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Cornerstone Summit 2018—Enterprise Imaging

Cornerstone Summit 2018—Enterprise Imaging
An Operational Approach to Driving Enterprise Imaging Outcomes

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An Operational Approach to Driving Enterprise Imaging Outcomes

In 2017 KLAS convened nearly 60 healthcare executive thought leaders in enterprise imaging from both provider and vendor organizations to identify key functionalities and best practices to help push the industry forward. A survey was created for KLAS to go out and measure the most advanced enterprise imaging organizations. Following the 2017 Enterprise Imaging Summit, KLAS interviewed 137 of the most advanced healthcare organizations executing their enterprise imaging strategies about their experiences. Our goal was to understand what factors allow these organizations to achieve meaningful outcomes. As the data flowed in, several key operational areas emerged as essential for driving enterprise imaging outcomes; topics included governance, workflow, partnership, and delivery. Another trend that emerged is that those provider organizations who are not seeing outcomes are often taking shortcuts in these areas (e.g., do not have a governance structure, have not engaged deeply with their vendors, etc.). Dr. Chris Roth, Vice Chairman of Radiology at Duke, invited all participants to work collaboratively during the conference: "All of us will be an imaging patient one day and we all have the privilege of designing the system that will be taking care of us. We must expect faster, higher quality, and more reliable systems."

During the 2018 summit, participants discussed these findings and identified the most impactful best practices that will benefit the industry and help both providers and vendors drive successful outcomes. Both providers and vendors can use those guiding principles as they develop and expand their own enterprise imaging strategies.

The results of this summit are being publicly shared in an effort to improve the success with which enterprise imaging is being achieved.

Purpose of the Summit


Enterprise imaging has the potential to revolutionize patient care by increasing physician collaboration, improving access to critical patient images, making physicians more productive, and improving data management. Achieving these outcomes is no small feat, however. As they embark on their journey, providers must make decisions about the approach (whether it should be centralized, federated, deconstructed, etc.), rules and governance, whose technology they will leverage, and how they will roll out their strategy over time. Given the complexity of enterprise imaging, it is no surprise that some provider organizations see success and achieve outcomes while others face myriad obstacles that prevent them from recognizing the desired return on investment.

What Outcomes are Providers and Their Vendor Partners Achieving

As KLAS has watched this market evolve, two things have become increasingly clear. First, success in enterprise imaging does not happen by accident; success is deliberate, and taking shortcuts to reach the destination often causes problems down the road. Second, most providers would not label themselves as experts in enterprise imaging, and they are relying heavily on expertise and guidance from their imaging vendors to help make them successful. In fact, providers who have reached the highest levels of maturity in their enterprise imaging strategies in four key areas—strong governance, organizational funding and IT support, ability to ingest images electronically, and a fully deployed encounter-based imaging strategy—report that their vendors are strong partners who have helped them reach success. “[Our vendor] has been key in building our strategy,” said an IT director who reported success in enterprise imaging. “We haven’t been using our VNA for very long, but we can already see a positive impact. Governance is key. We started early due to the feedback from other providers and the advice of [our vendor]. I can already see the benefit of doing things correctly from the beginning.”

Vendor Partnership Rating—By Maturity of Provider Imaging Strategy

On the other end of the spectrum, when vendors are not providing the necessary level of guidance to their customers, providers report challenges around adoption, connecting additional services lines, and achieving outcomes. According to a VP of radiology, “Universal viewers require a lot of work from both providers and vendors. . . . While we have the responsibility to encourage adoption, we would love to receive help from [our vendor]. They should provide best practices and benchmarks so that we can hold our physicians accountable. . . . They should work more closely with us so that we can get better results, which would impact and help everyone.”

There are several key areas where vendor guidance coupled with provider work can make a notable impact on providers’ success in enterprise imaging: workflow, governance, delivery, and outcomes. In April 2018, key provider thought leaders, imaging vendors, and EMR vendors met to create a list of best practices and key topics for consideration that the industry can use to avoid taking potentially detrimental shortcuts and increase the odds of success in enterprise imaging.


Ensuring that clinicians have access to patient images in the EMR is essential to increasing physician collaboration around patient care. In fact, when asked about what outcomes they are achieving, providers who do have integration with the EMR are quick to note that it has been integral to their success: “[Our viewer] is fully integrated with our EMR, and that has improved outcomes in many ways. I even think that integration has increased system adoption by our referring physicians. [Our viewer] is easy to use, so most of the referring physicians are able to navigate the two systems with few problems if any” (PACS administrator).

