The Next Era of Enterprise Imaging: Cloud, Reporting, and the Radiologist Experience

As radiology contends with rising imaging volumes, workforce shortages, and persistent burnout, enterprise imaging strategies are entering a new phase. Cloud-native platforms and intelligent reporting workflows are increasingly viewed not simply as infrastructure upgrades, but as foundational tools for improving reliability, enabling collaboration, and allowing radiologists to focus more fully on patient care.

Recently, Applied Radiology convened a roundtable discussion to explore how these technologies are reshaping enterprise imaging today, and where they are headed next. Moderated by Applied Radiology Group Publisher Kieran Anderson, the conversation featured Julie Pekarek, Chief Product Officer at Optum Enterprise Imaging; Richard Friedland, MD, Founder and Chief Medical Officer of Radloop; and Sonia Gupta, MD, Chief Medical Officer at Optum Enterprise Imaging.

A Moment of Alignment in Radiology

Asked what excites her most about radiology today, Pekarek pointed to what she sees as a renewed leadership moment for the specialty. Radiology, she noted, was among the first areas of medicine to embrace digital transformation, and with clearer cloud and AI use cases now gaining traction, it is reclaiming that role. With more mature technology and improving adoption curves, she sees radiology once again positioned as a technology leader within healthcare.

Dr. Friedland described the current environment as a “golden moment” for the field, one defined by growing alignment among health systems, vendors, and radiologists. Across these groups, there is increasing consensus around shared priorities: efficiency, quality, and sustainability. Cloud-native platforms, he noted, enable innovations to scale uniformly across sites rather than remaining siloed within individual departments.

Enterprise Imaging and the Patient Record

Pekarek emphasized that enterprise imaging is increasingly understood as part of a broader patient record strategy, one that extends the electronic health record beyond alphanumeric data to include a longitudinal imaging record. Together, these elements form a more complete view of the patient that can follow them across care settings.

Patient expectations are a major driver of this shift. Pekarek pointed out that patients increasingly expect their imaging data to be as accessible as other digital information in their lives. “Handing someone a CD today is like handing them a rotary phone,” she said. Cloud-based enterprise imaging supports easier access and sharing of images, helping clinicians and patients move more seamlessly across sites of care while supporting more timely clinical decision-making.

Reliability, Trust, and the Cloud

From the radiologist’s perspective, Dr. Friedland highlighted reliability as one of the most meaningful benefits of cloud-based systems. One of the daily stressors of radiology practice, he noted, has traditionally been uncertainty around system performance and dependence on onsite IT support. Cloud-native platforms reduce those points of failure, allowing radiologists to focus on interpretation rather than troubleshooting.

Trust has become a defining factor in this transition. Pekarek pointed to advances in cloud maturity and cybersecurity as key reasons health systems are increasingly comfortable moving core imaging workloads to the cloud. Friedland agreed, noting that attitudes have shifted markedly. Where “the cloud” once prompted hesitation, it is now widely viewed as dependable, scalable, and secure.

The Digital Transformation of Reporting

As enterprise imaging infrastructure has evolved, reporting has undergone a parallel transformation. Dr. Friedland traced a major inflection point to the adoption of structured reporting, when reports began to be viewed less as narrative text and more as data assets. Once reporting became data-driven, it opened the door to analytics, quality measurement, and meaningful application of AI.

Pekarek noted that health system leaders today are focused on maximizing existing investments rather than replacing core systems. Intelligent reporting tools, particularly those enabled by AI, offer a practical way to add automation and efficiency without wholesale platform disruption. Reporting, she said, has become one of the most impactful areas for near-term AI investment.

Addressing Burnout Through Workflow Intelligence

Dr. Gupta, speaking from her experience as a practicing oncologic radiologist, emphasized how small workflow gains can have outsized impact. Faster access to prior studies, streamlined navigation, and AI-assisted reporting may save only seconds per case, but those seconds accumulate across hundreds of exams each day.

She also highlighted the role of AI in reducing both clerical and cognitive burden. Automated measurements, draft reports, and decision-support tools help radiologists spend less time on repetitive tasks and more time on complex interpretation and communication. With burnout affecting more than half of radiologists, according to Dr. Gupta, reducing this burden is critical to sustaining the workforce.

Dr. Friedland added that advanced reporting platforms can embed guidelines, quality metrics, and supporting literature directly into reports, improving consistency while reinforcing the clinical value of radiology’s contributions, an important factor in combating burnout.

Closing the Loop on Patient Care

A recurring theme throughout the discussion was what Dr. Friedland described as the “last mile” of radiology: ensuring that findings translate into appropriate follow-up and action. Unified, cloud-based workflows make it easier to track recommendations, communicate across care teams, and reduce gaps in care.

Dr. Gupta noted that this visibility provides radiologists with peace of mind. Knowing that findings are acted upon, and that patients are not lost in the system, addresses one of the more subtle but significant stressors in daily practice.

Looking Ahead

Looking three to five years ahead, the panelists envisioned more unified and anticipatory workflows, with AI increasingly handling logistical and administrative tasks. This shift, Dr. Friedland suggested, will allow radiologists to return more fully to consultative roles, focusing on complex problem-solving and multidisciplinary collaboration.

For health system leaders embarking on enterprise imaging transformation, the advice was consistent: think long-term, select trusted partners, and begin with governance. As Dr. Gupta emphasized, strong governance, particularly around AI, sets the foundation for sustainable, patient-centered innovation. Together, these perspectives point to an enterprise imaging future defined not only by technology, but by alignment, between systems, clinicians, and patients—enabled by cloud-native platforms and intelligent reporting.