From the Chair: The Imaging Informatics Profession - SIIM News Winter 2009

Bradley J. Erickson, MD, PhD
Chair

I am sitting here writing this article at my kitchen table while watching the news: The economy is officially in recession. Over a half-million in the United States have lost their jobs—as bad as 1974. We are all seeing the effects of slowdowns, layoffs, and plant closings. The impact on health care is likely to be profound. We probably won’t see the bread lines—people waiting in line for food—that were too common in the 1930s. I think we will see (longer) lines at the emergency room. People probably will have food, but they won’t have insurance, forcing them to wait until their disease is certain and serious. Then they will appear at the emergency room because they know they can’t be refused.

Those of us who are a part of the health care system will feel the consequences. We will be asked to deliver substantially more with reduced resources. We all know that there are inefficiencies in the health care system—duplication of effort, duplication of imaging tests, little or no communication of what the patient has had performed. Redundant imaging studies are a significant problem for both patients and the health care system and will be more common when patients use emergency rooms as their primary mode of care.

I just returned from RSNA and, despite the news of the economy that I just described, attendance was solid, and most PACS and RIS vendors I spoke to said that this was one of their best years. My impression is that while there were fewer people in the booths, those that were there were very serious about purchasing.

How does one reconcile these views? The government views proper use of information technology as a part of the solution to the need for efficiency. The problem we have is not so much lack of information, as a lack of communication of information. We in health care repeatedly ask patients about their medications and allergies and chief complaint, because our systems do not communicate well enough. This problem is well-recognized and the vendors are responding.

Integration and pure web clients were hot topics at both the SIIM and RSNA annual meetings this past year. My impression is that while there were not too many new gadgets and gizmos in PACS and RIS, there was significant progress in the ability of vendors to provide a more seamless experience for users who need to use products from different vendors. It is important that this trend for greater integration continue. While some organizations have pursued a single vendor strategy, it is probably not possible for one vendor to provide the best tool in every category. The trend for health care providers to acquire others also forces greater integration across vendors.

The need for integration is broader than just health care, and many vendors have leveraged some of those tools. Web technology is one example of how one can provide a strong feel of integration of information even with so-called legacy systems. The trend to web clients in imaging informatics started many years back and continues to be strong. Every vendor clearly feels they need to have a web client to be viable. The rationale for web has been spelled out many times—it is usually easier to support, it can make integration with other applications easier, and it provides a wide distribution mechanism. Integrating information and information systems is one of the key interests of SIIM members. The technology that enables this is one of the key competencies of our members.

The next level above web clients is web services. Here also, web services and service-oriented designs are becoming more prevalent in medical imaging systems. While DICOM has proved a tremendous boon for imaging systems for many years, it does not provide the optimal method for image transfer across health care enterprises. The IHE profile for cross-enterprise document sharing for imaging (XDS-I) recently adopted web services as its preferred method for image sharing, and this promises to be a more efficient and supportable method for image exchange. Adoption of this will be the first major step to avoiding the widespread headaches associated with relying on compact disks as an image sharing method. Sharing non-image data like exam reports, descriptions, and annotations is also starting to develop momentum and will be important to actually controlling health care costs by improving system efficiency.

Imaging is clearly in the cross-hairs of the payors, and we will see reductions in reimbursement. Imaging informatics has a golden opportunity to play a central role in impacting the nature of the reforms that will be occurring. Efforts like Integrating the Healthcare Enterprise have demonstrated the ability of the imaging community to develop valuable technology that can share information: sharing the knowledge that a procedure has been done, as well as sharing the images and the reports.

Dr. Erickson is a Professor in the Department of Radiology at the Mayo Clinic, Rochester.