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16 - 20 May 2022 IST-Africa 2022 Copyright 2022 Authors
Enterprise Medical Imaging in
the Global South: Challenges
and Opportunities
Ernest ZULU1
and Lighton PHIRI2
1
Adult Hospital, University Teaching Hospitals
2
The University of Zambia
Zambia
16 - 20 May 2022 IST-Africa 2022 Copyright 2022 Authors
Radiological Examination Process
16 - 20 May 2022 IST-Africa 2022 Copyright 2022 Authors
Motivation, Problem Area
Two fundamental challenges affecting effectiveness
and efficiency of radiological services in the global
south:
• Critical shortage of radiologists
• Limited use of modern medical imaging practices
Potential solution to address the second challenge:
• Implementation of Enterprise Imaging
(EI)—techniques and workflows for
– Acquiring
– Indexing
– Managing
– Storing
– Analysing ….clinical images
16 - 20 May 2022 IST-Africa 2022 Copyright 2022 Authors
Research Objectives
To:
• Highlight challenges that adversely affect effective
interpretation of medical images
• Explore the opportunities associated with the
implementation and adoption of EI strategies in
order to enhance medical imaging interpretation in
Zambia
16 - 20 May 2022 IST-Africa 2022 Copyright 2022 Authors
Research Approach, Methodology
Study approach
• Mixed method approach
– Case study at University Teaching Hospitals
– Meta-analysis
Methodology
• Strengths‐Weaknesses‐Opportunities‐Threats
(SWOT) analysis
– Records analysis
– Personal observations
• Enterprise Medical Imaging Meta-analysis
16 - 20 May 2022 IST-Africa 2022 Copyright 2022 Authors
Major Outcomes/Results (1/2)
• 2815 health
facilities in Zambia
• Owned by
– Government of the
republic of Zambia
(GRZ)
– Military
– Non-Governmental
Organisations (NGO)
– Private
• Our work focused
on public health
facilities (GRZ)
16 - 20 May 2022 IST-Africa 2022 Copyright 2022 Authors
Major Outcomes/Results (2/2)
• 151 facilities
classified as Level 1,
2 or 3 Hospitals
– Majority owned by
GRZ
• Radiologically
equipped according
to level in GRZ
facilities
• Only 8 GRZ
Radiologists,
operating in 5
facilities
16 - 20 May 2022 IST-Africa 2022 Copyright 2022 Authors
Major Outcomes/Results: UTH Case Study (1/2)
Workflow challenges
• No Radiology Information System (RIS) or Hospital
Information Service (HIS)
– Inadequate request forms
– Repetitive entries of patient details
– Uncollected final reports
– Tedious annual returns report generation
• No Picture Archiving and Communication System
(PACS)
– No systematic storage of images and reports
– Manual reporting
– Multiple registration of same patient
– Use of non-DICOM image acquisition
• Long report turnaround time
– Few Radiologists
– Heavy workload
16 - 20 May 2022 IST-Africa 2022 Copyright 2022 Authors
Major Outcomes/Results: UTH Case Study (2/2)
• Total examinations: 92, 599
• Majority of modalities are X-rays and Ultrasound,
mostly done in lower-level hospitals
16 - 20 May 2022 IST-Africa 2022 Copyright 2022 Authors
Major Outcomes/Results: EMI Analysis (1/2)
Challenges affecting EMI implementation
• Challenges of integration of various clinical imaging
disciplines into unified EI
– Differences in workflows (e.g. ordering of an imaging
exam)
– Challenging patient identification in non-DICOM images
– Differing image qualities and standards (measurements,
image colour, patient positioning)
– Linking of all patients’ images and reports in the EMI
viewer to the patients’ EHR
