Monique Rasband

Enterprise Imaging Trends 2018, a recent KLAS Research report, addresses the following questions:

• How wide and deep is the adoption of enterprise imaging (EI) tools and strategies?
• What imaging-related outcomes are providers achieving today?
• What are the strengths and weakness of the respective imaging vendors?
• What best practices are leading provider organizations to success in EI?

We asked these questions of representatives from 137 organizations that were live with vendor-neutral archives (VNAs), universal viewers, and/or image exchange solutions in 2017. The content of these interviews describes the general state of EI today and can give us an idea of how to improve that state in the future.





Predictably, the number of organizations using EI tools has increased in recent years. Of the aforementioned organizations interviewed, 55 percent use both a VNA and a universal viewer. Thirty percent use a VNA alone, and 15 percent use a universal viewer alone. In addition, certain service lines have become entrenched in the market. For example, the interviews showed that in the market overall, the radiology service line is connected over 75 percent of the time for both VNAs and universal viewers. Cardiology is next on the list and connected at most provider organizations in the US using EI tools.

Despite this promising data on the adoption of tools and service lines, other adoption trends cause concern. For example, the rate of expansion into new service lines remains inconsistent. About half of provider organizations are adding one or two service lines per year, but over a third of the market isn’t seeing any year-over-year expansion. The reasons for this stalled progress vary; some organizations cite internal problems such as a lack of buy-in or poor governance, while others blame vendors for not stepping in.

Most worrisome, perhaps, is the fact that only 19 of the interviewed organizations reported having highly mature EI strategies. Such strategies include the following: (1) organizational IT support and funding; (2) the ability to electronically ingest images; (3) a fully deployed encounter-based imaging strategy; and (4) strong governance. Over a third of organizations using EI tools have strategies with only one or two of the necessary elements. Gaps in an organization’s strategy often lead to slower growth, lower satisfaction, and difficulties in vendor relationships.






While disparities between vendors’ tools may impact providers, vendors’ levels of experience and abilities to partner with provider organizations are proving more important. Two of the strongest EI vendors are proof of this. IBM Watson Imaging (Merge) consistently offers reliable technology, but customers speak even more about the vendor’s collaboration leading to more positive outcomes. Likewise, Agfa HealthCare earns providers’ gratitude by providing excellent integration with EMRs, but the real news centers on Agfa’s increased involvement in developing provider organizations’ EI strategies.

Fujifilm (TeraMedica), Carestream, and NTT DATA are delivering solid tools and sometimes partner well with providers, but their inconsistency leads to fewer positive outcomes for their customer bases overall. Providers praise the functionality offered by Hyland Healthcare but wish the vendor was more persistently engaged. GE Healthcare and Mach7 Technologies struggle with technology issues but lag the most in terms of delivering guidance.

At this point, Cerner is the only EMR vendor that also offers a VNA and universal viewer. Reported satisfaction with these tools reaches surprising heights. Unfortunately, it appears that relatively few customers are aware of Cerner’s EI offering; a broader customer base may be needed in order to verify that Cerner’s tools help provider organizations improve as well as tools offered by vendors working more exclusively in EI.






One piece of good news centers on the improvements in the outcomes of EI tools. Most organizations reported that their satisfaction had increased in the key areas of accessibility of relevant images, physician productivity, patient-care collaboration, and data management. This was true for both VNAs and universal viewers. In particular, almost 75 percent of providers noted their enhanced satisfaction with the data-management capabilities in their VNAs.

However, about 25 percent of provider organizations stated that their EI tools haven’t led to any positive outcomes. The two most frequently mentioned barriers to these positive outcomes are a lack of integration with the EMR and limited adoption of the EI tools in the first place. These problems often come as a set, with a lack of EMR integration leading to providers’ reluctance and inability to use the tools optimally.

It should come as no surprise that the provider organizations who report achieving the most outcomes through their EI tools are generally the same organizations that have highly mature EI strategies. Organizations with highly mature strategies report achieving 80 percent of their expected outcomes, while those with immature or nonexistent strategies only achieve 30 percent. In order to see more and better outcomes, provider organizations must build their strategies through applying best practices.






