CIO eBook: A Healthcare IT Journey in 8 Chapters

CIO eBook chronicles healthIT migration from paper to electronic record keeping

Julia Weidman, Carestream Health

Three years ago, when we embarked on our CIO eBook, the healthcare IT world was in a different place. EHR adoption was starting to rise, enabling more complete information access electronically within the enterprise.  Images were not typically available via a patient portal. They were hand-carried by the patient or sent by messenger to the referring physician. 3D studies were less prevalent, and study file size was smaller. Storage was a threat, but not a major obstacle. Cloud storage was commonplace for other industries, but not healthcare. Now look at how far we’ve come.

To understand the journey, read the eBook, “From Trust to Use and Beyond,” for a look at the major factors that have been driving clinical collaboration and change in healthcare IT. The interactive eBook takes a case study approach to the critical issues that are at the root of healthcare IT: trust, access, data, mobility, interoperability, integration and VNAs. Here’s a summary of what you’ll learn:

The issue of trust is at the heart of Chapter 1 in our CIO eBook. Clinicians are coping with change by placing trust in the things that have worked for them in the past. They know that when they spend time with patients, outcomes improve. Yet there is never enough time available. Meanwhile, adopting new procedures and a new workflow, no matter how promising the results might sound, is perceived as taking time away from patient care. So clinicians are skeptical. Chapter 1, “Building Trust”, is the story of Maureen Gaffney from Winthrop-University Hospital on Long Island, NY.  She is a clinician—physician’s assistant (PA-C) and RN who has ascended to Senior Vice President Clinical Operations and Chief Medical Information Officer (CMIO). image of Carestream CIOebook

Ms. Gaffney’s approach to transforming her hospital was clear from the start. She began by enlisting the buy-in of senior management at the hospital, ensuring resources and transparency. Most of the actions taken on behalf of her project were guided by multidisciplinary committees which always included a clinician and an informatics specialist as members. The starting place was to ensure data integrity, coupled with an understanding of how the data would be used, and how the electronic version would fit into the clinical workflow. Continue reading

White Paper: Functional Requirements for Enterprise Clinical Data Management

Defined requirements lay the path for future growth and change

picture of newly planted plant

Requirements to grow your imaging enterprise

Ignace Wautier, Carestream Health

As healthcare organizations plan for the future growth and integration of clinical data into their IT ecosystems, it’s crucial to start with clearly defining the functional requirements that span the needs of users across the enterprise. Why? Because well-defined functional requirements specify exactly what IT systems need to accomplish in each department and across the healthcare organization, and delineate the metrics for success. Also, functional requirements help frame the core questions posed in Requests for Proposals (RFPs) or tenders and define for vendors the capabilities that must be provided to advance interoperability and accessibility. Lastly, if your organization wants to plan for growth and change, functional requirements define the standards that must be met to ensure future compatibility and minimize disruption.

This white paper provides an overview of the key functional requirements that must be built around four distinct modules:

  • Data capture and ingestion
  • Clinical management
  • Enterprise repository/archive
  • Collaboration

Continue reading

Apps Watch in Healthcare

Incorporating patient-generated data to assist diagnosis

Demonstrating the APP for Fosters

Cristine Kao, Carestream Health

Apps Watch

From time to time, we report news and perspectives on the latest in healthcare app development, and the use and potential for new apps in healthcare, and especially radiology.

Incorporating patient-generated data to assist diagnosis.

Several key trends in healthcare are converging to change the way we collect and employ data to help clinicians collaborate for the benefit of patient outcomes. Patient portals today often give patients the ability not only to view their own medical records, but also to supplement them with personal observations and findings that can often aid the clinician in a diagnosis and in the evaluation of a course of treatment.

A recent Harvard Business Review article by John Halamka, CIO of Beth Israel Deaconess Medical Center (BIDMC) describes how this newly possible collaboration between a patient and his doctors Continue reading

Medical Apps and More Medical Apps

Medical apps watch: development, use, and potential

Cristine Kao, Carestream Health

Medical Apps and More Medical Apps

From time to time, we report news and perspectives on the latest in healthcare app development, and the use and potential for new medical apps in healthcare, and especially radiology.

