At the centre of the healthcare ecosystem

International Hospital speaks to Archie Mayani, VP of Product Management at Change Healthcare Enterprise Imaging, about the company and their cloud-based imaging platform, one of the first major cloud-native enterprise imaging platforms offered as a fully managed software as a service.

International Hospital: Can you give us a bit of background about Change Healthcare?

Archie Mayani: Change Healthcare (Nasdaq: CHNG) is a global company, established in 2005 with subsequent mergers and acquisitions that propelled the company to its current expansion as an international corporation. We operate in more than 120 key locations around the world, including North America, Australia, Europe, the Middle East and Asia. Our corporate headquarters is located in Nashville, Tennessee, USA.

We are a leading independent healthcare technology company, focused on accelerating the transformation of the healthcare system. Our interconnected position at the centre of healthcare allows us to serve as a catalyst for greater collaboration on the path to value-based and consumer-centric care. We play a vital role in helping the system to not only function, but to also work smarter. Change Healthcare solutions touch one in three U.S. patient records to facilitate more than 117.2 million clinical network transactions each year, are used by 92% of the top U.S. health plans covering 175 million patients and bill $1.7 trillion annually.

IH: What services / products does the company provide?

AM: As a healthcare technology company, Change Healthcare offers end-to-end data and analytics-driven solutions to improve clinical, financial, administrative, and patient engagement outcomes for thousands of hospitals, health systems, physician practices, payer organizations, community health services, labs, and dental practices.

Change Healthcare’s distinctive Intelligent Healthcare Platform powers our unified portfolio of solutions to help our customers improve operational efficiency, decisionmaking, and patient outcomes, while also enabling innovation as the healthcare system evolves. Our suite of solutions touches every aspect of the healthcare ecosystem to improve care, increase engagement, manage data, optimize workflows, and reduce costs in any and all care settings.

IH: Who are your key customers?

AM: Change Healthcare sits at the centre of the healthcare ecosystem, serving providers, payers and patients. Our Intelligent Healthcare Network gives customers access to approximately 800,000 physicians, 117,000 dentists, 60,000 pharmacies, 5,500 hospitals, nearly 400 vendors and 600 laboratories, as well as nearly all government and commercial players.

While we don’t generally identify all of our customers outside of case studies or other mutually agreed-upon communications, I can say that Bronson Healthcare and CHS [Community Health Systems] have been publicly announced as development partners [in the United States], and EIN Archive is also being deployed commercially at a growing number of other hospitals and IDNs [Integrated Delivery Networks] with more on the horizon. As of January [2021], we have 92 million studies totalling 3.9 petabytes in our Enterprise Imaging Network Archive alone – with the pace and scale of adoption accelerating.

IH: The company’s Enterprise Imaging Network (EIN) is the first major cloud-native enterprise imaging platform offered as a fully managed software as a service (SaaS). What are the main benefits of hosting the imaging network in the cloud and in providing this as a SaaS solution?

AM: We want to unburden our customers – both clinicians and IT professionals – to allow them to focus on what they do best: take care of patients, without having to unnecessarily focus on the business of boxes and wires. Cloud-native technology abstracts management of non-value-add capabilities such as data center management, IT infrastructure and talent, planning of downtime schedules, migrations, and upgrades. Best practice 3rd-party-certified cybersecurity is built in. The solutions offers frequent, seamless, no management required upgrades, with 99.99% uptime.

Change Healthcare is the only major Enterprise Imaging vendor building a cloud-native end-to-end Enterprise Imaging solution that meets customers where they are at in their cloud journey. Because the service is delivered on a subscription basis, with no upfront migration fees, financial impact is predictable and moved from a capital expense to an operating expense.

IH: Are you partnering with any major radiology device manufacturers?

AM: We work to ensure that all of our solutions are compatible with the devices offered by each vendor and for all the modalities of digital radiology. Instead of partnerships with specific vendors, we leverage standards and APIs to ensure interoperability and compatibility. We partner with a broad range of artificial Intelligence and other technology vendors including TeraRecon, iCAD, Zebra, Nuance, Vital Images, and many others to deliver a complete end-to-end Imaging workflow.

IH: Can you tell us about the installation process?

AM: At a very high level, we start by identifying all sources of imaging data wherever the customer has it – on-premise archive, off-site data centers, etc. Then we bring a transfer appliance to rapidly copy the data from each location and bring it to one of several cloud data centers. The data is rapidly ingested (at speeds of up to one million studies per day) into our Enterprise Imaging Network Archive, where it is then validated, tested, and moved live. We synchronize any changes made in the source system during the transfer and ingestion process so all patient data is completely up to date at go-live.

