Thinking about stratifying your imaging technology? Think about your people. Part 2:

by Skinner & Associates’ Guest Contributor: David Whitney, CTO of Medical Diagnostic Imaging Group (MDIG)

As healthcare organizations consider stratifying their imaging technology, the process of augmenting their technical skill-sets to sustain a newly adopted platform can be easily overlooked. Part 1 provided a high level overview of what stratified technology is, and what skills and roles are required to plan for an environment. Part 2 assumes an organization has already analyzed requirements and gaps within their existing environment, and is focused on fulfilling those needs.

How can an organization address resource challenges?

While this may seem like an age-old human resource challenge, building or sustaining a business may conflict with an organization’s strategy to grow a business. Growth cannot be impacted by a behind-the-scenes reallocation of resources. Metaphorically, addressing these challenges is similar to changing the tires on a racecar while it circles the track. Typically, pit stops are designated along straightaways of a track and designed for addressing maintenance at a point of lesser course disruption and influence from track participants. As with racing, timing is essential to performing maintenance at points which are least disruptive to day-to-day operations or disruptive to growth strategies. Organizations must be free to address the challenges of a twisty road ahead, while establishing predetermined maintenance points to address the car. Timing is essential; expedient execution is critical. Many solutions exist to address the timing and execution of an organization’s resources.


Continuing Education Programs:

An excellent option for organizations maintaining a clearly defined and long straightaway approach to future state development. Education and training programs provide an excellent long term strategy, but may not provide the immediate needs for an organization. While these programs provide career path engagement and an excellent employee retention benefit, they must make sense for the bigger picture of an organization’s transformation. It is essential to invest in your talent pool but cost, duration, staff capacity, and criticality should be mutually considered when approaching resource gaps. Regardless, an organization must still understand its future state roadmap and one solution may not fit all technical initiatives.

Permanent Placement:

An excellent option for organizations maintaining a clearly defined and long straightaway approach to future state development. Long-term recruiting may require minimal upfront investment, but candidates must be fully vetted to understand what value and impact they will have within an organization’s current and future state. Although permanent placement is a short term investment, long term expenses to maintain employee skill-sets offset upfront savings and critical to maintain value and employee satisfaction needed for retention. An organization must also closely track employee satisfaction to ensure these investments are protected over the longer term, and return on investment is realistic. Social media, job boards, and word-of-mouth provide cost effective avenues for sourcing talent, but an organization must maintain a strong understanding of resources available in today’s market. Now that an organization understands which gaps exist, it must ensure each candidate is vetted by a stakeholder who understands what to “specifically” look for within the pool of candidates. By considering a quality recruiter with deep industry relationships, an organization can offset much of this job-to-candidate matching and achieve a high-success rate of employee adoption.

Staff augmentation:

An excellent option for organizations attempting a challenging or short to mid-length straightaway approach to future state development. As a short to mid-term solution, staff augmentation will handle a here-and-now solution, but expense may be higher as compared to permanent placement over the duration of an initiative. A major advantage to augmentation is the ability for staffing in accordance with the scope of an initiative. Cost can be contained and long-term expense is limited if the objective and duration is precisely defined. However, an organization must always examine their future state roadmap and consider any likelihood of the role as permanent placement.  In such event, identifying a temp-to-perm placement is always possible during initial negotiation and selection. Once again, utilizing a quality recruiter or consultant to assist with augmentation can provide a high-success rate of employee adoption.


An excellent choice for organizations addressing a very challenging, undefined, or extremely short straightaway to future state development. Although the highest short term expense, a quality consultant can provide the most flexible solution for initiative driven objectives. Instead of focusing on individual talents, an organization can focus on initiatives while exploiting a consultant’s tool-box of skill-sets. However, choosing the right consultant or group requires an investment in diligence. The chosen consultant must be able to deliver on-time, at cost, and provide the value as defined by an organization’s needs. With the correct choice, an organization can accurately forecast and control bottom line costs. Keep in mind that expense overrun can become a costly mistake with these precious commodities when an organization loses sight of its short-term initiatives and milestones.

In conclusion, creating a stratified imaging platform will provide a flexible and cost effective solution for an organization. However, the sustainability and success of a stratified environment is dependent on the people that support it. By sourcing personnel according to the results of resource analysis, an organization can effectively realign its people with the processes and technology.


Dave Whitney is a former candidate and client of Skinner & Associates. UnknownDave is the Chief Technology Officer at Medical Diagnostic Imaging Group (MDIG) based in Phoenix, AZ and a frequent contributor to the subject of Health Information Technology.

Taking Control of your Medical Imaging Data

Is your organization struggling to get control of its imaging information during this time of healthcare delivery transformation? You are not alone.  

By Sandra Lillie – Founder, Meade Advisory

How many times have we heard that hospitals are in transition from procedure-centric healthcare to patient-centered health delivery?  Daily, do you say?