– Lack of EMI-specific ontology and standard nomenclature
– Medico-legal concerns
– Use of mobile devices for image acquisition and personal
privacy
16 - 20 May 2022 IST-Africa 2022 Copyright 2022 Authors
Major Outcomes/Results: EMI Analysis (2/2)
Additional challenges facing EI implementation in the
global south
• Substantial cost and ongoing investment for
maintenance
• Requirement for good Information and
Communication Technology (ICT) support service,
• Training of users and requirement for a good
understanding of complexities involved in EI
implementation
16 - 20 May 2022 IST-Africa 2022 Copyright 2022 Authors
SWOT Analysis: Strengths
• Well-trained radiologists
• Organised existing imaging stakeholder
departments
– Well-established administrators
– Standard Operating Procedures (SOP)
– Manual workflows in place, could be incorporated in
EI-centric ecosystem
– Fairly equipped imaging ecosystem at all levels (level 1, 2
and 3), DICOM-compatible machines
• Ongoing mobilisation of Teleradiology equipment
16 - 20 May 2022 IST-Africa 2022 Copyright 2022 Authors
SWOT Analysis: Weaknesses
• Subsidiary departmental imaging services not
integrated into mainstream clinical imaging
• Continued use of analog imaging in some modalities
• Use of visible light based image capturing
equipment in some subsidiary services
• Poorly-serviced equipment with frequent and long
downtimes
• Lack of good ICT infrastructure
16 - 20 May 2022 IST-Africa 2022 Copyright 2022 Authors
SWOT Analysis: Opportunities
• Developing EHR system (SmartCare)
• Pre-existing e-Government services for internet
connectivity
16 - 20 May 2022 IST-Africa 2022 Copyright 2022 Authors
SWOT Analysis: Threats
• Unreliable internet connectivity
• Uncertain acceptability of EI
16 - 20 May 2022 IST-Africa 2022 Copyright 2022 Authors
Conclusion and Outlook
• SWOT analysis was conducted; highlighted the
challenges and opportunities of implementing
successful EI strategies
– Motivation for implementation of EI strategies
• Meta-analysis conducted to consolidate information
on general challenges of EI implementation against
local challenges
• Ongoing: Pilot study to fully understand current
imaging workflows with expected outcome of
automation of the workflows
• In pipeline: Implementation of
– PACS and RIS
– Machine learning models
• Further research required in exploration of
automatic radiology report generation
16 - 20 May 2022 IST-Africa 2022 Copyright 2022 Authors
Bibliography
[1] O. Bwanga, J. M. Sichone, P. N. Sichone, and Y. B. Kazuma, ‘Image
Interpretation and Reporting by Radiographers in Africa: Findings
from the Literature Review and their Application to Zambia’, Med. J.
Zambia, vol. 48, no. 2, pp. 125–135, Aug. 2021 [Online]. Available:
https://mjz.co.zm/index.php/mjz/article/view/877
[2] D. A. Clunie, D. K. Dennison, D. Cram, K. R. Persons, M. D. Bronkalla,
and H. ‘rik’ Primo, ‘Technical Challenges of Enterprise Imaging:
HIMSS-SIIM Collaborative White Paper’, J. Digit. Imaging, vol. 29, no.
5, pp. 583–614, Aug. 2016, doi: 10.1007/s10278-016-9899-4. [Online].
Available: https://doi.org/10.1007/s10278-016-9899-4.
[3] C. A. Petersilge, ‘The Enterprise Imaging Value Proposition’, J. Digit.
Imaging, vol. 33, no. 1, pp. 37–48, Nov. 2019, doi:
10.1007/s10278-019-00293-1. [Online]. Available:
https://doi.org/10.1007/s10278-019-00293-1.
[4] C. J. Roth, L. M. Lannum, and K. R. Persons, ‘A Foundation for
Enterprise Imaging: HIMSS-SIIM Collaborative White Paper’, J. Digit.
