COVID-19 is now everywhere, and these are the longest months in my career when I have not traveled or met in person with our customers and thought leaders. My recent virtual meetings and conversations with industry partners, analysts and thought leaders at academic institutes and health authorities across the globe have signified the need to reimagine delivery of care, by focusing on “predicting” and “preventing,” with an emphasis on catching the disease before it strikes. There is growing need to aggregate clinical informatics, population profile, family and social history, wearable device informatics and pixel intelligence residing in diagnostic imaging. This makes clinical and social sense and emphasizes the need to intelligently consume predictive analytics, artificial intelligence (AI) and machine learning (ML) on a secure and modular platform ecosystem.
However, before we begin discussing the outcomes-based application of innovative technologies in healthcare, let’s understand what COVID-19 has taught us so far, and how we could better prepare ourselves as we transition out to the “new normal.”
COVID-19 and Diagnostic Imaging
Pre-pandemic. While healthcare organizations across the globe have remained under pressure to deliver cost-effective and high-quality care, the advent of COVID-19 exposed vulnerabilities in terms of how technology has created access and information silos. The pandemic has also exposed the basic premise on which our health systems have been designed. This initial phase of lack of multispecialty data and systems interoperability posed significant diagnostic challenges. While coronavirus disease was eventually declared a pandemic on March 11, the importance of diagnostic radiology was already being reimagined.
The pandemic. As COVID-19 spread globally, there was growing interest relating to the role of diagnostic imaging, appropriateness of chest X-rays and computed tomography (CT) scans when it comes to screening, detection and follow up management. While the appropriateness of chest X-rays or CT scans to pinpoint COVID-19 pneumonia was being evaluated, a group of experts in Italy had been busy exploring the benefits of bedside ultrasound as one possible alternative for detection of COVID-19 pneumonia. There were also initial reports that some technology startups were evaluating their machine learning algorithms, and developing new models, to detect COVID-19 specific findings leveraging chest X-rays and CT scans. The bottom line, radiologists within the healthcare system and outside their enterprise were struggling to exchange useful imaging data with their international colleagues in their quest for collaborative learning and understanding this new disease.
The transition. I strongly believe that this phase of transitioning out to the “new normal” will provide critical lessons learned in relation to how health systems prepare themselves before returning to business as usual. Radiology departments, while they have seen significant decline in certain diagnostic procedures due to the focus on COVID-19 related hospital visits, with the need to work remotely and in self isolation, have also mandated the need for secure and modular industrial scale enterprise imaging platforms. It was obvious that while COVID-19 was being evaluated from a diagnostic radiology perspective, and capabilities of PACS, COVID-19 related AI initiatives would pop up as well. While there have been few initiatives that are still works in progress, one thing is for sure, the utility of AI within existing PACS will require workflow integration, and that’s where I see the enterprise imaging platform standing out with its secure and modular ecosystem. Technology providers who have built an enterprise imaging platform for modularity have already demonstrated several successes during this pandemic. At short notice, these providers are fulfilling requests of customers ranging from at home workstation setups, image exchange and real-time collaboration to 100 percent remote supported go-lives.
The new normal. We do not know yet what the new normal would look like, however I think we do agree on the fact that COVID-19 has not only exposed the vulnerabilities in our healthcare system, its operations and infrastructure set up, but also the need for radical change how we deploy secure and modern platform ecosystems. Clinicians were already overwhelmed with data, so it is now time to implement solutions that automate their workflows, improve productivity, provide analytical intelligence into outcomes, and help offer optimized tasks that machines and software are better programmed to do.
Why Enterprise Imaging?
An enterprise imaging platform simplifies the access of a single comprehensive patient imaging record, and empowers physicians and hospital management to make informed decisions through consolidation of multiple service lines within and outside the enterprise.
It should enable a comprehensive strategy that builds upon standards-based platform and:
• Enhances care collaboration
• Optimizes resources
• Streamlines costs
When it comes to diagnostic radiology or other specialty imaging, the path toward enterprise imaging has never been more meaningful than it is now, for the following four main reasons.
1. Patient-centered view cross enterprise
An enterprise imaging solution should provide a universal view of patients’ multispecialty imaging timeline and journey. With COVID-19, patients may have been followed up over the duration of their care pathway with X-rays or CT scans, and in some cases with portable devices like point-of-care ultrasounds. During this pandemic, in the U.K. for example, the National Health Systems (NHS) was able to deploy enterprise imaging Xero Exchange technology to establish connected radiology services across Yorkshire and the Humber. This modular technology will allow these organizations to view patient images and reports across seven NHS hospital trusts, as well as the newly established NHS Nightingale Hospital Yorkshire and the Humber.
