What makes you so special, DICOM?


Editor’s note: This blog post was originally published on HIT Leaders & News.

Back in May 2011, I was talking to a doctor at The Guardian’s sadly short-lived Health Network show in London. We were discussing what Enterprise Content Management actually meant, and specifically about what sort of content our ECM solution can manage.

“Everything…” I said. “Any unstructured information. Whatever doesn’t fit comfortably into the rows and columns and tables of a database. Your EPR is for your discrete patient data. Your ECM system is for all of the unstructured information that completes that record: the letters, the photographs, the diagnostic outputs, the scanned paper…”

“So, what about medical images?” he asked. “What about DICOM?”

Indeed, what about DICOM. On the one hand, everyone had a picture archiving and communication system (PACS), but on the other hand, it seemed crazy that here I was talking about ECM, a technology that is hardly new, being able to manage pretty much any document format except DICOM.

Technology is constantly evolving, don’t get stuck in the past

There were a lot of good arguments for keeping medical images separate: special viewers were needed, displays needed to be of a certain quality, the systems were bandwidth-hungry, and so on. But even as I was talking about this, none of it really rang true. Why should hospitals be investing hundreds of thousands of pounds in ECM systems to manage their unstructured information, but then be expected to invest millions of pounds on a system dedicated to the handling of one file format?

I told the doctor that I envisaged a point where DICOM content would be just another format that ECM manages.

“You think that you can replace PACS with ECM? Good luck with that…” was the response.

Fast forward to 2015. Whilst the England Rugby team hasn’t progressed, the tech industry has. One by one, the arguments for a dedicated PACS system have fallen: Enterprise medical viewers such as those from Calgary Scientific and TeraRecon provide a single window onto multiple DICOM repositories, display quality has improved radically and continues to improve, and bandwidth is cheaper, as is storage.

Going beyond archiving

Meanwhile, the DICOM industry has muddied the waters with the concept of the Vendor Neutral Archive (VNA). The idea of a VNA is to provide a single archive repository for all DICOM and non-DICOM content. In practice, most VNAs achieve this by wrapping the non-DICOM content in DICOM, rendering it virtually useless for any purpose other than archiving. In order to be truly useful, and portable (especially at the end of a contract), content needs to be stored in its native format; like an enterprise content management system.

Meanwhile, there has been a lot of confusion around definitions of a VNA. One VNA vendor whispered to me that it stood for Virtually Nearly Anything! In reality though, what is an enterprise content management system if it isn’t at least VNA?

The key word here is “archive.” An ECM system is so much more than an archive for old documents. ECM enables you to automate and improve processes that are currently dependent on physical documents by replacing paper forms with electronic forms.

You also capture and save clinical content directly to the repository, track and measure processes to ensure service levels are met and deliver documents wherever they are needed – without requiring them to be printed. ECM is much more than just an archive, where you put stuff when you’re finished with it.

Our approach to managing all content is to keep it in its native format in a single repository. Taking this approach enables you to incorporate DICOM content into workflows that are driven as easily as if they were Microsoft Word documents or HTML forms. It also means that customers know they can change their EMR, RIS, and even eliminate their PACS/VNA systems without compromising the availability of their DICOM content.

The only issue left outstanding in this approach is the view that DICOM is special and needs its own dedicated repository.

It isn’t, and it doesn’t.

Steve Rudland

Steve Rudland

Steve Rudland has worked in the enterprise software industry since 1993, specialising in information sharing, process management, and collaboration technologies; specifically, their application in healthcare, social housing, and local government.... read more about: Steve Rudland

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