Vendor Neutral Archive Interoperability Radiology

Imaging is one of the few places a rural hospital can still turn a profit. Here's how not to waste it.

Mike Moore October 20, 2026

Imaging is one of the few places a rural hospital can still turn a profit. Here's how not to waste it.

There is fifty billion dollars moving into rural healthcare over the next five years, and most of the people spending it are doing it for the first time. The Rural Health Transformation Program sends money to all fifty states, roughly two hundred million dollars per state in year one, to modernize care in the communities that need it most. It is the largest federal investment aimed squarely at rural health in a generation. And on episode five of Flight Path, rural-operations veteran Mitchell Fong made a point worth pinning to the wall before anyone signs a purchase order: build for year six, not just year one.

That framing matters because year one has been a scramble. Vendors that never used to return a rural operator's call are now filling their inboxes. The temptation is to grab a stack of one-off tools while the money is here. Mitchell's warning is that the operators who do that will spend year three untangling a dozen disconnected systems. The ones who win will start with a strategy and keep the whole ecosystem in view.

 

Imaging is a rare rural profit center. Protect it.

Here is something that surprises people outside rural health. Most services in a critical access hospital run on cost-plus reimbursement, which is exactly what it sounds like: you recover your costs, and not much more. Imaging is different. As Mitchell put it, imaging is an area where, on a fee-for-service basis, you can actually have a healthier margin. For a lot of rural facilities, imaging is one of the few departments that can run as a genuine profit center, and that margin helps subsidize the primary and inpatient care that does not pay for itself.

So imaging is not just a clinical capability in a rural hospital. It is part of how the doors stay open. Which makes it worth asking a hard question: is your imaging actually earning what it could, or is it leaking value on the way out the door?

The repeat-scan tax

Here is where the money leaks. A patient gets imaged locally, then gets referred to a specialist in the city. The urban provider looks at the study and says, we need to repeat this. Maybe it lacks contrast, maybe it is a lower-quality image, maybe it does not have all the slices the specialist wants. So the patient goes back into a machine and redoes a test they already sat through.

That is a cost problem and a trust problem at the same time. Industry estimates put somewhere between ten and twenty-five percent of imaging spend on redundant, unnecessary tests, and the patient experience of repeating a scan is a poor way to start a relationship with a new provider. It gets worse: Mitchell notes that studies suggest somewhere around twenty to thirty percent of rural emergency transfers happen because the local center lacks the imaging or diagnostic capability in the first place. Every one of those transfers is a case that might have stayed local, and in rural medicine, a day in a distant hospital bed is real money.

And patients have learned the pattern. Some skip the local scan entirely, driving to the city for imaging they could have gotten down the road, because they assume it will be redone anyway. That is revenue walking out of the community, and it is avoidable.

The fix usually is not another machine

It is tempting to read all this as an equipment problem. Sometimes it is; a region genuinely short on CT or MRI should look hard at a shared, hub-and-spoke build rather than a scanner in every town. But often the scan already happened. The problem is that the image could not travel, or the specialist could not reach the priors.

That is an interoperability problem, not a hardware one. When a radiologist reads a new study, they want the prior exams next to it. When a specialist is meeting a patient virtually and cannot rely on physical touch, as Mitchell points out, the image is the exam. If the local study is high-fidelity and reachable, the specialist reads it instead of reordering it. The patient avoids the repeat. The payer avoids paying twice. And the revenue for that scan stays in the community that did the work.

Here is the plain version. A Vendor Neutral Archive, or VNA, is simply one place where every image lives, in a standard format, no matter which machine or software created it. A viewer sits on top so any authorized clinician, local or urban, can open any study from anywhere. Capture is the easy part. Reach is the part that pays for itself.

Three questions for anyone writing a rural imaging plan

  • When a patient is referred out, can the specialist actually open your images and the priors, or do they reorder the study by default?
  • Is imaging being treated as the profit center it can be, or is repeat imaging quietly handing that margin to the hospital down the road?
  • Are you buying a point solution for year one, or infrastructure you will still be glad you bought in year six?

If those questions are uncomfortable, that is the point. The gap usually is not capture. It is reach.

Where Mach7 fits

Making images reachable is the whole point of what we build. Mach7's Enterprise Imaging offering brings your studies into one Vendor Neutral Archive (VNA), moves them where they need to go with the Communication Workflow Engine (CWE), and opens them in the Enterprise Viewer (eUnity), with AI enablement for the tools your teams want to run, and Flamingo as our next offering. For a rural or regional network, the goal is simple: every image in one place, owned by you, readable wherever the specialist happens to sit, so the scan you did once gets read once.

Hear the full conversation with Mitchell Fong on Flight Path, available on YouTube, Spotify, and Apple Podcasts.

eUnity is a diagnostic viewer intended to display medical images and associated clinical reports to aid in diagnosis by trained healthcare professionals. Professional and prescription use only. In the United States only, eUnity supports digital pathology whole-slide imaging (WSI) for reference and referral use and is not intended for primary diagnosis.