The shift to value and focus on outcomes demands greater reliance on patient-centered information across care settings and time versus procedure-based information across events.  For organizations to adapt, they need good visibility to the breadth of clinical content associated with their patients as individuals and as populations.

Strategic reasons to get control of your organization’s imaging systems and content:

  • Some of the richest content resides in a hospital’s imaging and specialty departments, whether radiology, cardiology, orthopedics, dermatology or surgical imaging. The list is long and the content is often held in proprietary system silos.
  • Enterprise image and content management is a priority for many healthcare delivery organizations (HDOs) as they work to make patient information more interoperable, liquid and available to physicians and enterprise systems, like the EHR.
  • Unlocking silos of rich clinical information, both discrete and unstructured, into an accessible foundation enables easier, more efficient consumption for a multitude of purposes.

shutterstock_145545664With enterprise imaging, the medical imaging informatics community is maturing and evolving its definition of the set of capabilities to capture, index, manage, store and provide access to exchange, as well as provide business analytics for, all clinical imaging content across the healthcare enterprise.

You CAN get greater control over your medical imaging information. How do we approach unlocking this clinically-rich content and gain control for our organizations?

Enterprise imaging, or de-coupling PACS, unlocks your organization from proprietary imaging solutions or PACS. This is not only technically feasible but cost-effective today where it would have been viewed as emerging just five years ago. In fact, it is far costlier to fail to gain increasingly independent control of your imaging data.

Steps to gaining control:

→  Step one: Inventory imaging and specialty department imaging content and solutions. Identify your timelines for refreshing imaging information technology (i.e., PACS) currently in place.

→  Step two: Identify important imaging management, view and workflow tools your clinicians utilize today.

→  Step three:  Assess your options in the market to get independence and control at each layer of enterprise imaging:

  1. Image visualization (enterprise image viewer)
  2. Image workflow/worklist capabilities
  3. Image storage and management (vendor neutral archive)


Questions to ask your organization and your vendors:

  • What are the benefits to implement some or all of enterprise imaging (de-coupled PACS) during an imaging solution or PACS replacement?
  • What is your organization’s expectation for technology providers as you work to bring “disconnected” patient content together for better results and cost savings?
  • What are the key considerations and roadblocks to achieving an IT architecture to support control of your organization’s image data?
  • What analytics, reports and visualization technology are needed most at this time to speed insight and operational effectiveness?


What does it mean to your personnel?

As with any enterprise strategy, the commitment to take control of your medical imaging data requires strong governance and operating controls.  Skillfully moving the organization forward to information independence from the Vendor Lock of proprietary PACS rewards the adaptive innovators willing to advance their organization.

Organizations recruit Enterprise Imaging Directors and staff charged with the responsibility to break down image silos to make this important clinical information more fluid across the organization’s stakeholders.

Directors of Enterprise Imaging must have a demonstrated knowledge of the clinical imaging content produced in specialty departments outside of radiology and cardiology; and productive strategies to manage them toward access across the organization in a patient-centric manner. Leaders in enterprise imaging need to be experienced in the imaging technologies currently implemented and informed on the innovations taking place in the market; with a focus on interoperability, image management strategies,
breath of visualization technologies, and workflow solutions that can be adeptly applied to their organization; and with an exceptional level of communication and organizational skills to achieve results.

Sandra Lillie


Sandra Lillie is a client and former candidate of Skinner & Associates.  Sandra is the founder of Mead Advisory services providing advanced strategy, and consulting expertise, to enable clients to leverage their organization to improve market alignment, collaboration, support and better results.  


Thinking about stratifying your imaging technology? Think about your people. Part 1:

by Skinner & Associates’ Guest Contributor: David Whitney, CTO of Medical Diagnostic Imaging Group

As healthcare organizations consider stratifying their imaging technology, augmenting technical skill-sets required to sustain a newly adopted platform can be easily overlooked.

What is a stratified imaging platform? A stratified imaging platform is simply deconstructing a unified single-vendor platform into modular and interoperable layers of applications. This modular approach to an imaging platform, if designed correctly, provides infinite flexibility for provisioning additional software and services across image producing systems. Interoperability standards allow an organization to utilize multiple technical vendors and solutions for a customized approach. This provides a technological fit for demanding imaging environments without reliance on a single vendor’s roadmap and innovation. Logically speaking, the PACS (Picture Archiving and Communication System) still exists in the core of stratified environments. However, the PACS may now be comprised of several physical layers of imaging technology which expands the technical footprint of an enterprise imaging solution. Most commonly, a VNA (Vendor Neutral Archive), EDV (Enterprise Diagnostic Viewer), and WFM (Work Flow Manager) at the core of the solution.

