Technical Challenges of Enterprise Imaging: HIMSS-SIIM Collaborative White Paper

Journal of Digital Imaging, Aug 2016

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 order- and 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.

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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)


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David A. Clunie, Don K. Dennison, Dawn Cram, Kenneth R. Persons, Mark D. Bronkalla, Henri “Rik” Primo. Technical Challenges of Enterprise Imaging: HIMSS-SIIM Collaborative White Paper, Journal of Digital Imaging, 2016, pp. 583-614, Volume 29, Issue 5, DOI: 10.1007/s10278-016-9899-4