Lessons from integrating digital pathology into clinical enterprise imaging at Michigan medicine

Our journey at Michigan Medicine involves integrating the pathology department into our Clinical Enterprise Imaging (CEI) program. We're using a centralized Picture Archiving and Communication System (PACS) to transform the department into a fully digital operation. Our goal is to achieve primary diagnosis by [summer 2024], a significant milestone in our digital transformation. This process will enhance interoperability and diagnostic precision through the Digital Imaging and Communications in Medicine (DICOM) standardization across various imaging modalities.Enterprise imaging is a comprehensive approach that involves capturing, analyzing, routing, and managing clinical images and multimedia content from various specialties in a seamless workflow. Our modern enterprise imaging systems integrate radiology, pathology, dermatology, and other fields using a vendor-neutral format for managing and storing images. This approach ensures comprehensive access to imaging data, enabling physicians to diagnose, share insights, and make informed patient-care decisions. By connecting previously siloed information and leveraging standards like DICOM and HL7, we're enhancing the diagnostic and treatment process across multiple specialties. The DICOM standardization plays a crucial role in this, ensuring compatibility with standards-compliant applications and avoiding future data migrations.Our journey toward a cohesive digital pathology environment began with a collective effort. We standardized DICOM protocols across multiple scanners, addressing vendor hesitance and limitations. This collaborative approach has not only improved system integration and accessibility but also fostered a sense of shared accomplishment. Implementing robust quality control workflows using DICOM metadata has significantly enhanced the accuracy and reliability of our diagnostics, a testament to our collective dedication.Integrating metadata from our Laboratory Information System (LIS) with our PACS has also streamlined diagnostics and boosted interdisciplinary collaboration. We utilize HL7 information to fill the DICOM headers before the data resides in the Vendor Neutral Archive (VNA). Our ongoing projects include developing a PACS-driven workflow that integrates LIS and Electronic Health Records (EHR) systems, further enhancing diagnostic efficiency and functionality.In summary, this oral presentation will cover the lessons learned from integrating digital pathology into our Clinical Enterprise Imaging program at Michigan Medicine. It will focus on the five pillars of functionality in enterprise imaging at Michigan Medicine, including image capture, storage, viewing modality, image exchange workflow, and analytics. Additionally, it will highlight the importance of the CEI Cross-functional Technical Support Team and CEI Governance-steering, Operations, and Stewardship committees.

Learning Objectives

1. Understand the integration process of the pathology department into the Clinical Enterprise Imaging program at Michigan Medicine, including the use of a centralized Picture Archiving and Communication System.         
2. Comprehend the comprehensive approach of enterprise imaging, which involves capturing, analyzing, routing, and managing clinical images and multimedia content across various specialties using a vendor-neutral format, and the role of DICOM and HL7 standardization in enhancing interoperability and diagnostic precision.        
3. Recognize the collaborative efforts and quality control workflows implemented to standardize DICOM protocols, and integrate metadata from the Laboratory Information System with Picture Archiving and Communication System.