With demand on departments only increasing in response to the COVID-19 pandemic, this new technology enables the connected hospitals, which collectively cover a patient population of over 3 million, to diagnose patients who are transferred between sites at a much quicker rate than was previously possible. Patients will also benefit from this new technology as, in some cases, it will reduce the number of scans a patient needs, lowering the amount of radiation they receive, as well as the number of visits the patient needs to make to hospital.
In the Netherlands, a nationally deployed COVID-19 portal solution has been introduced where technology solution providers are supporting customers in making DICOM images easily and efficiently available for other hospitals. This way, after triage, all the patient’s imaging information is shared securely with the receiving care team, so they can prepare to treat the patient quickly upon arrival.
2. Secure, multispecialty real-time communication and collaboration
Whether sharing imaging data within the enterprise or the need for collaboration with external expertise, the silos of imaging solutions have posed security, integration and interoperability challenges when it comes to multi-disciplinary team meetings. Agfa HealthCare for example, has built its tools and applications on a modular platform ecosystem, enabling on-demand onsite and offsite image exchange, and real-time chat and collaboration capabilities when needed, including integration with Microsoft Teams. This allows customers not only the privilege to share patients’ diagnostic imaging data in a secure environment between colleagues working in the hospital or at home, but also external expertise could be engaged when needed, in a secure environment.
3. Faster reporting: Remote, at home or on-premise
To deal with the COVID-19 outbreak, the continuity of the radiology reporting activities is crucial. To guarantee this, care providers are expanding the remote reporting capabilities for their radiology teams. In Ireland, a radiologist who was concerned about being able to work should the need to self-isolate arise approached one of our colleagues to set up a home desktop The hospital already had a VPN connection available as well as spare hardware, and within 20 minutes of assembling the spare clinical review workstation and a clinical monitor, the radiologist was able to log in, use his own profile from the hospital and report in his own home, including full speech recognition, with images instantly available over a normal broadband connection.
With new diseases come new terminology. Since they are not standard in the radiology lexicon, radiologists are providing feedback that their speech recognition software was struggling with the recognition of new terms like Coronavirus or COVID-19. This was slowing down the reporting turnaround, since repeated manual correction of the non-recognized terms was needed. A seamlessly integrated reporting solution improves the efficiency of reporting workflows with a rules-based reporting engine.
4. Augmented intelligence: Using data to better measure, predict and take action
Optimizing radiology capacity in times of pandemic is key. With natively embedded analytical intelligence, there is more than ever a need to move toward “predictive intelligence.” Catching first signs early can help stop the spread, and this is what our customers in Italy have done. With text search on radiology reports for terms like pneumonia, pneumonitis, or any other relevant terms, they were able to retrospectively track the start of the outbreak. Enterprise imaging’s data analytics module can help with daily real-time monitoring of the number of radiology exams allowing departments to better understand, plan or reorganize radiology services capacity for adequate workflow and response time in time of crisis. The data analytics module could be integrated with Google Maps to help visualize geographical information that can help local decision making in the fight against the virus spreading, such as by visualizing infection clusters.
Customers are already thinking ahead and exploring use cases to leverage our rules-based workflow engine, to practically implement image-based AI/ML algorithms not only for clinical use, but also to enable framework of collaboration leveraging our academic and teaching workflows based on COVID-19 data lakes.
The Road Ahead
Across the globe, we are not only responding to the unique requests of our customers and enabling COVID-19 specific configurations and workflows, but more recently, we have even helped one of the largest pediatrics health systems in the United States, G-Live, 100 percent remotely supported. Among the unique challenges of the project were the escalating concerns regarding coronavirus, which forced a change in approach as the hospital implemented a policy restricting on-site vendor engagement. As a testimony to their sense of ownership, confidence with the enterprise imaging platform and the trust the project team cultivated through the customer-enablement implementation methodology, the hospital was adamant that the Go-Live proceed as a planned. And so, it did.
In conclusion, as the silos of data and diagnostic imaging PACS systems are being collapsed and secured, the modular enterprise imaging platform approach is gaining significance, as it offers systemness and security. Solution providers who have continued listening to their customers and thought leaders, respective governments, business partners and pool of talented resources have ended up offering the best of innovation during these challenging times as a mark of respect to all those working on the frontlines helping deliver care where it was needed most.
Anjum M. Ahmed, M.D., MBBS, MBA, MIS, is global chief medical officer for Agfa HealthCare. He is a high-impact President’s Club award winning healthcare IT solutions and innovation leader, with over 21 years of progressive experience: a track record of building innovative strategies and solutions by leveraging advanced medical technology and healthcare information systems, to introduce and deliver care-centered solutions in the healthcare industry.
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