Why Providers Need to Incorporate Diagnostic Images Into EMRs

Monique Rasband of KLAS explains that EMRs without images don’t tell a complete story.

By Monique Rasband, senior director of research, KLAS.

After decades of struggle, electronic medical records (EMRs) are now widely implemented in hospitals and medical practices across the country. For the most part, however, these records contain plenty of text but do not include all-important, worth-a-thousand-words diagnostic images.

As such, EMRs are not telling the whole story. Indeed, about 70 million computed tomography and 30 million magnetic resonance imaging procedures are performed annually, each generating hundreds or even thousands of images – all of which are likely to be missing from EMRs, according to IMV Medical Information Division, a research company based in Des Plaines, IL.

Often times EMRs have an abundant amount of text, but are missing complementary images.

The good news: Healthcare organizations are finally ready to turn their attention to incorporating these images into their EMRs. “Some of the dust has settled and providers are ready to get started,” said Monique Rasband, senior director of research at KLAS, a Salt Lake City-based research firm. “Before, when providers were using many disparate systems where the data was scattered all over the place, it was not practical to concentrate on imaging. But now it makes sense to add imaging as a diagnostic piece that can greatly supplement the information that is currently in EMRs.”

“Now it makes sense to add imaging as a diagnostic piece that can greatly supplement the information that is currently in EMRs.”

Monique Rasband, Senior Director of Research, KLAS

As a result, providers are moving toward enterprise imaging – which is defined by the HIMSS-SIIM Enterprise Imaging Workgroup as a “set of strategies, initiatives and workflows implemented across a healthcare enterprise to consistently and optimally capture, index, manage, store, distribute, view, exchange and analyze all clinical imaging and multimedia content to enhance the electronic health record.” (1)

Confusion muddies the path to incorporating diagnostic images into EMR

The problem, however, is that while this definition provides a basic understanding of enterprise imaging, confusion ensues when trying to actually execute the game plan. “On the surface, it seems straightforward. But the definition still seems to be fuzzy when I talk to providers and they talk about enterprise imaging,” Rasband said. Indeed, some leaders consider just storing radiological images in a vendor neutral archiving (VNA) system as enterprise imaging. Others contend that other types of images such as cardiology, dermatology, ophthalmology, pathology and wound care need to be included as well. Still others might contend that enterprise-imaging initiatives should also incorporate workflow, image exchange and universal viewer technologies.

The confusion stems from a few factors. First, a variety of medical-imaging vendors offer definitions that closely align with their product offerings. “Different vendors may have pieces of the solution. These vendors then tend to center the definition around their offering. That causes confusion because providers look to these vendors for guidance,” Rasband explained.

No “one size fits all” option

The fact that enterprise imaging does not come in a one-size-fits-all option adds to the confusion. Healthcare organizations need to define enterprise imaging based on their unique situations and goals. More specifically, organizations need to define the functional requirements of users across the enterprise.

“The definition should depend on the goals of the organization. Are you operating a cardiac facility? A cancer center? A children’s hospital? There is not one single way to do enterprise imaging,” Rasband said. “Quite frankly, I wouldn’t want providers to have one strategy. Leaders need to look at their patient population, their goals and their specialties, and then figure out their roadmap based on their goals and their patients.”

“Leaders need to look at their patient population, goals and specialties, and figure out their roadmap based on their goals and patients.”

M. Rasband

Finally, leaders need to acknowledge that enterprise imaging is not a once-and-done proposition but instead is a journey. “Organizations can’t just implement a VNA and the next week say they are doing enterprise imaging,” she pointed out.

As such, organizations must continually strive to establish enterprise initiatives that go beyond simply storing images. An enterprise-imaging initiative should also provide context, accessibility, and relevance.“Imagine you move into a house with a big basement that has built-in shelves and you start randomly storing a variety of things down there. It’s not organized and now a year later you go down to find the Christmas lights. But you have no idea where those Christmas lights are because there’s so many things in there,” Rasband said.

Indeed, to truly support an enterprise-imaging initiative, healthcare organizations need to have “a really good plan in place so all of those images are stored correctly and can be matched to the patient,” according to Rasband. “If images are going in and don’t match up to the patient, then they are not as valuable,” she added. “In the United States, this is especially challenging because of the lack of the patient identification number.”

To move toward this more robust enterprise imaging, organizations should work with vendors that bring context, accessibility, and relevance to clinical data by offering:

• VNAs capable of storing a variety of images including radiological, cardiological, lab reports, and others
• Common workflow across multiple locations
• A single point of access to patient information, allowing information to be shared easily
• An image viewer that does not require software download, providing broad access to patient images

Overall, by taking a more strategic approach to enterprise imaging, healthcare organizations can move beyond simply storing images. Instead, they can integrate images into EMRs in a way that makes it possible to enable providers to make more informed decisions and move clinical care forward. #EMR #enterpriseimaging

Monique Rasband is a senior director of research at KLAS, a Salt Lake City-based research firm.

Learn more:

Read University of Iowa Healthcare’s roadmap for imaging enabling the EHR.

Learn about Carestream’s approach to enterprise imaging.



  1. Society for Imaging Informatics in Medicine. SIIM’s Strategic Perspective on Enterprise Imaging. https://siim.org/page/enterprise_imaging

Learn successful strategies from a leading healthcare provider on how to bring all “ologies” into your enterprise imaging platform.


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