How does this impact technology? Each layer of a stratified environment has become increasing innovative. For instance, a true-VNA has an enormous amount of flexibility, including the ability to ingest not only modality produced DICOM images (as was the requirement for a PACS), but also non-DICOM formatted image objects collected from new sources. These sources can be as broad as mobile devices, digital documents, motion capture, and audio files. The VNA must also be highly interoperable and provide various integration methods to image producing devices and enterprise diagnostic viewers.

The enterprise diagnostic viewer also provides a great deal of flexibility, and capabilities continue to expand at a rapid pace. EDVs are comprised of integrated stand-alone software packages, pure web browser-based applications, and hybrids of both, depending on use-case. In any case, a modern viewer should provide a high-level of interoperability for image enabling a VNA. Now, an organization can provide many different viewer applications based on specific needs a user. Radiology can immediately take advantage of new innovations including not only standard radiology toolsets, but also enhanced specialized multi-modality rendering, data-driven imagery, and advanced visualization capabilities.

Although work flow managers have been utilized for years to some extent in radiology, a robust product line is quickly emerging. RIS (Radiology Information System) and EMR (Electronic Medical Record) platforms have evolved in parallel with rudimentary teleradiology worklists to diverse platforms for consolidating and managing patient procedures across the lifecycle of the patient encounter. These software applications are designed to create cost-savings and increased efficiency and quality by presenting relevant and actionable information to users within a consolidated interface. This means that radiologists are immediately presented with relevant information for rapid diagnosis and minimal administrative tasks. Inversely, supporting staff managing cases are provided the necessary tools to ensure relevant information and distribution of exams happens in accordance with quality and efficiency, while ensuring issues are identified, resolved, and tracked.

How does this impact personnel and resources? Disassembling a unified imaging system to create a modular platform requires governance, a solid strategy and diligent execution. Unlike implementing or sustaining a single-vendor solution, layering multiple vendors within a stratified platform may require many more points of integration, a broader knowledge of interoperability standards, robust vendor management, intense data aggregation, comprehensive regression testing and augmentation of supporting staff and communication protocols. There are several key technical roles and skill-sets to appreciate within a stratified environment:

Subject Matter Experts (SME): Possibly one of the most diverse skill-sets required to achieve stratification, the SME must maintain in-depth knowledge of an organization’s technical systems and capabilities with a deep appreciation for operational and clinical needs. Proposing and maintaining a multivendor solution requires that an SME must be abreast with current technology offerings best suited to the organization and a keen eye for identifying solutions to future opportunities. SMEs are critical to creating sanity in best practices for selection, implementation, utilization and optimization. A healthcare SMEs skill-set should contain deep technical experience, clinical practice and process proficiency, and security and legal comprehension.

Project and Portfolio Managers: More technology layers, vendors, and projects require more PM resources. Managing contracts, implementation, and change control within a multi-vendor environment means that an organization will be managing several enterprise imaging initiatives simultaneously. Although vendors may provide a portion of professional services, an organization’s PMO (Project Management Office) must bind all initiatives together into a tracked and communicated set of deliverables. Ensuring all initiative are timed and delivered accordingly is critical to the success of the objectives. An organization’s project management team needs to be diversified in broad technical knowledge while tracking with high-level business objectives.

Integration Engineers: Within a unified environment, application level integration (e.g. RIS/PACS) is provided within a closed architecture and maintained by a single vendor. Stratifying services across multiple applications and vendors implies that developing and sustaining a high level of interoperability requires engineering talent at many levels of integration. Although much of a single application’s support and development is commonly handled by the providing vendor, the urgency and criticality of a healthcare system means an organization must be prepared to support 1st level triage of system issues. Without maintaining at least a 1st level engineering staff versed in multi-vendor technology and interoperability, an organization is constrained to service level agreements with individual vendors which may not satisfy the needs of an organization’s users.

Informatics and Data Experts: A highly stratified environment introduces a multitude of data sources and flows. Creating actionable data from diverse applications and data sources requires aggregating data from multiple integration points, data repositories, and formats. The interoperability challenges seen during the wave of EMR (Electronic Medical Records) adoption is a great example of why organizations cannot rely entirely on a single vendor’s capabilities and resources to support actionable enterprise data. Without data expertise to assemble disparate data into meaningful information, an organization will be challenged to correlate data across the enterprise. And, without strong clinical informatics expertise to understand data flows across enterprise system processes, the organization will be challenged to provide and substantiate clinical decision-making. Both roles require a strong mix of technical and operational expertise to correlate relevant data and processes to business objectives.

Support Services: At the support desk, technology is always a problem and not the solution. As technology enabled devices expand across an organization’s environment, so do the challenges for support staff. This results in more devices to support, additional applications to understand, and a myriad of interoperability challenges to troubleshoot. Organizations need to understand the additional capacity and knowledge that may be required for a stratified platform.