Hundreds of medical apps are being released for healthcare every month, for both Android and iOS smartphones and tablets. Yet clinicians are finding it difficult to determine how to use this cascade of applications. Many medical apps permit patients to provide data to clinicians about personal health status—number of steps per day, or calories per meal, or finer nutritional detail. Certainly this is valuable background, assuming the physician has the time to review it. But where does this additional data belong in the EHR (if at all)?

If your organization is pursuing a Vendor Neutral Archive (VNA), determining guidelines for storage, clinical rules and information lifecycle of consumer data should definitely be part of your enterprise planning, as it can easily add function to your collaborative efforts among patients, PCPs and specialists.

Many of the new apps are helpful to clinicians and do not include HIPAA-sensitive data:

Medical Apps: EpocratesEpocrates has several such apps, like the Nephrology Tool with its renal data and calculators, or the Epocrates continuing medical education (CME) tool with over one million active members pursuing CME on their smartphones.


Medical Apps: Medscape

Medscape is another useful app for both Android and iOS devices that helps clinicians stay up-to-date with the latest journal articles and news. This week in radiology, for example, Medscape reports on discoveries funded by the Brain Initiative, as well as news from RSNA about radiologists’ use of social media to raise their public profiles and other articles covering new studies. (Source:

Medical Apps: ePSS

Clinicians we spoke to told us they used the AHRQ ePSS app to screen patients quickly for a quick evaluation of possible preventive steps applying to patients based on a number of risk factors including age, sex and more.


Medical Apps: iMedical

iMedicalApps keeps track of all things healthcare app-related and recently published an excellent rundown entitled “The Best Medical Apps Released in 2015 for iPhone & Android.” They reference apps including clinical, educational, practical, helpful, and yes, even fun. Examples include Bard VR (using Google Cardboard to the iOS ResearchKit and discussion of recent studies launched using the kit as a framework.

Are you using healthcare apps in your enterprise? Everything Rad would be interested in hearing about your favorite apps and how you are incorporating app data into your collaborative workflow, data storage and access.

Cristine Kao, Healthcare IT, CarestreamCristine Kao is the global marketing director for Carestream’s Healthcare Information Solutions (HCIS) business.



Editor’s Note: Stay tuned for our next App Watch post which will discuss how apps are generating “big data” and what that might mean for your enterprise data storage and access planning.

What Does Clinical Collaboration Really Mean?

Carestream Clinical Collaboration PlatformCristine Kao, Carestream Health

We’ve been talking about clinical collaboration and Carestream’s Clinical Collaboration Platform quite often since before RSNA 2014.

For us, clinical collaboration was born out the use of our vendor-neutral archive (VNA). The VNA served as a housing mechanism for medical images across a variety of –ologies, not just limited to DICOM images. With the VNA, the images remain safe and accessible when necessary, however, to enable intelligent, user-based sharing, more than just storage is needed.

To go beyond the VNA and expand the capabilities that truly lay within its technology, there remained a need to bring in other systems that could result in an enterprise-wide tool to unite departments. With our own Clinical Collaboration Platform, we break down the capabilities in four areas: capture, manage, archive, and collaborate.

Capture. The goal is to provide a unified, patient-centered clinical record that pulls together images and data from departmental systems across the enterprise, and even beyond it. The solution needs to be flexible enough to be where the data acquisition happens: bed-side, by specific modalities, even from mobile devices in a wound care/urgent care environment.

Manage. From a web-based portal the user can now manage clinical imaging data whether it’s at the point of care or as part of the administrative process. Having the right clinical context to each image or clinical data ensures that information can be properly stored, viewed, and share these clinical images and accompanying data. This capability involves advanced metadata tagging, quality control to ensure consistency, and leveraging latest industry standards to ensure interoperability.

Archive. This stage involves the storage and access of clinically meaningful data throughout the enterprise, with access across each patient’s clinical history. This consolidated repository for clinical data helps to support effect collaboration via intelligent lifecycle management, optimized storage and access anytime, anywhere, standards-based and vendor-neutral, and risk-free migration from legacy archives.