Due to the fast nature of data copying using the transfer appliance and accelerated ingestion through use of the massively scalable computing resources present in the cloud, migration can be completed in just a few weeks rather than several months required for a traditional migration. The implementation minimizes customer workload associated with the migration as it is included as part of the overall managed service. Some customer Involvement is of course necessary to ensure proper interface with existing systems.

Because Enterprise Imaging Network is hosted in the cloud, there is very little hardware required beyond a gateway edge server at each customer site. However, depending on customer needs for additional hardware to meet their imaging requirements, we have partnerships with hardware vendors such as Barco, Eizo, Dell, HP Inc, HP Enterprise, Netapp, and others. This helps ensure our customers can access any needed hardware to implement our cloud and on-premises solutions.

IH: How do you maintain security of imaging data over the network?

AM: We align with multiple best-practice security standards. Enterprise Imaging Network Archive is both HITRUST and SOC2 certified. Connections to the Enterprise Imaging Network are managed through well-protected https APIs. All API connections are continuously monitored for malicious behaviour and fraud. If malicious behaviour or fraud is detected, connections are automatically disconnected.

All communication into and out of Enterprise Imaging Network is encrypted (using TLS 1.2). All data stored within EIN (objects and metadata) is encrypted using AES-256.

All Enterprise Imaging Network infrastructure has automated malware detection software installed. The anti-malware software is continuously updated in response to newly defined attacks. In addition, all operating system instances within EIN are updated regularly to ensure the latest security patches are in place. It is not possible for a user with legitimate access to one customer’s data in EIN to access, modify, or delete another customer’s EIN data.

IH: High internet bandwidth is required for a high-resolution imaging cloud-based network. Does this pose a stumbling block for some healthcare facilities looking to adopt this EIN solution?

AM: Internet bandwidth requirements can obviously impact the performance of any cloud-based solution and will vary on a customerby- customer basis depending on size, volume, location, and local internet infrastructure. Because the Archive and Viewer components of Enterprise Imaging Network are delivered from the same platform, the Viewer has immediate and direct access to the images for use by the vast majority of enterprise users. In addition, for diagnostic specialists, because Enterprise Imaging Network leverages proprietary streaming technology to our on-premise Radiology Solutions PACS, download performance can be comparable to retrieval from a local cache. As our cloud solutions evolve and diagnostic viewing is moved to the cloud, study retrieval and viewing should be as fast and light as any other browser-based streaming service.

IH: Enterprise Imaging Network incorporates a PACS and a number of analytics applications, can you tell us more about these?

AM: Enterprise Imaging Network currently comes with a universal viewer. A cloud diagnostic viewer is in development. Our current analytics offering comes with a Radiology Insights core package that is used to drive data insights and value from the organizational data. That, in turn, provides visibility and meaningful insights to drive efficiency, productivity, and other goals that are important to the organization. We also support premium packages and professional services offering customization and consulting to achieve data-driven results. Additional analytics packages for other specialties and functions are in active development.

IH: What is in the pipeline for Change Healthcare?

AM: Because cloud-native, multi-tenant architecture allows a single upgrade to be delivered Instantaneously to every customer at once, automatically, we are delivering a consistent cadence of feature enhancements and improvements on a regular basis – so in some ways our pipeline is constantly evolving to responsively align to customer needs and wants on an iterative basis.

In terms of larger cloud service offerings in the imaging space, we have two primary solutions in development. The first is a completely cloud-native SaaS enterprise imaging solution incorporating diagnostic viewers, AI-driven workflow solutions, AI algorithm integrations, analytics, and more, designed to meet the unique needs of the radiology practice space, with anticipated presence in market in the fall of 2021.

Our other core cloud initiative is a similar end-to-end cloud-native SaaS imaging platform for the hospital and IDN market, incorporating and improving upon the file management infrastructure and systems present in the current Enterprise Imaging Network with a target in-market date of fall 2022. Customers interested in beginning their cloud journey with Change Healthcare shouldn’t feel that they need to wait until a complete cloud solution is available. Because of the speed advantages offered by our streaming technology, we can pair on-premise and hybrid solutions to deliver immediate ROI, while laying the foundation for a complete cloud migration with even greater benefits at a later date.

IH: Is there anything you’d like to add as the last word?

AM: Enterprise Imaging Network was truly built with a vision to democratize data and harness its power with enabling technologies like AI, machine learning, and natural language processing that can turn the ever-exploding healthcare data into insights for population health management. To that effect, we have already started seeing the value of centralization of all of imaging data to fuel innovation through AI and machine learning models that improve radiologist productivity while reducing burnout. We have several new innovations including AI orchestrated worklist, intelligent workflows to pull up relevant prior studies using body region/anatomical awareness, and smart screening workflows for mammography.