Endoscopy image management A buyer's guide for health systems

Short answer: Endoscopy image management is the software and workflow that takes images and video from the procedure room, ties them to the right patient and order, stores them, and sends them to the EHR, a PACS, or a VNA. It sits between your scope equipment and your health record.

A complete setup usually does five jobs:

1. Gets the order. The EHR sends the order and patient details, usually by HL7.
2. Puts the patient on the room's worklist. Staff pick the patient instead of typing demographics.
3. Captures. Stills, and often video, come from the video processor or camera.
4. Stores and lets staff fix mistakes. Someone needs one place to review images and correct a wrong-patient or mixed-up exam.
5. Delivers. Images go to the procedure note, the EHR record, and any archive your organization requires.

When you compare vendors, ask how each of these five jobs is handled, and by which product. Gaps usually show up between jobs, not inside them.

Three common approaches

You will usually see one of three approaches. None is right for every health system. The table is a starting point for your own questions.

Short answer: Your EHR sets most of the requirements. Ask each vendor which messages it receives from your EHR, how images get back into the record, and where physicians will see them while they document. Get the answer in writing for your specific EHR, not "we integrate with all major EHRs."

If you document in Epic Lumens

• Ask how images reach the Lumens procedure note, and whether they are there when the physician starts documenting.
• Ask whether you also keep media in Epic Gallery, Epic's image archive, and how the vendor sends to it.
• Ask which interfaces are used: HL7 orders in, and images out by API, HL7 MDM, or file drop.
• Ask whether the vendor's product is listed on Epic Showroom, under which designation and category, and check the listing yourself. Showroom is public. A listing tells you how Epic describes the product's category. Epic does not endorse, certify, or verify the integrity, safety, performance, or practices of any listed developer or their software. For endoscopy image capture, Epic's Toolbox category is Endoscope Data Capture.
• Ask what your Epic team builds and what the vendor builds. This drives your internal workload.

If you run Oracle Health (Cerner)

• Ask how images are delivered back into Cerner, and in what form.
• Ask how orders and patient details come in, so each image lands on the right patient.
• If you need a GI-specific endoscopy report writer, ask whether one is included or whether you will need a separate product, and plan for that decision separately.

If you run MEDITECH, including Expanse

• Ask how images reach the MEDITECH record. Common options include a PDF sent over HL7 or a cold-feed PDF drop.
• Ask how the room worklist is built from MEDITECH orders.
• Ask whether a separate report writer is part of the plan.

If you have more than one EHR

Some health systems run one EHR at the main campus and another at affiliates. Ask which EHR is the master for each workflow, and how the vendor keeps images from crossing between them.

Short answer: A VNA is not always required for endoscopy images. Some image management systems store images themselves and send them straight to the EHR. Others rely on a PACS or VNA as the store. Ask which kind you are buying, and let your archive policy decide, not the vendor's architecture.

Questions to settle early:

• Does the product store images itself? If yes, you can go live without buying an archive. If no, the archive is on your critical path.
• If you already run a PACS or VNA, how does the product send to it? Look for standard DICOM services: C-Store to send, C-Move to retrieve, and Storage Commitment to confirm the archive received the study.
• Can it send to more than one archive? This matters when a health system VNA and an affiliate archive both need copies.
• Does the archive need HL7, or only DICOM? Fewer interfaces mean fewer things to maintain.
• Who fixes a wrong-patient image after it was archived? Ask how a correction reaches every downstream copy.

Short answer: It depends on each room's equipment. Some video processors and cameras can pull the patient from a DICOM worklist and send images straight to the image system, with no PC in the room. Others need a capture station at the tower.

Map every room before you compare quotes:

• Which processors support DICOM Modality Worklist (MWL) and C-Store? Check the exact model and software version. Two models from the same maker can differ.
• One path per room? Ask whether a room should use DICOM-direct or a capture station, not both, and whether licensing changes between the two.
• Ultrasound and other add-on devices. For endoscopic ultrasound, ask whether images come through the main processor as picture-in-picture or straight from the ultrasound unit.

Short answer: Most endoscopy departments run more than one scope brand, and fleets change over time. Choose image management that treats every room the same way, whichever tower is in it, and that supports each processor model you own today, by a named path.

Ask for:

• A device list by model, not by brand. For each processor or camera you own, ask the path (DICOM-direct or capture station), whether stills, video, or both are supported, and whether it is live at customer sites or supported but less common.
• Coverage outside GI. Bronchoscopy, ENT and speech pathology (FEES), urology, the OR, and pain management often have their own cameras.
• Single-use scopes. Ask how each single-use scope system's images get captured.
• A plan for the next purchase. If you change scope vendors in a few years, what changes in the image system? Ideally, only the room setup.

Short answer: Endoscopy runs early, late, and on weekends. Ask who answers the support line at every hour, whether they are the vendor's own staff, and what happens to an urgent call after hours. Then call the number yourself.

Questions to ask:

• Who answers after hours, weekends, and holidays? A person, a voicemail box, or a ticket form?
• What counts as urgent, and what happens next? Ask how an after-hours urgent call reaches someone who can fix it.
• How do online cases and email get handled? Ask when they are picked up.
• How is patient data handled during support? Look for a secure remote session instead of PHI in email or web forms.
• What happens after go-live? Ask about check-ins, training for new staff, and software updates.

Short answer: Ask for the documents your integration and security teams will need, before you sign. A vendor that can share them during evaluation makes the project easier to plan.

1. Interface documentation. Can we see the interface specification for our EHR before we buy?
2. DICOM conformance statement. Which DICOM services do you support, as the image system and as an archive client (MWL, C-Store, C-Move, Storage Commitment)?
3. HL7 samples. Can we see sample HL7 messages for orders in and images or documents out, for our EHR?
4. Security and SOC. Do you maintain a current SOC 2 report? Which type, which audit period, and how do we request it? Can you provide a BAA, a VPAT, and answers to our security questionnaire?
5. Hosting. Does it run on-premises, in our own cloud tenant, or in the vendor's cloud? Who controls backups and access?
6. Data migration. Can you move images and reports from our current system? How do historical records stay linked to the right patients? Is there a test load before go-live?
7. Support availability. Who answers the phone 24/7/365, and are they your staff?
8. Wrong-patient corrections. If an image lands on the wrong patient, where is it fixed, and does the fix reach the EHR and every archive?
9. Pricing model. What drives the quote: rooms, capture stations, interfaces, sites, migration? What is included?
10. Go-live plan. What does your team do, what does our team do, and how is the timeline estimated for our project?

• DICOM: The standard for medical images. Imaging devices and archives use it to send, store, and retrieve images.
• Worklist (MWL): DICOM Modality Worklist. A list of scheduled patients that a device or capture station pulls, so staff pick the patient instead of typing details.
• HL7: The messaging standard EHRs use to exchange orders, patient updates, results, and documents.
• MDM: An HL7 message type for documents. One common way to send images or documents into an EHR.
• VNA: Vendor neutral archive. An enterprise archive that stores images from many departments and systems.
• PACS: Picture archiving and communication system. Stores and displays medical images, often for a single department.
• Lumens: Epic's application for GI and pulmonology procedures, where endoscopists document findings and create the procedure report.
• Gallery: Epic Gallery, Epic's image archive for clinical media.