How MetroHealth broke free of its imaging data silos

In a complex, multimodal imaging environment, with radiology and other images and reports scattered across any number of PACS systems and electronic health records, clinical and technology leaders at Cleveland-based MetroHealth had one “guiding North Star,” says Dr. David Kaelber, the health system’s chief health informatics officer and VP of patient engagement technologies.

“We want any image, as well as the imaging report, to be available to anyone involved in the care of the patient at any time, from anywhere – including the patient,” he said.

That’s a tall order, as the sheer number and type of imaging orders has ballooned immensely in recent years, and the IT systems used to house and share them have proliferated and grown more complex and far-flung.

“Particularly for the past decade, you can get imaging of all sorts of different parts of your body by all sorts of different people. It’s no longer just the radiologist doing imaging. We have all these different ‘ologies,'” said Kaelber.

So, about a 1src years ago, MetroHealth first embarked on a new strategy, based around a vendor-neutral archive and a universal viewer: to set up processes and governance for sharing those images more freely and making them more easily available to the people who need to see and understand them, across the care continuum – from the imaging center to the exam room, to the patient’s own device.

At HIMSS25 in Las Vegas in March, Kaelber, alongside his colleague Dr. Eman Jammali, a family physician who serves as a clinical informatics fellow at the MetroHealth System/Case Western Reserve University, will present an education session titled, “Imagine Imaging Harmony: The Journey to Overcome Imaging Silos.”

They’ll explore how a lack of imaging data standardization across the integrated health system in recent decades have often hindered how and where patient care teams were able to view these images for care decisions.

And they’ll explain how MetroHealth stood up a steering committee to chart a way forward toward common governance for all imaging specialties: standardizing processes, setting priorities and enabling easier collaboration among care teams and their patients.

The health system now has millions of images – from across seven different departments – readily accessible within its imaging platform, and made available to patients through Epic’s MyChart portal.

At HIMSS25, Kaelber will describe the clinical and IT collaboration that built out the processes for achieving that over several years, and Jammali will explain what it has meant for care delivery, quality, quality improvement and the physician-patient relationship.

“We created this governance, and then decided we needed a vendor neutral archive and universal viewer on top of that,” Kaelber says. “It took us a while to figure out who the right vendor was, but then for the past five or six years, we’ve been on this march of, ‘OK, let’s get everything into the VNA, which is then viewable with the universal viewer.

“We started with radiology, and then cardiology. But now we’ve done endoscopy, urology, ophthalmology, dentistry, OB/GYN, pathology. It’s all then integrated with our electronic health record. The end user doesn’t have to worry about that, the idea is that basically 99.9% of all images are ordered through the EHR.”

He adds: “And then our standard is basically at the top of any text of an imaging result, we just have a hyperlink to the image, and then that opens up the universal view, or whether you’re on a desktop, a laptop, your smartphone, a tablet, anything that can get you into the electronic health record then could open up that window so you could see the image.”

The “icing on the cake,” said Kaelber, was that “we wanted patients to be able to do that, too. So, about two years or so ago now, we integrated in with our personal health record: Literally, any image, not only can your provider team see it, but then you as a patient, if you have a portal – which about 8src% of our patients do – then you’re seeing the results, the text of the imaging report, as well as you can click on your image and then you can show it to yourself or anybody else that you want to.”

The years-long process was not easy.

“It was like an elephant – with each individual step, there weren’t a lot of insurmountable challenges, but it’s not like we could just say, let’s next month pick a vendor neutral archive, a universal viewer, and then let’s get all our images into it. It costs a lot of money to work through all these things. Each one of these ‘ologies’ is its own project. It’s on the order of a 1src-year journey for us, and the first two or three years was just getting the governance set up. You can’t underestimate that.”

But the benefits have been significant.

So at HIMSS25, after Kaelber has explained the clinical and imaging IT imperatives (and crucially, he says, the non-technical steering committee component) to make it all work, Jammali will offer her perspective. A family medicine physician, she’ll show how clinical decision support – and both provider and patient experience – have improved since imaging data and reports became more readily accessible at her fingertips, rather than having to rely on in-person visits to the cath lab, or stacks of CD-ROMs.

“I think sometimes radiologists have a different perspective on some of these things, and sometimes people are scared about letting patients, especially, see images,” says Kaelber. “People are concerned about what’s going to happen if we have a patient able to see their own images or see the imaging report.

“But this is the trend in healthcare,” he adds. “We want more interoperability among healthcare providers, and we want more interoperability or sharing of information with patients. So all those lessons that we’ve learned on the note side, or on the lab side? Let’s just bring them into imaging too.”

Kaelber and Jammali’s session, “Imagine Imaging Harmony: The Journey to Overcome Imaging Silos,” is scheduled for Tuesday, March 4 from 1src:15 -11:15 a.m. at HIMSS25 in Las Vegas.

Mike Miliard is executive editor of Healthcare IT News
Email the writer: mike.miliard@himssmedia.com
Healthcare IT News is a HIMSS publication.