Providers and vendors who attended the 2018 KLAS Enterprise Imaging Summit identified several areas where improvements could be made relating to workflow. Of those solutions, three stood out as the most impactful. First, the need for providers to standardize the capture, upload, and workflow for visible-light images was made clear. Second was the importance of standardizing for encounter-based imaging for all specialties. During KLAS’ enterprise imaging research, the need for encounter-based imaging was frequently mentioned in provider interviews, and almost half of those interviewed do not have a plan to deploy this today. Third, the need for image exchange and improved interoperability was underscored. These suggestions, as well as other key recommendations for avoiding shortcuts, can be seen in the chart below

Which Will Have the Greatest Impact on Workflow Success

What Are the Three Metadata Elements Needed for Visible-Light Images

Another key takeaway from the provider and vendor discussion on workflow was the need to move to standardize what metadata should be included with captured images. The summit groups were then asked to identify what three metadata elements are the most critical. There was a strong consensus around including the body part, with patient information (e.g., name and ID) and reason for the encounter (e.g., diagnosis, primary complaint) following as the next most important pieces of metadata.


While the importance of governance may seem intuitive to some, a surprisingly large number of providers doing enterprise imaging do not have clear governance in place. Even among those who do, governance may live at the department level and lack the participation and input of the greater organization. In these cases, the lack of governance has hampered success. A chief of cardiology noted, “We are the barrier to wider implementation of the VNA because we don’t have any governance or initiatives within our organization to implement it.”

Enterprise Imaging Governance Structure

As governance progresses from nonexistent to departmentally focused to organizationally focused, the number of outcomes providers report increases. Because each provider’s goals and structure are unique, the specifics of governance from organization to organization vary.

However, providers and vendors identified several guiding principles and questions that can help create successful governance in several contexts.

The first guiding principle identified was the need for close collaboration between clinicians and IT staff. Suggestions for improvement in this area included creating a common vision among stakeholders, IT rounding to better understand enterprise imaging, and participation of C-level individuals responsible for technology. The second important takeaway was the need to create greater alignment within provider organizations. Here, providers and vendors pointed to C-level, medical director, and specialty buy-in; aligned purchasing and funding strategies; and a strong steering committee as ways to help drive alignment. Thirdly, a clearly defined road map is key. This includes setting targets, goals, and finish lines to celebrate along the way. Several other recommendations were discussed and are shown below.

Which Will Have the Greatest Impact on Governance Success


Delivery is the operational practices of a vendor that ultimately are tied to their customers’ success. The principles that successful vendors abide by can be seen at work not only in imaging but across healthcare IT in general. Providers can help support their vendor(s) by communicating clearly and often and being open to difficult discussions that will benefit both parties in the long run.

During this discussion, the importance of having a strong partnership was stressed repeatedly as key to successful delivery. Several of the most impactful ways this can be achieved are as follows: The first suggestion for developing good partnerships was to have providers and vendors focus jointly on outcomes. This provides a common vision that helps facilitate additional conversations about governance, deployment plans, implementations, etc. A second important guideline was for providers and vendors to develop a clear understanding of the problem they are trying to solve. This also includes communicating the problem to all stakeholders within the provider organization itself (e.g., C-levels, IT, individual departments, etc.). Third was the need for vendors to provide strong executive sponsorship and regular touch points to drive collaboration and foster deeper partnerships.

Which Will Have the Greatest Impact on Delivery Success

In addition to the suggestions listed above, KLAS has identified several key elements to strong provider/vendor partnership and delivery. These elements were identified as part of confidential interviews with 50 vendors to understand how they approach sales, training, and support. When their answers were correlated with their customers’ satisfaction, several best practices or guiding success principles emerged:

Prescriptive Selling
The best predictor of customer satisfaction is how a vendor sells to their customers. There are three primary types of selling: à la carte, packaged, and prescriptive. In an à la carte model, customers can pick and choose what modules, level of support, training, and other aspects of the solution they wish to purchase, regardless of how their choices may limit their success. On the other end of the spectrum is prescriptive selling. Vendors who sell prescriptively have a deep understanding of each customer and a clear view of what success looks like. This allows them to prescribe the modules, interfaces, training, services, and other elements that they know will lead to a customer’s success. Beyond simply prescribing the recipe for success, prescriptive vendors are principle driven and are willing to walk away from a potential customer if they cannot foresee success. Vendors who sell this way tend to have customer satisfaction a full 12 points higher than those who sell à la carte.

