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July 28, 2016

Takeaways from the HIMSS-SIIM White Paper on Image Exchange

The Healthcare Information and Management Systems Society (HIMSS) and the Society for Imaging Informatics in Medicine (SIIM) Joint Workgroup recently published its first white paper, “Considerations for Exchanging and Sharing Medical Images for Improved Collaboration and Patient Care1.” The paper, released in conjunction with the SIIM 2016 meeting earlier this month, was produced by the workgroup’s Image Exchange sub-committee, which includes members from provider, consulting and healthcare IT organizations. It explores the use cases, challenges and standards for medical image exchange.  

As more healthcare organizations begin to look at medical image exchange as a key part of the broader enterprise imaging strategy, we at lifeIMAGE believe there are many sound recommendations in this paper that should be taken into consideration. Below we highlight five recommendations from the HIMSS-SIIM group, along with our observations as to how we have seen them contribute to effective, enterprise-wide image exchange utilization at large health systems.

[Note: lifeIMAGE did not contribute to the content of the HIMSS-SIIM whitepaper in any way, and what follows are our opinions relative to its independent recommendations.]

Recommendation: “Health systems should take the opportunity to view image exchange technology as more than a way to streamline dealing with CDs. Electronic exchange provides opportunities for improved operational workflows that can positively impact patient care, reduce cost, improve patient and clinician satisfaction, and can even increase revenue opportunities in key service lines.”

We agree with the suggestion that medical image exchange should be looked at as more than just CD management. Our SVP of Client Services recently wrote an article sharing a similar sentiment. As he explains through the example of a large academic health system, as organizations transition sources of image data from CD to electronic transfer, the operational and clinical value increase exponentially. It is ideal to follow a two-pronged implementation approach that addresses how to decentralize CD ingestion, while also receiving exams electronically through the lifeIMAGE network.


Recommendation: “An effective governance organization will clarify the enterprise’s strategic goals, deliver clear communication to stakeholders throughout the organization, provide a framework for decision-making about image exchange, and can help arbitrate conflicts that arise… Adding other leaders or clinicians from imaging-intensive areas to this governance structure can balance disparate objectives of clinicians, IT, and business leaders.”


The image exchange use cases in the HIMSS-SIIM white paper explore needs in a range of clinical disciplines: trauma, tele-burn evaluation, wound management, oncology second opinions, and outpatient encounters in neurosurgery and rheumatology. Within the lifeIMAGE customer base, we regularly work with areas such as these on their unique needs and requirements for incorporating image exchange into their patient care workflows. It is apt that the paper advises image exchange governance include involvement from multi-disciplinary leaders. Such representation is key to enterprise-wide rollout and utilization.

Recommendation: “Real value in image exchange comes from transforming this into a proactive service that makes the outside images available to the appropriate departments in their familiar local tools (EMR, PACS, VNA, Enterprise Clinical Image Viewer, etc.) with minimal manual effort.”


This is a particularly powerful observation. We believe the most desirable approach to image sharing is when the complete imaging history is available in the EHR for immediate use during the patient encounter. Clinicians can provide safer, higher quality care when they are proactively made aware of the imaging history, instead of having to navigate to a second-screen application to look for imaging. In addition, we have learned through our work with large health systems that there is tremendous efficiency to deploying image exchange technology via integration with the EHR becuase provider training and adoption stems from care delivery workflows that are already in place.

Recommendation: “You will need a granular breakdown on what roles are allowed to request that exams be sent to other facilities, and which roles actually send the exams. Will received images be triaged or evaluated for appropriateness before they are made available to the reviewing physician? If yes, who will be responsible for the triage function? How will physicians be notified that images are available for review? Thoughtfully considering questions such as these will contribute to project success.”


Transferring imaging data is part of the equation; the key to a truly effective enterprise exchange strategy lies in how data is made available in applications and to physicians in accordance with a healthcare organization’s data management policies and preferences. The administrators of the image exchange platform should be able to leverage highly configurable tools to enforce policy. In the lifeIMAGE customer base, we’ve seen this become particularly essential when an enterprise begins to exchange thousands of exams a month, at which point it is critical for multiple policies to be automatically supported through the platform.

Recommendation: “During a vendor selection process, we strongly advise scrutinizing the vendors’ commitment to standards-based exchange, and require that they commit to a delivery roadmap and timeline for providing these tools.”



This is a recommendation we suggest all healthcare organizations act on during the image exchange evaluation process. It is simply too risky to partner with a technology provider that may not be able to support future initiatives or collaborations that may be on the horizon for a health system. Ask vendors about the architecture of their networks and the industry interoperability groups they participate in (HIMSS Interoperability Showcase, Sequoia Project/Carequality, Commonwell, etc.).

The full text of “Considerations for Exchanging and Sharing Medical Images for Improved Collaboration and Patient Care” is available here. The authors of this HIMSS-SIIM whitepaper are Amy Vreeland (Imaging Strategies), Kenneth R. Persons (Mayo Clinic), Henri (Rik) Primo (Siemens Medical Solutions), Matthew Bishop (Unity Point Health), Kimberley M. Garriott (Logicalis), Matthew K. Doyle (Epic), Elliott Silver (McKesson), Danielle M. Brown (Aspirus) and Chris Bashall (Sir Charles Gairdner Hospital).



1Vreeland, A., Persons, K.R., Primo, H.(. et al. J Digit Imaging (2016). doi:10.1007/s10278-016-9885-x

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Jackie Leckas

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