SIIM presenters offer conference insights
The 2008 Society for Imaging Informatics in Medicine (SIIM) conference clearly demonstrated that diagnostic imaging has moved beyond the radiology department to the healthcare enterprise. The integration of data from clinical specialties across the medical continuum has long been the goal of groups such as the Integrating the Healthcare Enterprise (IHE)—an objective that may at last be coming to fruition, according to two presenters from this year’s meeting in Seattle.

“There are still quite a few challenges for imaging informatics professionals (IIPs), with one big one being the integration of information across the enterprise and ensuring quality transfer, storage and retrieval of information from different systems,” said Elizabeth A. Krupinski, PhD, research professor in the department of radiology research at the University of Arizona in Tucson.

Krupinski, also a SIIM board member, chaired the organization’s research and development symposium during the annual meeting.

“Some of the other challenges are more specific to the radiologists and pretty much center on workflow issues—getting through the very large amounts of image data in an efficient manner without incurring a negative impact on diagnostic accuracy,” she added. “These issues were all addressed at the conference and some interesting potential solutions proposed, but there is still a lot of work to be done especially on the workflow issue.”

Herman Oosterwijk, president of the Denton, Texas-based healthcare informatics education firm OTech, and a scientific session presenter on DICOM integration and troubleshooting, said that IIPs gain tremendous insights from interacting with one another at the meeting; oftentimes, this can be of more value than attending educational sessions, he noted.

“Ongoing challenges for the IIP include dealing with the advent of digital mammography, which is a challenge by itself from a workflow perspective, and integrating cardiology, 3D software packages and voice recognition—yes, rads still hate it after all these years—and supporting the operating room,” he said.

Krupinski was most impressed with the growing utilization by imaging interpreting physicians of on-line resources as well as the integration of data from image-based clinical specialties outside radiology.

“There were two areas that I saw some new directions being taken,” she said. “One was with studies looking at the use of free online radiology search tools such as by radiologists. There were a few studies, mostly descriptive in nature, that reviewed search logs to determine where radiologists were searching from, how long they were staying online."

“Since it was just looking at logs the investigators could only conjecture about reasons for searches, what they were doing for X amount of time, but there were some interesting statistics about where the users were and how long the search sessions tended to be. It would be interesting to poll users to get a more in-depth picture of their motivations and their reactions to the information available via such searches, but it seems clear that these types of on-line search tools are only going to become more popular in their use,” she observed.

“The second area was that there were a few more presentations on informatics from other image-based clinical specialties. There was one talk on the incorporation of burn images into a PACS that really demonstrated how, with the right support and people, imaging informatics can work for many different applications. Another talk that I found significant was on DICOM for teledermatology as its being implemented in the VA system,” she noted.

Oosterwijk found a debate pitting IHE against service-oriented architecture (SOA) interesting, yet also troublesome.

“The SOA discussion got a lot of attention, but I truly don’t see it happening in the real world really soon,” he observed. “Remember, IHE is now getting close to its tenth year and yet only very few sites are compliant with the most basic profile—scheduled workflow. We first should concentrate on getting this implemented in the field before we come up with other great acronyms.”

In addition to its educational and scientific presentations, and networking opportunities, the SIIM conference also allowed attendees to take the pulse of trends in imaging informatics via hands-on demonstrations and vendor technical displays.

“One early trend is the broadening of the definition of imaging informatics to go beyond just radiology and into the entire healthcare enterprise,” Krupinski noted. “We see a little bit of it each year at the meeting with talks on pathology, dermatology and burn care, but it's only just beginning to cross-specialty boundaries. This is likely to increase dramatically in the future as telemedicine applications become more common as a function of reimbursement codes changing to become more favorable,” she observed.

“There were some products on the exhibition floor that reflected this trend as well, showing some neat products such as an information portal system (Blue Ocean, Exogen) that simply accessed a variety of information systems within a hospital to provide an integrated set of patient data such as radiology, pathology, labs, cardiology and pharmacy in a single intuitive interface. These types of systems are likely to change the way decisions are being made about patient care in the very near future,” she noted.

Ongoing work in system integration by a variety of developers was the trend that most impressed Oosterwijk in the technical exhibit hall.

“There was a significant emphasis on infrastructure,” he said. “After all, what good does it do to have a half-hour report turn-around time if you can’t find the referring physician for another two hours to convey a critical finding? Teaching files are also becoming more important, as is witnessed by McKesson’s purchase.

“Another area I found notable is the advent of middleware: the Mayo clinic in Arizona is using Acuo boxes to make up for a lack of fault tolerance and a limited number of associations to their direct-attached storage (DAS) boxes. In addition, Exogen’s demo of a unified worklist was noteworthy; its viability is a direct result of vendors not using a standard worklist mechanism as defined by DICOM,” he said.
Oosterwijk said that IIPs should take notice of this development trend and look to how their systems and workflow can be improved using appropriate middleware solutions.