Strong Implementation and Training
Another factor that affects customer success is training. Many vendors offer training as part of an initial install, but vendors who consistently drive high customer satisfaction prescribe rigorous ongoing training focused on driving usability and deep adoption. This ongoing training ensures that, as use of a product or product suite expands, all new users are making full use of the available functionality, they are using the tools in the optimal way in order to achieve outcomes, and the organization is receiving their money’s worth.

The importance of strong training is reinforced by the KLAS Arch Collaborative research that looks at clinician satisfaction with their EMR. The Arch Collaborative research shows that provider organizations can improve their experience by ensuring that end users are making training a priority by requiring users to complete a proficiency test, requiring that clinicians complete a certain number of hours of training, and incorporating training into departmental meetings.

Strong Relationship
Another key to success is a strong relationship. Serviceoriented vendors often leverage account management to drive customer success. Providers, particularly those working in complex spaces such as enterprise imaging, benefit tremendously from having contacts that understand their organization’s structure as well as their goals. It should be noted that not all account management is created equal. Account management that truly makes a difference requires that account managers and other supporting staff on the vendor side be truly empowered to break down barriers for their customers.


The goal of any enterprise imaging strategy is to achieve outcomes, whether they are around efficiency, cost, collaboration, security, or patient care. Vendors need to have a clear understanding of what customers hope to achieve (i.e., both implicit and explicit expectations) and clearly communicate which outcomes the vendor can deliver on and what the expected delivery timeline looks like. The desired outcomes outlined in the 2017 KLAS Enterprise Imaging Summit (held last year) included:

Cost Savings

  • Decreased duplicate studies
  • Decreased costs for duplicate archives
  • Improved ROI

Improved Care

  • Improved patient care
  • Improved patient engagement

Data Management and Security

  • Decreased duplicate studies
  • Decreased data loss
  • Improved data management
  • Improved data security

Physician Productivity

  • Improved efficiencies
  • Improved clinician collaboration
  • Improved physician satisfaction

Improved Analytics

Interoperability and Integration

  • Improved interoperability
  • Adherence to standards


KLAS will continue to measure the progress of providers and vendors in enterprise imaging in subsequent reports, but the hope is that we as an industry can progress faster and with less pain by avoiding shortcuts and ensuring that outcomes can be achieved consistently. At the end of the summit, Dr. Cheryl Petersilge (Medical Director, Integrated Content at Cleveland Clinic) extended the invitation to the industry (both providers and vendors) to use this white paper as a starting place to foster productive collaboration and build successful enterprise imaging road maps.

Summit Attendees

Erik Ables
Solution Leader, Clinical & Diagnostic Imaging, Cerner

Dr. Anjum Ahmed, MBBS, MBA, MIS, ITIL
Global Director, Imaging Information Systems, Agfa HealthCare

Tarik Alkasab, MD, PhD
Radiology Clinical Lead, Service Chief, Informatics/IT and Operations, Massachusetts General Hospital

Mikael Anden, CFCHE
President, North America, Sectra

Massimo Angileri
VP EMEA, Carestream

Raz Atanasiu, MBA
CTO of Enterprise Imaging, Hyland

Paul Barnes
Senior Manager, Client Successs, Merge, an IBM Company

John Basile
Director of Radiology, CareMount Medical

Christian Bazinet, MBA
Chief Operating Officer, Intelerad

Sean Bina
Vice President of Access and Patient Engagement, Epic

Tim Blakely
Director of Imaging, Renown Regional Medical Center

Roger Boodoo, MD
Radiologist, Clinical Informatics Fellow, University of Illinois Hospital

Steven H. Brick, MD
Physician Executive Director, MedStar Medical Group Radiology

Carol Corder
Vice President, Neurosciences, HCA—Regional Medical Center—Bayonet Point

Jacques Cornet, MBA
VP & Business Leader HCIS US and Canada, Carestream

Ron Cornett CT, MR, CIIP
Director of Information Technology, Radiology Ltd.