Collaborate. This is the ultimate stage that supports dynamic collaboration between providers, patients, payers, administrators and IT managers, with tools and views tailored to each user’s needs. The main goal is to put patients at the center of efficient, effective healthcare. This involves EMR/EHR integration, zero-footprint interface for administrators, user-specific functionality, patient engagement, and payer reporting.

With the evolution of the VNA going beyond the simplicity of storage and access, it is clear that these new capabilities will bring out the value of allowing clinicians to collaborate with each other and take part in valuable communication with their patients. This has been the direction healthcare has been heading in for sometime, and the time is now to embrace these advancements.

You can visit our website for more information about Carestream’s Clinical Collaboration Platform.

Cristine Kao, Healthcare IT, CarestreamCristine Kao is the global marketing director for Carestream’s Healthcare Information Solutions (HCIS) business.


The Next Imaging Evolution Will Contain a New PACS

SIIM 2015 KeynoteThe theme of SIIM 2015 is “Creating the Image Enabled Enterprise”—a mission to bring radiology and imaging informatics to the forefront of healthcare enterprises.

This theme came through loud and clear in Donald K. Dennison’s opening keynote, “The Next Imaging Evolution: A World Without PACS (As We Know It).” Dennison was not explaining how PACS would eventually go away, but highlight how the way in which the technology is built, the capabilities it provides, and the way in which it is used will change–moving from a departmental technology to one that is integrated throughout the healthcare provider enterprise and EMR. In fact, that change is happening faster than we may believe.

Dennison kicked off the keynote describing the three main forces that are currently changing the world RIS and PACS:

  1. Payment reform shifting from volume to value-based reimbursement models
  2. EMR adoption
  3. Consolidation of healthcare providers with larger ones buying or affiliating with smaller hospitals, care facilities, or imaging centers

From there, Dennison moved on describe the current state of imaging in the 2010s. The section on departmental vs. enterprise imaging focused on how imaging is managed today, and how it will need to move to the enterprise model moving forward. Departmental imaging isolates radiology, but still contains numerous imaging informatics benefits such as uniting the VNA, enterprise viewer, image archive, PACS, radiology portal, and reporting within the radiology department.

Enterprise imaging will move this information throughout the organization, and will be dependent on the discovery, presentation, storage, and management of the imaging data.

To accomplish this, Dennison highlighted governance as being the key. If IIPs are not sitting down with Document Management and EMR people, this could lead to duplicate work. Governance on where the imaging data is going to be put and how providers will access it is a must. Doing so will result in an informatics that is sensible, indexed, and presented in context when accessed.

Dennison went on to tackle clinical decision support (CDS), interoperability with Web APIs such as HL7 and DICOMweb, multimedia-enhanced radiology reporting, and how there is a plethora of informatics that must be measured if quality is truly to be achieved today.

He arrived at what PACS vendors need to do in order to meet these pressing needs, and it essentially came down to using a PACS in a single-vendor system–encouraging vendors to make a better PACS. One that is engineered to integrate the worklist, image display, report center, and advanced visualization. It must be easier to deliver MERR, there should be one desktop to manage, and should add VNA-like features to the PACS server.

For providers, it is much easier for them to manage all of these capabilities with a single PACS vendor than managing a different vendor for each one.

In his closing remarks, Dennison commented on how imaging informatics professionals have a lot to offer in an era of consolidation, standardization, and integration. Professionals must have a plan in place and they must share it outside their department walls. Every IT investment must have measureable value, and a policy must be developed for imaging record quality—going back to the importance of having governance in place.

Consistency and completeness of records in the age of interoperability and EMR access will be vital, so professionals must be ready to prove their value, because as Dennison said, “Evidence is king.”

PulvinoRich Pulvino is the digital media specialist for Carestream. He is attending SIIM 2015 from May 28-30 at the National Harbor in Maryland, and will be publishing blog posts throughout the event.

Clinical Collaboration Platform Grown from the Enterprise VNA

We have discussed the evolution of the vendor-neutral archive at length on Everything Rad, and that conversation will not dissipate any time soon.

Healthcare facilities are dealing with petabytes upon exabytes of data, and not only do they need technological resources to store this data, but they also need a system that can properly categorize the data, and provide access to it across different -ologies.