Imaging, vol. 29, no. 5, pp. 530–538, Oct. 2016, doi:
10.1007/s10278-016-9882-0. [Online]. Available:
https://doi.org/10.1007/s10278-016-9882-0
16 - 20 May 2022 IST-Africa 2022 Copyright 2022 Authors
Enterprise Medical Imaging in
the Global South: Challenges
and Opportunities
Ernest ZULU1
and Lighton PHIRI2
1
Adult Hospital, University Teaching Hospitals
2
The University of Zambia
Zambia

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Implementing Enterprise Imaging in Zambia

  • 1. 16 - 20 May 2022 IST-Africa 2022 Copyright 2022 Authors Enterprise Medical Imaging in the Global South: Challenges and Opportunities Ernest ZULU1 and Lighton PHIRI2 1 Adult Hospital, University Teaching Hospitals 2 The University of Zambia Zambia
  • 2. 16 - 20 May 2022 IST-Africa 2022 Copyright 2022 Authors Radiological Examination Process
  • 3. 16 - 20 May 2022 IST-Africa 2022 Copyright 2022 Authors Motivation, Problem Area Two fundamental challenges affecting effectiveness and efficiency of radiological services in the global south: • Critical shortage of radiologists • Limited use of modern medical imaging practices Potential solution to address the second challenge: • Implementation of Enterprise Imaging (EI)—techniques and workflows for – Acquiring – Indexing – Managing – Storing – Analysing ….clinical images
  • 4. 16 - 20 May 2022 IST-Africa 2022 Copyright 2022 Authors Research Objectives To: • Highlight challenges that adversely affect effective interpretation of medical images • Explore the opportunities associated with the implementation and adoption of EI strategies in order to enhance medical imaging interpretation in Zambia
  • 5. 16 - 20 May 2022 IST-Africa 2022 Copyright 2022 Authors Research Approach, Methodology Study approach • Mixed method approach – Case study at University Teaching Hospitals – Meta-analysis Methodology • Strengths‐Weaknesses‐Opportunities‐Threats (SWOT) analysis – Records analysis – Personal observations • Enterprise Medical Imaging Meta-analysis
  • 6. 16 - 20 May 2022 IST-Africa 2022 Copyright 2022 Authors Major Outcomes/Results (1/2) • 2815 health facilities in Zambia • Owned by – Government of the republic of Zambia (GRZ) – Military – Non-Governmental Organisations (NGO) – Private • Our work focused on public health facilities (GRZ)
  • 7. 16 - 20 May 2022 IST-Africa 2022 Copyright 2022 Authors Major Outcomes/Results (2/2) • 151 facilities classified as Level 1, 2 or 3 Hospitals – Majority owned by GRZ • Radiologically equipped according to level in GRZ facilities • Only 8 GRZ Radiologists, operating in 5 facilities
  • 8. 16 - 20 May 2022 IST-Africa 2022 Copyright 2022 Authors Major Outcomes/Results: UTH Case Study (1/2) Workflow challenges • No Radiology Information System (RIS) or Hospital Information Service (HIS) – Inadequate request forms – Repetitive entries of patient details – Uncollected final reports – Tedious annual returns report generation • No Picture Archiving and Communication System (PACS) – No systematic storage of images and reports – Manual reporting – Multiple registration of same patient – Use of non-DICOM image acquisition • Long report turnaround time – Few Radiologists – Heavy workload
  • 9. 16 - 20 May 2022 IST-Africa 2022 Copyright 2022 Authors Major Outcomes/Results: UTH Case Study (2/2) • Total examinations: 92, 599 • Majority of modalities are X-rays and Ultrasound, mostly done in lower-level hospitals
  • 10. 16 - 20 May 2022 IST-Africa 2022 Copyright 2022 Authors Major Outcomes/Results: EMI Analysis (1/2) Challenges affecting EMI implementation • Challenges of integration of various clinical imaging disciplines into unified EI – Differences in workflows (e.g. ordering of an imaging exam) – Challenging patient identification in non-DICOM images – Differing image qualities and standards (measurements, image colour, patient positioning) – Linking of all patients’ images and reports in the EMI viewer to the patients’ EHR – Lack of EMI-specific ontology and standard nomenclature – Medico-legal concerns – Use of mobile devices for image acquisition and personal privacy
