Enterprise Imaging (Proof of Concept)
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Enterprise Imaging

Enterprise imaging is the usual umbrella term for all clinical imaging across a healthcare organisation - radiology and the other imaging specialties, often called "the -ologies". The HIMSS-SIIM Enterprise Imaging Workgroup defines it as a set of strategies, initiatives and workflows for capturing and managing all clinical imaging and multimedia content to enhance the patient record.

References

Terms

Term Scope
Enterprise imaging All clinical imaging: radiology plus the other imaging specialties. Used in this guide.
Medical / clinical imaging General plain-English term
Diagnostic imaging Often used to mean radiology only - for example the NHS England Diagnostic Imaging Dataset covers radiology
Diagnostics Wider: imaging plus pathology, physiological measurement and endoscopy - for example NHS England diagnostic waiting times and community diagnostic centres

Imaging Specialties

Specialty Typical images Typical reporting / workflow system See
Radiology X-ray, CT, MRI, ultrasound, mammography, nuclear medicine, PET-CT, interventional radiology Radiology Information System (RIS) Radiology Scheduled Workflow (SWF.b)
Endoscopy Still images and video from the endoscope Endoscopy Reporting System (ERS) Endoscopy
Cardiology Echocardiography, cardiac catheterisation, ECG Cardiology information system / cardiovascular PACS Other Imaging Specialties
Ophthalmology Retinal photography, OCT Ophthalmology EPR or image management system Other Imaging Specialties
Medical photography Clinical photographs (for example dermatology, wounds) Medical illustration system, or capture app linked to the EPR Other Imaging Specialties
Obstetric and point-of-care ultrasound Ultrasound outside radiology Maternity system, or departmental system Other Imaging Specialties
Digital pathology Whole slide images, gross specimen photographs Pathology LIMS and digital pathology image management system Other Imaging Specialties

System Landscape

Each specialty usually keeps its own reporting or workflow system, because it holds specialty-specific workflow, structured reporting and national data returns. Images are stored in a shared archive and viewed through one viewer launched from the EPR.

flowchart LR
    EPR["EPR / Order Comms<br/>(Order Placer)"]
    TIE["Integration Engine"]
    subgraph Specialty["Specialty reporting / workflow systems"]
        RIS["RIS<br/>(radiology)"]
        ERS["ERS<br/>(endoscopy)"]
        CIS["Cardiology system"]
        OTH["Other -ologies"]
        LIMS["Pathology LIMS"]
    end
    subgraph Devices["Acquisition devices"]
        MOD["Radiology modalities"]
        SCOPE["Endoscope video processor"]
        ECHO["Echo / cath lab"]
        CAM["Cameras, retinal, WSI scanners"]
    end
    subgraph Platform["Enterprise imaging platform"]
        PACS["PACS / Image Manager"]
        VNA["VNA<br/>(Vendor Neutral Archive)"]
        VIEW["Enterprise viewer"]
    end
    REG["Regional / national sharing<br/>(for example National Imaging Registry)"]

    EPR <-->|orders, results<br/>HL7 v2 / FHIR| TIE
    TIE <--> RIS
    TIE <--> ERS
    TIE <--> CIS
    TIE <--> OTH
    TIE <--> LIMS
    RIS -->|worklist| MOD
    ERS --> SCOPE
    MOD -->|DICOM| PACS
    SCOPE -->|images, video| VNA
    ECHO -->|DICOM| VNA
    CAM -->|DICOM / non-DICOM| VNA
    PACS --> VNA
    VNA --> VIEW
    EPR -.->|launch in context| VIEW
    VNA <--> REG
Component Role
EPR / order communications Places requests (Order Placer) and receives reports. Usually does not capture images or write imaging reports.
Integration engine Routes HL7 v2 (and increasingly FHIR) orders, results and patient administration (ADT) messages between the EPR and the specialty systems
Specialty reporting system (RIS, ERS, …) Scheduling, worklists, structured reporting, national data returns (DID, NED). Sends the report back to the EPR.
PACS / Image Manager Stores and serves DICOM studies, mainly radiology; provides the diagnostic viewer for reporting
VNA (Vendor Neutral Archive) Long-term archive across specialties, DICOM and non-DICOM, independent of any one PACS vendor
Enterprise viewer Single viewer for clinicians, launched from the EPR in the patient's context
Regional / national sharing Image and report exchange between organisations - see Image Sharing

Large EPRs sometimes include modules for some specialties (for example radiology or endoscopy workflow). In most NHS trusts the specialty system stays separate; this is a local decision - To confirm for each trust.

Relation to Pathology

Pathology is part of diagnostics but is not usually counted as imaging, apart from digital pathology. The pathology report is covered by the Cancer Pathology Report IG. Imaging and pathology meet in the cancer pathway - see Imaging in the Cancer Pathway.