Technical Challenges of Enterprise Imaging: HIMSS-SIIM Collaborative White Paper
Technical Challenges of Enterprise Imaging: HIMSS-SIIM Collaborative White Paper
David A. Clunie 0 1 2 4 5
Don K. Dennison 0 1 2 4 5
Dawn Cram 0 1 2 4 5
Kenneth R. Persons 0 1 2 4 5
Mark D. Bronkalla 0 1 2 4 5
Henri “Rik” Primo 0 1 2 4 5
0 Mayo Clinic and Foundation , 200 First St. SW, Pb 2-58, Rochester, MN 55905 , USA
1 Department of Information Technology, University of Miami Health System , Miami, FL 33136 , USA
2 Don K Dennison Solutions Inc. , 205 Fern Cres, Waterloo, ON N2V 2P9 , Canada
3 David A. Clunie
4 Digital Health Services , Siemens Healthineers, 65 Valley Stream Parkway, Malvern, PA 19355 , USA
5 Merge Healthcare , 900 Walnut Ridge Drive, Hartland, WI 53029 , USA
This white paper explores the technical challenges and solutions for acquiring (capturing) and managing enterprise images, particularly those involving visible light applications. The types of acquisition devices used for various general-purpose photography and specialized applications including dermatology, endoscopy, and anatomic pathology are reviewed. The formats and standards used, and the associated metadata requirements and communication protocols for transfer and workflow are considered. Particular emphasis is placed on the importance of metadata capture in both orderand encounter-based workflow. The benefits of using DICOM to provide a standard means of recording and accessing both metadata and image and video data are considered, as is the role of IHE and FHIR.
Anatomic pathology; Archive; Dermatology; Digital image management; Digital Imaging and Communications in Medicine (DICOM); Endoscopy
Scope
This paper is one of a series of white papers on Enterprise
Imaging developed by HIMSS-SIIM workgroups [
1–6
]. It
focuses on describing and solving the technical challenges
of enterprise imaging, and does not dwell on the rationale
for enterprise imaging except to the extent that the use cases
illustrate the technology.
The primary area of focus is the inclusion of visible light
imaging into an enterprise imaging strategy together with
radiology and cardiology, such as might be found in clinical (as
opposed to research) use in a typical large adult or pediatric
patient care facility, or an integrated group of ambulatory
facilities that share a common infrastructure. It does not address
several other areas that might well be considered appropriate
candidates for inclusion, but which have highly specific
workflow requirements and are reviewed elsewhere,
specifically radiotherapy [
7
] and dentistry [8].
This paper provides insight into the type of devices,
formats, and standards involved, along with the associated
metadata needs and communication protocols for transfer. It also
reviews alternative methods of managing these images and
their associated information (metadata), and the common
types of systems used.
The companion white paper on enterprise viewing [
2
]
provides a high level overview of the requirements, technical
challenges, and solutions for query and retrieval of images
for display. This paper elaborates on the available standard
protocols and formats that support viewing use cases, but does
not address the tools necessary for user interaction or specific
to a particular clinical use, nor such issues as color
consistency, speed and responsiveness, appropriate choice of display
hardware, or the importance of the viewing environment,
whether for desktop or mobile devices.
In the interest of interoperability, throughout this paper a
strong emphasis is placed on the use of standards, both formal
and de facto. Interoperability between systems from different
vendors is a prerequisite for successful Enterprise Imaging.
The use of closed, proprietary systems that lack standard open
interfaces, formats, and protocols is eschewed.
There are different approaches, patterns, and practices for
acquiring, storing, and displaying enterprise imaging data.
These need to be reviewed and understood before making a
choice for a particular deployment. Considerations include the
installed base of equipment, software, formats and standards,
the relative priority of different use cases and the mixture of
medical specialties, existing workflow practices, the size of
the enterprise, and extramural integration partners. Given the
diversity of users, a mixture of different approaches is often
needed and centralized components may have to support
several alternative standards in order to be successful.
Accordingly, this white paper attempts to be descriptive rather
than prescriptive in its exploration of the possibilities.
The use of APIs to access image data and metadata will
also be considered, as an alternative to handling images (or
sets of related images) using a document-oriented paradigm.
A comprehensive set of references is provided, since one
white paper cannot do justice to the entire field; the lessons
learned by both early adopters and mature practitioners are
expected to be useful to readers.
Architectural Conside (...truncated)