds/Neuro) interpretation 24x7, creating uniform SLAs across the IDN, or taking over Imaging for a newly acquired hospital.
This “cart/horse” dilemma may have more to do with the question of how elements such as a VNA fit into the overall workflow of Imaging Service Lines. So, while the VNA may address enhanced image accessibility across multiple facilities, it may not impact the way images are accessed and by whom or why.
Conversely, addressing the workflow orchestration requirements of the Imaging Service Line may better identify who needs access to images across the enterprise, and how and when they need access. For example, in a 15 hospital regional IDN it may be beneficial to be able to route images for a specific diagnosis to a particular specialist. Or, perhaps shared coverage of the 3rd shift between the 4 different Radiology Groups who read for the IDN so they can leverage economies of scale and skill to meet the SLA needs of the IDN. Similarly, in a rapidly consolidating healthcare environment shifting toward value-based versus fee-for-service care, workflow orchestration may play a much greater role than elements such as a VNA. Being able to intelligently connect to disparate systems and locations, and convert all that data into actionable insight enables things like measuring and proving quality, value and performance.
I think, given the bigger picture, Medicalis has it right. Workflow orchestration first via “Connecting What You Have” may be a more meaningful starting point for Imaging Service Lines, who can then determine how best to deploy technologies such as the VNA. Several years back one of the Universal Viewer vendors pushed the notion of implementing the viewer ahead of the VNA, stating that image access is more important than where the images are located. Tools such as Medicalis’ “Glossary of Terms” may be helpful in getting all the stakeholders (Strategy, Clinical, and IT) involved and aligned in their Imaging Service Line process, and forging ahead with informed strategic implementations during this time of rapid healthcare consolidation.