As previously implied, partnering with a vendor ready to help deploy a solid EI strategy gives a provider organization a huge leg up in the market. Vendors may shoulder the most responsibility in this area. However, provider leaders are responsible for choosing vendors with laudable track records and calling for partnership behaviors. These behaviors include putting in the time to get to know customers, proactively sharing expertise, pushing back when providers begin moving in bad directions, and aiding in the creation and carrying out of solid EI strategies.

Providers and vendors must both work to set clear expectations. Unspoken assumptions about roles, timing, and outcomes often lead to frustration for both parties. One common misunderstanding occurs when provider organizations believe that they will be able to quickly add service lines to their VNAs and universal viewers but become disappointed when vendors cannot move at the expected speed. Customers and vendors who set clear timelines early on can build trust and prevent disappointment.

Other than choosing a strong partner, the most important thing a provider organization can do may be to use an effective governance structure. Too many organizations have no governance in place, and others find limited success in departmentally focused models. Positive outcomes correlate best with IT/PMO steering committees, which help involve all key stakeholders and facilitate collaboration between the clinical and IT teams.






The most influential improvements happen when providers and vendors collaborate in their shared mission to help patients lead healthy lives. I look forward to watching this mission be fulfilled by devoted imaging advocates everywhere.



Monique Rasband is a research director at KLAS Research. Providers may access a free copy of the report (registration required) 

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In order to see more and better outcomes, provider organizations must build their strategies through applying best practices.

Enterprise Imaging Trends

Last year I had the opportunity of going to Tanzania with a small group from Radiology without Borders. Our goal was to help Muhimbili University get their breast imaging program ramped up so that they could hopefully provide earlier detection. Also accompanying our energetic group were Brian Wetzel and Laurie Ziegler, both very experienced healthcare providers from Our Lady of Lourdes Memorial Hospital in New York. Before our journey, we had shipped an older analog unit to Tanzania that had been generously donated. Coming from an oncology background, I had not had the experience of seeing mammography equipment being transitioned. I was a bit taken aback as I watched Dr. Tariq Gill teach the radiology residents how to read an analog mammogram. I learned quickly what one does with a processor and how to clean it. Connectivity? . . . PACS? There was no PACS. It was a true moment of appreciation, and I realized just how far breast imaging has come.

“Breast Imaging 2014: Finding a Partner for the Future,”

 discusses the evolution of breast imaging as detection technology has gone from analog to CR to DR and now to the addition of tomosynthesis. In the report, KLAS talked to 183 providers to find out which mammography vendor providers would choose if they were making a decision today, to understand how breast imaging vendors are performing according to providers and to gauge future plans for purchasing automated whole breast ultrasound. So what did we learn?


When providers were asked which digital mammography vendor was their top choice, GE customers were not always loyal to GE, with 63 percent citing Hologic as their top choice. While many chose Hologic because of tomosynthesis, many also said Hologic was the best breast imaging partner.
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Tomosynthesis is approved in the U.S. only for Hologic, but Siemens customers are optimistic that their vendor will eventually provide this technology, and the majority reported they are willing to wait for it because of their relationship with Siemens and because of the performance of Siemens’ current equipment.

Energy around Partnerships, Tomosynthesis and Ultrasound


Healthcare providers report that they are looking for a partner to help them navigate the chaos and confusion in the world of breast imaging caused by social and political issues, dense-breast laws, and increasing consumer involvement. Providers who have adopted tomosynthesis reported overwhelmingly positive feedback, and those who have not are looking forward to FDA approval for other vendors in the future. Additionally, more providers are looking at automated whole breast ultrasound, and breast applications for general ultrasound are getting stronger.

We have clearly come a long way in the technology for breast cancer detection, and while we still have a long way to go, providers seem optimistic for the future.

The report also looks at providers’ plans for tomosynthesis and mammography information systems. The vendors discussed in this study are FUJIFILM, GE Healthcare, Hologic, MagView, MRS, PenRad and Siemens. For more information, check out the report, 

Breast Imaging 2014: Finding a Partner for the Future

If you don’t have access the report, please e-mail 

As breast imaging technology advances, providers are looking to vendors to help meet their needs. Find out here which vendors are favored.

Author | Monique Rasband

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Enterprise Imaging Trends

Breast Imaging Technology Evolves, Providers Search for Partner