  • 11. 16 - 20 May 2022 IST-Africa 2022 Copyright 2022 Authors Major Outcomes/Results: EMI Analysis (2/2) Additional challenges facing EI implementation in the global south • Substantial cost and ongoing investment for maintenance • Requirement for good Information and Communication Technology (ICT) support service, • Training of users and requirement for a good understanding of complexities involved in EI implementation
  • 12. 16 - 20 May 2022 IST-Africa 2022 Copyright 2022 Authors SWOT Analysis: Strengths • Well-trained radiologists • Organised existing imaging stakeholder departments – Well-established administrators – Standard Operating Procedures (SOP) – Manual workflows in place, could be incorporated in EI-centric ecosystem – Fairly equipped imaging ecosystem at all levels (level 1, 2 and 3), DICOM-compatible machines • Ongoing mobilisation of Teleradiology equipment
  • 13. 16 - 20 May 2022 IST-Africa 2022 Copyright 2022 Authors SWOT Analysis: Weaknesses • Subsidiary departmental imaging services not integrated into mainstream clinical imaging • Continued use of analog imaging in some modalities • Use of visible light based image capturing equipment in some subsidiary services • Poorly-serviced equipment with frequent and long downtimes • Lack of good ICT infrastructure
  • 14. 16 - 20 May 2022 IST-Africa 2022 Copyright 2022 Authors SWOT Analysis: Opportunities • Developing EHR system (SmartCare) • Pre-existing e-Government services for internet connectivity
  • 15. 16 - 20 May 2022 IST-Africa 2022 Copyright 2022 Authors SWOT Analysis: Threats • Unreliable internet connectivity • Uncertain acceptability of EI
  • 16. 16 - 20 May 2022 IST-Africa 2022 Copyright 2022 Authors Conclusion and Outlook • SWOT analysis was conducted; highlighted the challenges and opportunities of implementing successful EI strategies – Motivation for implementation of EI strategies • Meta-analysis conducted to consolidate information on general challenges of EI implementation against local challenges • Ongoing: Pilot study to fully understand current imaging workflows with expected outcome of automation of the workflows • In pipeline: Implementation of – PACS and RIS – Machine learning models • Further research required in exploration of automatic radiology report generation
  • 17. 16 - 20 May 2022 IST-Africa 2022 Copyright 2022 Authors Bibliography [1] O. Bwanga, J. M. Sichone, P. N. Sichone, and Y. B. Kazuma, ‘Image Interpretation and Reporting by Radiographers in Africa: Findings from the Literature Review and their Application to Zambia’, Med. J. Zambia, vol. 48, no. 2, pp. 125–135, Aug. 2021 [Online]. Available: https://mjz.co.zm/index.php/mjz/article/view/877 [2] D. A. Clunie, D. K. Dennison, D. Cram, K. R. Persons, M. D. Bronkalla, and H. ‘rik’ Primo, ‘Technical Challenges of Enterprise Imaging: HIMSS-SIIM Collaborative White Paper’, J. Digit. Imaging, vol. 29, no. 5, pp. 583–614, Aug. 2016, doi: 10.1007/s10278-016-9899-4. [Online]. Available: https://doi.org/10.1007/s10278-016-9899-4. [3] C. A. Petersilge, ‘The Enterprise Imaging Value Proposition’, J. Digit. Imaging, vol. 33, no. 1, pp. 37–48, Nov. 2019, doi: 10.1007/s10278-019-00293-1. [Online]. Available: https://doi.org/10.1007/s10278-019-00293-1. [4] C. J. Roth, L. M. Lannum, and K. R. Persons, ‘A Foundation for Enterprise Imaging: HIMSS-SIIM Collaborative White Paper’, J. Digit. Imaging, vol. 29, no. 5, pp. 530–538, Oct. 2016, doi: 10.1007/s10278-016-9882-0. [Online]. Available: https://doi.org/10.1007/s10278-016-9882-0
  • 18. 16 - 20 May 2022 IST-Africa 2022 Copyright 2022 Authors Enterprise Medical Imaging in the Global South: Challenges and Opportunities Ernest ZULU1 and Lighton PHIRI2 1 Adult Hospital, University Teaching Hospitals 2 The University of Zambia Zambia