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J Digit Imaging. 2016 Oct;29(5):559-66. doi: 10.1007/s10278-016-9888-7.

Orders- Versus Encounters-Based Image Capture: Implications Pre- and Post-Procedure Workflow, Technical and Build Capabilities, Resulting, Analytics and Revenue Capture: HIMSS-SIIM Collaborative White Paper.

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Department of Information Technology, University of Miami Health System, 1425 N.W. 10th Avenue, Miami, FL, 33136, USA.
Duke Health Technology Solutions, Hock Plaza, 2424 Erwin Road, Durham, NC, 27705, USA.
Department of Radiology, Duke University Hospital, 2301 Erwin Road, Box 3808, Durham, NC, 27710, USA.
Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, MLC 5031, Cincinnati, OH, 45229, USA.


The decision to implement an orders-based versus an encounters-based imaging workflow poses various implications to image capture and storage. The impacts include workflows before and after an imaging procedure, electronic health record build, technical infrastructure, analytics, resulting, and revenue. Orders-based workflows tend to favor some imaging specialties while others require an encounters-based approach. The intent of this HIMSS-SIIM white paper is to offer lessons learned from early adopting institutions to physician champions and informatics leadership developing strategic planning and operational rollouts for specialties capturing clinical multimedia.


Clinical multimedia; Clinical photography; DICOM; Dermatology; ECM; EHR; Encounter; Encounters-based; Enterprise archive; Enterprise imaging; Image capture; Imaging; Imaging informatics; Imaging workflow; MWL; Medical photography; Opthalmic imaging; Orders-based; PACS; Scope video; VNA; Visible light imaging; XDS; XDS-i; non-DICOM

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