Imaging as a pillar of your strategic enterprise-wide platform

Digital imaging beyond radiology has become a true enterprise requirement for care delivery

The days when imaging strategy only concerned radiology are gone. Executives consistently reported expansion across:

• All “ologies” including orthopedics, surgery, ophthalmology and cardiology
• Non-DICOM content such as dermatology photos and bedside images
• Growth in video-based content (endoscopy, robotics, gate[SR1.1] analysis)
• Early planning for digital pathology, though implementation remains limited

The message for leadership: fragmented imaging ecosystems can create clinical blind spots, inefficiency and workflow challenges.

or executives, this reinforces the need for enterprise imaging roadmaps that align with electronic health record (EHR) [MG2.1][SR2.2]modernization, workforce strategies and long-term digital transformation.

One participant summarized the challenge well: “You don’t want isolated pockets of imaging. You want everything under one umbrella.”

Cloud-based imaging has become the strategic default

Across organizations — large academic systems, regional networks and community hospitals — cloud migration emerged as one of the clearest directional trends.

Why cloud is winning:

1. Workforce distribution and radiologist shortages: Radiologists are increasingly working remotely. Cloud-native picture archiving and communication systems (PACS) and zero-footprint viewers allow organizations to deliver high-performance imaging nationwide, improving turnaround times and supporting 24x7 operations.
2. Mergers and acquisitions: Executives managing multi-EHR[or multi-PACS environments emphasized that cloud simplifies system consolidation and ongoing interoperability.
3. Data center transformation: Several CIOs reported strategic mandates to reduce or eliminate on-premises data center footprints, making imaging one of the highest-value candidates for cloud migration.

As one leader explained: “Moving to the cloud wasn’t an IT decision—it was a business decision tied to scalability and our radiology staffing model.”

A leadership divide: Rural providers face a different reality

While cloud transformation accelerates in larger systems, executives from rural and critical-access hospitals highlighted systemic constraints:

• Limited budgets and thin margins
• Scarcity of PACS/admin talent
• Dependence on larger partner health systems
• A survival-first mindset: “If it isn’t broken, we aren’t fixing it.”

These comments serve as a strategic reminder: technology roadmaps must account for the operational and financial realities of each care setting. A “one-size-fits-all” enterprise imaging model will fail without tailored pathways for smaller facilities.

Imaging support models are consolidating into central IT

A decade ago, imaging departments commonly controlled their own PACS environments. That is no longer the norm.

Executives reported:

• Increasing migration of PACS admin roles into IT
• Continuing reliance on clinical support (e.g. radiology admins) for first-line clinical workflow support
• Growth in enterprise service desks supporting imaging access through the EHR
• Rising demand for cross-trained imaging specialists in IT

The shift reflects imaging’s evolution into a business-critical enterprise system. Several participants explicitly stated that imaging now carries the same level of business continuity priority as the EHR.

This has clear implications for executive planning: resourcing must anticipate increased IT support loads; recruitment strategies must address the shrinking PACS admin workforce and governance must mature to support enterprise-wide imaging policies.

Patient engagement strategies are evolving — but images aren’t there yet

Despite widespread patient portal adoption, most executives stated they are not yet delivering images to patients, only written radiology reports.

The reasons are operational, not philosophical:

• Concerns about patient confusion
• Storage and bandwidth impacts
• Security and identity-proofing complexities
• Fragmentation between enterprise imaging platforms and patient portals

For executives building long-term digital engagement strategies, this represents both a limitation and an opportunity. As one informatics leader noted, “We know patients want it—our systems just aren’t there yet.”

AI adoption Is rising rapidly — but governance Is not keeping pace

The discussion made clear that AI in imaging is no longer experimental. It is becoming operational.

Systems are already using AI for:

• Stroke triage
• Lung nodule detection
• Mammography
• Work prioritization

Drivers include workforce shortages, physician burnout, escalating imaging volumes and pressure to improve turnaround times.

However, executives expressed significant concern that governance structures are lagging in AI usage.

Key gaps include:

• Lack of AI steering committees
• No standardized frameworks for bias, accuracy or revalidation
• No policies governing clinicians’ use of tools like ChatGPT
• Minimal transparency about AI usage in patient-facing results

One CNIO reflected: “People are absolutely putting clinical notes into ChatGPT. We need governance, guardrails, and retraining strategies.”

For healthcare executives, the takeaway is clear: AI governance must be elevated to an enterprise priority.

Digital pathology: High future value, low immediate readiness

Though widely seen as transformative, digital pathology is slated primarily for 2026–2027 in the organizations represented.

Barriers include:

• Immense imaging data size
• Lack of integrated workflows
• Competing enterprise initiatives such as EHR rollouts
• Limited specialty-trained personnel
• Uncertain ROI models

For now, digital pathology appears to be a “next wave” investment rather than a near-term initiative for most organizations.

The strongest executive consensus: Transformation requires ongoing investment

The session concluded on a rare point of unanimous agreement: the “one and done” approach to imaging technology investment is obsolete.

CIOs consistently reinforced:

• Training and optimization cannot stop at go-live
• User proficiency is a long-term journey, not a milestone
• Value realization requires sustained investment
• Without ongoing development, systems underperform and create operational debt

One leader summarized the executive mindset nicely: “These systems are living, breathing. Implementation is just the beginning. The ROI comes from continuous optimization.”

What healthcare executives should take away

From the perspectives shared across this CHIME focus group, several strategic themes emerged that all healthcare executives should consider when shaping their enterprise imaging agendas:

1. Imaging must be governed as a system-wide strategic asset. Whether radiology, cardiology, digital pathology or multidisciplinary specialties, siloed approaches create risk and inefficiency.
2. Cloud-based imaging is rapidly becoming the industry's norm. Executives should expect multi-year transformations involving platform rationalization, workflow redesign and new support models.
3. AI represents both high opportunity and heightened risk. Executives must invest not only in AI technology but in governance, monitoring and ethical frameworks.
4.  Talent shortages will become more disruptive than technology gaps. Recruitment, retention and cross-training strategies for imaging and PACS roles must be prioritized.
5. Continuous investment — not point solutions—will differentiate high-performers.

The organizations that commit to multi-year optimization strategies will be the ones that see measurable ROI.

Healthcare executives are navigating an unprecedented transformation in medical imaging — shaped by workforce challenges, rapidly evolving technology, cloud adoption and shifting patient expectations. The CHIME focus group made one thing clear: imaging has moved from a supporting function to a business-critical strategic pillar.

Organizations that embrace this shift with clarity, enterprise leadership and sustained investment will be best positioned to deliver higher-quality care, improve operational efficiency and compete effectively in a rapidly changing healthcare landscape.

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