• Digital Imaging Adoption Model (DIAM)
  • Professor Dr. Peter Mildenberger
  • Digital Imaging Adoption Model (DIAM)
  • Professor Dr. Peter Mildenberger

Checklist for modern image management

A few years ago, HIMSS developed the Electronic Medical Record Adoption Model (EMRAM), a seven-stage scoring system to assess the degree of digitalization achieved in a hospital. EMRAM not only looks at the mere existence of certain IT systems but also takes into consideration their interaction with the aim to improve the quality of care. Last year, a comparable model specifically geared towards image management was launched: DIAM. In an interview with VISUS VIEW Professor Dr. Peter Mildenberger of the Clinic and Polyclinic for Diagnostic and Interventional Radiology at Johannes Gutenberg University Hospital, Mainz, Germany, explained why he and his colleagues at the European Society of Radiology (ESR) support DIAM.

Professor Mildenberger, assessment of image data management is a component of the EMRAM scoring. Why DIAM, an assessment model specifically for image management?

EMRAM asks, for example, whether the hospital has installed an information system for the radiology department or, if you are aiming at stage 5, whether there is an overarching IT solution which integrates all film-based images in a single system such as a PACS. The answers such questions yield are inadequate to describe a modern networked image management approach. Technical developments such as voice recognition, certain analytical tools, quality indicators, cost models or processes are not taken into consideration. We at the European Society of Radiology, which developed DIAM in cooperation with HIMSS Analytics, wanted to create a kind of checklist that supports strategic decision making in imaging departments. DIAM helps hospitals to analyze the current state of affairs and understand which strategic decisions need to be taken in order to optimize image management.

What exactly does DIAM look like?

Very similar to EMRAM, DIAM is modelled around stages that provide information on the degree of digitalization in image management. Stage 0 means “zero digitalization”, stage 7 means “advanced maturity”. The assessment is based on ten focus areas for which certain parameters are evaluated such as overall software infrastructure, patient engagement and level of information exchange or process security.

Who analyses the results and assigns stages?

DIAM draws on information the facilities themselves provide. During the process the facility is guided through questionnaires and the ten focus areas.  The answers are thoroughly analyzed and the overall stage is determined. Moreover, the respondents receive a detailed assessment of their facility for each focus area and sub-area. For example the assessment of “patient engagement” is based on the answers on so-called Action Items, that is whether the patients can make appointments online or whether they have online access to their medical reports and images. The questions are highly standardized for two reasons: Firstly, scoring is much easier and secondly the analysis is reproducible and yields comparable results. Obviously not all questions and responses can be standardized, such as annual operating expenditures or handling of external films and storage media. In certain cases we also contact the facility and ask for clarification. Stage 6 encompasses a validation in a telephone conference and stage 7 requires an on-site visit by HIMSS and ESR experts.

What is the core idea behind DIAM and what added value do the individual stages offer?

We wanted DIAM to be barrier-free and we designed the questionnaire in a way that completing them takes a maximum of four hours. Facilities with a good overview of their infrastructure will be able to go through the process in much less time. The participating institutions see DIAM as a possibility to take stock and figure out what is possible and useful, which objectives have been achieved and where measures need to be taken. We want to provide assistance with designing a suitable IT strategy and identifying investment potential and we want to show what exactly modern image management can do. The analysis is a kind of high-level roadmap for IT development geared towards the Heads of IT and the Board of Directors. Upon request HIMSS guides the facility through the implementation of a DIAM-based IT strategy. 

At this point however we cannot yet tell whether DIAM will provide comprehensive information on the general level of digitalization of image management in healthcare facilities and whether there will be differences among countries. Currently, DIAM, which was launched at ECR 2016, is still a pilot project and so far we have assessed only 20 facilities across Europe. Nevertheless we are confident that in the long run the model will yield valuable information on digitalization approaches in the different countries and facilities, very much what the EMRAM score is already doing today.