The animation below shows how VNA owners can build upon their systems to create the Clinical Collaboration Platform. The platform is able to capture data from various sources without changing departmental workflow.

A patient-centric repository is created that stores all of the medical imaging data whatever the format or modality, and distributes the images via the appropriate clinical viewer.

Case Study: Clinical Collaboration Across the Enterprise

Reggio Emilia Hospital in Italy is an excellent example of an organized clinical workflow environment. With an annual IT budget making up 3% of total hospital management budget, the infrastructure it has connect 1,500 clients on the local-area-network (LAN), and serves of provide health IT wide-area network (WAN) made up of 1,800 additional clients.

Although it had a solid IT infrastructure, Reggio Emilia Hospital was still looking for a solution for an integrated clinical image repository and distribution system.

In the case study embedded below, you can read how the hospital worked with Carestream to implement an integrated clinical data repository, and how this solution was able to provide collaboration capabilities across the enterprise, no matter where the clinical specialty data was coming from across the network.

You can visit Carestream’s website for more information about our Clinical Collaboration Platform that Reggio Emilia Hospital used to bring a collaborative clinical workflow across the enterprise.

The Top Medical Imaging Trends of 2015

VNA storing and sharing information

Technologies such as a VNA can provide telemedicine advantages by bringing data together under a single location.

A new year brings much in tow—new ideas to share, new trends to address, new technologies to install. While it is difficult to say exactly what will affect us the most as we begin 2015, there are certain trends that seem to leap out ahead of others. Here are five trends we expect to have a vital impact on medical imaging in 2015:

  1. 3D mammography. Digital breast tomosynthesis (DBT) has been a frequent topic in trade publications for a few years. As more studies are released touting the success of this technology in finding lesions and reducing recall rates, its popularity is only going to increase. Especially when top-tier media such as TIME names DBT one as one of the most important health advances made in 2014. Add to the equation the increase in states passing dense breast tissue notification laws, and DBT will only grow further as it has proven to be a technology that provides a more thorough exam for those with dense tissue. In Jan 2015, the Centers for Medicare & Medicaid Services (CMS) established two new add-on codes that extend additional payment when DBT is performed along with 2D digital mammography.
  2. Multimedia enhanced radiology reporting (MERR). Text-only reports are fading away. A study from Emory University and the Harvey L. Neiman Health Policy Institute found that 80% of respondents said MERRs “improved understanding of radiology findings by correlating images to text reports.” The study also found that the multimedia reports  provided easier access to images while monitoring progression of a condition, and saved time understanding findings without supporting images. While improving the radiology report, the multimedia-enhanced version also provides more financial value to radiologists. A recent study showed that 80% of respondents indicated an increased likelihood of preferentially referring patients to facilities that offer MERR, and 79% indicated an increased likelihood of recommending peers use facilities offering MERR.
  3. Wider adoption of cloud technologies. Radiology, along with the rest of the healthcare sector, is moving to the cloud, and it is happening fast. According to an article in Applied Radiology, the global cloud computing marketing in healthcare was valued at $1.8 billion in 2011, and is expected to grow at 21% at compounded annual growth rate (CAGR) of 21% to $6.8 billion by 2018. While initial upfront costs can vary between the intensity of building an organization’s own private cloud, or the ease and flexibility of using public cloud architecture, the process efficiency, financial predictability of paying for only what the organization needs, and long-term cost savings are making the cloud a worthwhile investment.
  4. Centralization of clinical data. Collaboration is a must for health facilities. No department can be left out of the patient experience equation. This means that department silos will have to be broken down—enabling personnel collaboration and the unification of clinical data. Vendor neutral archives (VNAs) are evolving beyond being a repository for radiology. The evolution is allowing the capability to store and exchange clinical content in DICOM and/or non-DICOM formats. This goes beyond the traditional capabilities offered by a VNA by embedding intelligent lifecycle management and meta-data management to optimize the efficiency of multiple archives. With this evolution, all clinical data is available, easily accessible and useable to provide enhanced patient care.
  5. Telemedicine. The global telemedicine market in 2016 is predicted to be $27 billion, with virtual health services accounting for nearly 60% of the total. Additionally, it is expected that by 2018, two-thirds of interactions with healthcare organizations will be conducted via mobile devices. Last year was an important year for telemedicine, as wearable technology became prominent. 2015 will be the year where we see significant growth in the telemedicine, as it is projected to grow at CAGR of 18% to $3.8 billion by 2019, according to Transparency Market Research. With virtual reading, diagnoses, and reporting now a possibility, expect telemedicine to bring together health facilities like never before—from large systems to those located in rural areas.

