From the Chair: SIIMbiosis™ - SIIM News Spring 2009

Bradley J. Erickson, MD, PhD
Chair

SIIM is responding to our difficult economic times by making creative adjustments to our plans—ones that we hope will keep SIIM viable for years to come. This is prompted by expected revenue reductions from the annual meeting, which is SIIM’s largest source of income. We suspect that both vendors and members will face greater challenges in justifying their attendance at the SIIM annual meeting this year. To assist individuals wishing to attend the meeting, the SIIM office has prepared a letter that potential attendees can share with their organizations to help justify their participation at SIIM 2009; contact SIIM for a copy of the letter. The annual meeting has been updated and streamlined this year to spotlight core focus areas and essentials such as implementing cost-effective solutions for attendees to take back and share with colleagues at their institutions. Meanwhile, some new planned programs and expansions have been placed on hold while we assess the impact of the economic situation on hospitals and imaging facilities.

Fortunately, SIIM has just completed a comprehensive survey of SIIM membership satisfaction. This study was focused on learning what current and former SIIM members value in SIIM and areas upon which we can improve. This data was thoroughly reviewed and discussed at a recent strategic planning retreat. The good news is that most members and former members responded positively and believe that SIIM provides significant value to its members. Some improvements that were suggested are improved content on the web, particularly for IIPs to deal with day-to-day issues. Another suggestion was more emphasis on interactive learning and less didactic lecture at the annual meeting, and changes to address this feedback have already been put in place within the SIIM 2009 educational program.

While no one enjoys the challenges of the current economy, it is an opportunity for us to focus on what is truly core to our organizations. In times of prosperity, we might have just looked the other way, but now, everything is getting a critical review. The routine maintenance and minor upgrades of IT systems are natural targets for budget reductions. Some of these may be done with little impact on users. Others could be the final straw that breaks the camel’s back. Knowing the difference is critical, and that is an important role for us in imaging informatics. SIIM can play an important role in supporting members through the challenging times by providing tools that assist in daily work activities; providing ongoing training and education for professional development and certification that documents the uniquely valuable profile of CIIPs; and helping to standardize job descriptions and expectations.

Since the times are tough, and we don’t have a huge development budget for a large software or hardware development project, I will take a more economical tact, proposing instead to coin a new term: “SIIMbiosis™”. I would like to coin this term to indicate the importance of having the correct relationship between medical imaging departments and informatics. Just as symbiosis can reflect a harmful, neutral, or mutually beneficial arrangement, it is critical that there be a collegial relationship between imaging departments and informatics to optimize the interaction between these two components of the enterprise. SIIMbiosis™ means constructively engaging those involved in creating and interpreting images, and those responsible for integrating and maintaining imaging informatics systems.

Not too long ago, SIIM (then SCAR) identified image overload as a significant challenge to the practice of radiology. It responded with the TRIP™ (Transforming the Radiological Interpretation Process) Initiative. This initiative was titled much more broadly than just image overload because it was (correctly) felt that focusing only on image overload would not be successful – that the whole process of interpretation would impact and be impacted by the image overload component of the practice. Image overload continues to be a challenge—indeed it seems worse, but maybe that is just my struggling memory. Certainly some tools and systems have improved in their ability to handle large data sets, but the gains have been disappointingly small, in my opinion.

That may reflect a lack of coordination in effort. There was an immediate need for existing systems to be modified to enable them to handle large data sets efficiently. That has been somewhat successful. The larger problem of using computers to extract and present the critical elements of these huge studies has not been addressed.

A successful imaging enterprise must work with the parts of the practice producing the large data sets to understand how best to meet practice requirements. The imaging devices in a modern radiology department are capable of producing huge volumes of data, but it is not clear that they should produce these large volumes, or that the entire data set should be handled in a uniform fashion. Many practices today create large series of images in order to produce other types of images, and then discard these source images. This is true for many modalities, most notably CT, MR, and even mammography. There is significant variation in how these are handled, and SIIM members could play a vital role in helping our field think about how to manage these appropriately. This variation exists within radiology departments, but I believe there is even greater variation in image handling policies in other departments, and the potential impact due to their large data demands could be much greater. SIIM members could serve as valuable guides to these other departments looking at the digital conversion.

Another SIIMbiotic relationship that must be cultured is the vendor-customer relationship. Having a single vendor for imaging modalities can be useful, but the benefit of a single vendor in the informatics realm may be even greater. The reason is that standards are not able to keep up with the rapid advance of the practice, and so it is common for vendors to implement ‘secret’ connections between their complementary products that improve performance and functionality. While we all look to greater interoperability between commercial systems, a strong relationship with your vendor(s) will make your organization stronger and more competitive in the short run, and probably in the long run as well.

Finally, SIIMbiosis exists between the imaging department and the referring physician and the patient. They are, after all, why we exist. If they are not benefitting from our services, they will look elsewhere. But for us to serve them well, we need to have good order information. Given that information, we are best able to perform the right test at the right time. Then we need to communicate results effectively and efficiently for them.

As we move into a new year, it is more important than ever for all IIPs and their institutions to stay abreast of the trends in health care IT and imaging informatics and maintain ongoing continuing education. This is not the time to fall behind; those who push forward and make an investment in their professional career now – while others may be holding back – will ensure their own value to the organizations they serve. SIIM – your professional society – is here to provide valuable education and resources to help you achieve that objective.

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