Dawn Cram
IS Director, Enterprise Imaging, Ochsner Health System

Matt Doyle
Software Developer, Epic

Glenn Galloway
CIO, Center for Diagnostic Imaging

Rick Gouse
Director of Product Management—Workflow, GE Healthcare

Nathan Gurgel
Director Product Marketing, HIT, Fujifilm

Fredrik Gustavsson, MSc, MBA
CTO for Sectra Imaging IT Solutions, Sectra

John Hansen
Offering Management Executive, Merge, an IBM Company

Howard L. Haronian, MD, FACC
Chief Medical Director, VP East Region for the Heart & Vascular Institute, Hartford HealthCare

Douglas J. Hartman, MD
Associate Professor, Department of Pathology, Associate Director, Division of Pathology Informatics, University of Pittsburgh Medical Center

Scott Henry
Manager Imaging Systems, Lancaster General Health/ Penn Medicine

Robert Herfkens, MD
Professor of Radiology, Standford Health Care, Associate Chair for Clinical Technology, Department of Radiology, Standford University

Karen Holzberger
VP & GM, Healthcare Diagnostic Solutions, Nuance

James Jay, MBA
President Imaging IT Solutions, Agfa HealthCare

Debbie Kelly-Scott
Assistant Vice President of Ambulatory/Ancillary Services, Catholic Health Services of Long Island

Marc Kohli, MD
Director of Clinical Informatics, Imaging, UCSF Medical Center

Sean Lambright
Head of Enterprise Imaging Strategy, Visage

Lou Lannum
Senior Strategy Imaging Consultant, Agfa HealthCare

Brad Levin
GM, Visage

Tomer Levy, MBA
VP, Strategic Portfolio, Imaging & Workflow, Change Healthcare

Brandon Long
Director & Solution Executive, Radiology & Enterprise Imaging, Cerner

Kara Marx, RN, MHS
Vice President of Applications, Sharp HealthCare

Jim Murry
CIO, Catholic Health Services of Long Island

Paul Nagy, PhD, FSIIM
Deputy Director, Johns Hopkins Medicine Technology Innovation Center, Johns Hopkins Medicine

Sara Osberger
FMSU Director, Enterprise Imaging, Fujifilm

Morris Panner
CEO, Ambra

Cheryl Petersilge, MD, MBA
Vice-Chair, Regional Radiology, Medical Director & Professor of Radiology, Cleveland Clinic Health System

Maria Piazza, BSEE, MBA
Senior Director, Product Management, Radiology Informatics, Philips

Jeffrey Prichard, DO
Director of Surgical Pathology and Anatomic Pathology Informatics, Geisinger Medical Center

Christopher Roth, MD, MMCI
Vice Chair of Radiology for IT & Informatics, Duke University Director of Imaging IT Strategy, Duke Health Associate Professor of Neuroradiology

Chris Sclafani, PE, MBA
COO, CareMount Medical

Richard T. Shirey
CIO, SVP, Hartford HealthCare

Rasu Shrestha, MD, MBA
Chief Innovation Officer, UPMC and Executive Vice President, UPMC Enterprises

Eliot Siegel, MD
Vice Chair, Research Information Systems, Imaging, University of Maryland Medical Center

Cynthia Smith, MBA
VP of Strategy for Imaging, Workflow & Care Solutions, Change Healthcare

Roy Smythe, MD
Chief Medical Officer Healthcare Informatics, Philips

Barry Stein, MD, MBA, FSIR, FACR, RPVI
Vice President and Chief Clinical Innovation Officer, Vascular & Interventional Radiologist, Hartford HealthCare

Bill Stoval, MBA
Executive Director of Offering Management for IBM Watson Health Imaging, Merge, an IBM Company

Jeffrey Sunshine, MD
CMIO, University Hospitals Health System

Carl Swanson
Systems Analyst, Imaging Information Systems, MedStar

Alex Towbin, MD, FAAP
Chair of Radiology Informatics, and Associate Chief of Radiology, Clinical Operations and Radiology Informatics, Cincinnati Children's Hospital Medical Center

Brian Wetzel
Director of Diagnostic Imaging/Cardiology & Radiology, Our Lady of Lourdes Memorial Hospital

Adam Whitlatch
Director of R&D, Epic

Jason Wiesner, MD, MBA
Medical Director, Teleradiology, Executive Physician Director Imaging, Radiologist, Sutter Health

Richard Wiggins, MD
Director, Imaging Informatics, Radiologist, University of Utah Hospitals and Clinics

Karley Yoder, MBA
Head of Product Mgmt, AI Analytics, GE Healthcare

Boris Zavalkovskiy
Director Diagnostic Services, Cancer Treatment Centers of America

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This material is copyrighted. Any organization gaining unauthorized access to this report will be liable to compensate KLAS for the full retail price. Please see the KLAS DATA USE POLICY for information regarding use of this report. © 2019 KLAS Research, LLC. All Rights Reserved. NOTE: Performance scores may change significantly when including newly interviewed provider organizations, especially when added to a smaller sample size like in emerging markets with a small number of live clients. The findings presented are not meant to be conclusive data for an entire client base.