Today’s changing healthcare landscape places an urgent emphasis on improving the quality of patient care and reducing overall costs in health facilities.   Adoption of new technologies such as 3D mammography, cloud computing, and telemedicine will play a major role.  So will our ability to become smarter in how we utilize health information through centralization of clinical data and multimedia enhanced radiology reporting (MERR).   As the benefits from these five key trends in medical imaging become more widespread, we will see further adoption and improve care for a larger population of patients around the world.

Carestream CMONorman C.W. Yung is the Chief Marketing Officer at Carestream.



The Future of the VNA: From Centralised Storage to an Information Exchange

VNA storing and sharing information

Many hospital organisations, particularly in Europe, are implementing VNAs to store non-DICOM content as well using the Cross-Enterprise Document Sharing (XDS) standard; the XDS standard also provides greater flexibility for storing and managing clinical content.

Hospital organisations throughout the world are increasingly turning to vendor neutral archives (VNAs) to manage and exchange medical images.  However, the growth of VNAs has generally depended on the incentives hospital organisations have had to collaborate.

In the US, hospital organisations have been reluctant to promote sharing medical images across organisational boundaries for a number of reasons, including cost, incentives, technology and competition.  Therefore, VNAs have largely been used to store medical images (particularly radiology or cardiology images using the Digital Imaging and Communications in Medicine [DICOM] standard) within a single hospital organisation.

Health care organisations in other regions, such as Europe and Australia, have had a longer history of sharing data and more incentives to collaborate.  Many organisations in these regions see VNAs as enablers for exchanging information.  In New South Wales, Australia, for example, more than 200 public hospitals and health centres exchange radiology images through a centralised VNA.  The state government invested heavily in e-health and implemented the VNA to improve access to care, particularly for patients in rural parts of the state who may otherwise need to travel several hundred miles to see a specialist in Sydney.

The VNA enables clinicians to share medical information regardless of the picture archiving and communication system (PACS) they use to manage radiology images.  Many hospital organisations, particularly in Europe, are implementing VNAs to store non-DICOM content as well using the Cross-Enterprise Document Sharing (XDS) standard; the XDS standard also provides greater flexibility for storing and managing clinical content.

Passage of the Affordable Care Act and the creation of accountable care organisations (ACOs) are changing incentives in the United States.   As more ACOs emerge in the US, a greater need will exist to exchange information between providers.  This will generate more demand for VNAs in the US.

With all of these changes occurring in different markets around the world, we’re seeing that the future of VNAs is taking shape in the following ways:

1)      Wider scope of content storage. VNAs will go beyond the traditional realms of storing radiology and cardiology DICOM images to become a hub for a wide range of content including non-DICOM images and scanned documents.  This content will be accessible even if stored in a remote location, thanks to the increasing use of the Cross-Enterprise Data Storage (XDS) standard.

2)      Changing roles and expectations for PACS.  The growth of the VNA and related technologies will challenge the traditional role of a PACS as a combined storage, viewing and workflow tool for medical images.  New tools will emerge to take on these functions.  Under this model, VNAs will play a major role in storing and managing access to content within and outside of hospital walls.  Universal viewers will provide a single solution for viewing and analysing medical images.  PACS will continue to play a strong role in workflow functionality, such as pre-fetching of radiology and cardiology images, and in image management, such as through a radiology information system (RIS).

3)      Greater linkage between VNA and electronic medical records (EMRs).    As this develops, clinicians will have quicker access to medical images and other clinical content within their EMR.  EMR vendors have taken note of the wider scope of content stored and managed by VNAs, and have begun to work with VNA vendors to achieve this goal.

Tony Perry The Advisory Board CompanyTony Perry is a Senior Research Analyst, Research and Insights, for The Advisory Board Company.