In conclusion, creating a stratified imaging platform will provide a flexible and cost effective solution for an organization. However, the sustainability and success of a stratified environment is dependent on the people that support it. By analyzing resource requirements, identifying skill-set gaps, and understanding options for placement an organization can realign its people with the processes and technology. Part 2 will discuss how an organization can address resource challenges.



Dave Whitney is a former candidate and client of Skinner & Associates. Dave is the Chief Technology Officer at Medical Diagnostic Imaging Group based in Phoenix, AZ and a frequent contributor to the subject of Health Information Technology.

Journey to RSNA, HIMSS, and Beyond… Networking into the Future.

Tis the Season…… yes, it’s the time of year to be jolly and all that, but this time of year also brings me great angst and nervous anticipation as the two most important conventions in our industry, RSNA and HIMSS gear up for their big crowds.


If you don’t know about these two big conventions, you are probably not in the Healthcare IT, Imaging and Informatics world. RSNA always falls immediately after Thanksgiving which unfortunately shortens my much loved family time for that holiday. Yes, for the last 20 years I have said goodbye to my house guests, gotten my winter coat out of storage (I live in Florida) , packed my warm winter suits and headed up to Chicago for a week of networking and selling. I love it and I hate it…… like most of you…..but without it, my knowledge of the companies, the people, and the trends in our industry would be severely limited.

Which companies are growing? Which start- up companies are destined for success? Which vendors and hospitals are hiring? Does booth size really matter? What candidates are searching for new opportunities? What companies do I want to pursue as clients? What companies do I want to recruit from? What parties can I snag an invitation to attend? Are my feet too tired to squeeze in some Magnificent Mile shopping?

In preparing for RSNA and HIMSS, my recruiters and I study the exhibitor listings, check their websites, read their news updates, do endless google searches, schedule appointments, check the career sites, talk with our MVP candidates, etc… but by far, the very best source of my information comes from networking with trusted executives, industry gurus and consultants who understand the big picture much better than I and are “in the know” on most of my questions.   You know who you are and I thank you for your valued opinions and expertise!

Until then, enjoy RSNA and if you see me at your booth, kindly ask me to have a seat and chat awhile… my feet are probably killing me!

Welcome to my Blog… Join the Discussion!

For those of you who don’t know me in this industry, I would like to introduce myself. Here is what I am and here is what I am not!

I AM a “connector “of people, a networking guru, a matchmaker extraordinaire in the industry of Healthcare IT, Imaging and Informatics. I have been recruiting in healthcare for over 35 years and have owned my firm, Skinner and Associates Executive Search, for the last 16 years.   I know how to hire recruiters… exceptional ones, who understand this industry and know how to network their way to success.   We are one of the very few, if not the only nationwide executive search firms to specialize in Healthcare IT, Imaging and Informatics. We have a vast database of clients and candidates and an even greater network of LinkedIN connections!

I am NOT a subject matter expert, think tank provider or industry thought leader BUT I do know how to find and network with the best of them and I want to share their knowledge with you! I am starting this blog to discuss the issues facing our industry that will impact hiring needs now and in the future. How should companies (vendors, providers, and payers) anticipate those hiring needs and retool their staff to meet the future successfully? How should candidates position themselves to align with the best companies, the highest salaries, the most meaningful and fulfilling work, the best training, and enable themselves to build the best future potential for their careers? Do I have the answers to these questions? Heck no! Do I know people who could help shed some light on these topics and answer more of the “big picture” questions for all of us? Heck yes!

Skinner pic

So here’s the deal.   Starting in January 2016, I will be inviting guest bloggers to pose some thought provoking questions and give all of my readers their valuable insight as to where the Healthcare IT, Imaging and Informatics industry is headed , the challenges they face in getting there and how this might impact our careers and staffing requirements. I invite my readers to email me ( to suggest topics for discussion or let me know if you have an interest in being a guest blogger for the Skinner Spotlight.  A sneak peek into suggested topics for discussion include:

  • Hiring or retooling staff to support the new HIT stratified (or deconstructed) environment, current challenges of a multi-vendor platform environment
  • Risk and impact of multi-system environments with consideration for HITECH and HIPAA, resource requirements (including governance and leadership needs) to drive imaging transformation
  • The changing role of the PACS Administrator, contractor vs direct hire
  • Integrating the various “ologies”, interoperability for an environment that is stratified and how to hire the right people to integrate and test new modules and software applications
  • Accountable care, population health management, Big Data, security, moving to the cloud, data center consolidation, mobile technology, focus on the patient, etc etc….

Ahhhhh… so much to cover on these topics but we will spotlight the most important aspects and I will invite people from my network who are “in the know” to talk intelligently on these topics so we can all better prepare ourselves for the hiring needs and careers of the future.   We will learn and grow together, stay tuned!

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