Overheard at SIIM14

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 - SIIM14

In May, informaticists, radiologists and other imaging IT stakeholders flocked to Long Beach, Calif., for the 2014 annual meeting of the Society for Imaging Informatics in Medicine (SIIM). The conference offers a chance for professionals to learn from one another and collaborate on the biggest issues in informatics.

Big data was the phrase on everybody’s lips. J. Raymond Geis, MD, chair of SIIM, set the tone with his introduction to the 2014 Dwyer Lecture that kicked off the meeting. “There’s a big new wave of images being generated in every clinical specialty,” he said. “From the first responders and EMTs up through primary care and the medical and surgical subspecialties.”

Geis also quipped that there are actually thousands of image viewers in each facility, if you count all the smartphones. This may feel like a bit of a nightmare for IT security, but it’s the reality.

Other presenters focused on the overwhelming tidal wave of data imaging continues to generate, and you can read more about what SIIM 2014 had to say about big data in this month’s cover story starting on page 6.

Big data also shared the SIIM headlines with discussions of data integration and bridging gaps across the enterprise—both in terms of breaking down imaging silos and bringing staff in different departments together—and clinical decision support and reporting. Read on to learn about a few other highlights Health Imaging saw trending at the meeting.

Decision support dilemmas

Integrating clinical decision support (CDS) in imaging is certainly more than a simple plug-and-play process. Thought has to be put into both when and how recommendations from a CDS system are presented, according to a presentation from Curtis P. Langlotz, MD, PhD, of the University of Pennsylvania Health System in Philadelphia, and Luciano M.S. Prevedello, MD, MPH, of The Ohio State University Wexner Medical Center.

The idea is to blend imaging appropriateness recommendations with other steps in the imaging process, such as safety checks, protocoling and scheduling. “In our view, this is all connected,” said Prevedello.

He offered the example of a patient referred for CT, but decision support recommends MRI would be better for the given indication. If processes are not in place to properly screen patients, an implant that’s not MRI compatible, for example, may not be discovered until the patient arrives for image acquisition. This then triggers another request, and can snag scheduling. A patient contraindicated for contrast is another example of when the optimal scan for an individual patient may not be what’s recommended by the CDS system.

CDS must be well integrated with existing systems and fine-tuned as decision support messages are displayed to users, Langlotz stressed. At his institution, initially the CDS was launched by the EMR upon order validation. The user was then prompted to go through the CDS process and provide information before a recommendation was given. Once the process was complete, the user was returned to the initial screen that prompted the start of the CDS process, which confused some users into unnecessarily activating CDS again, trapping them in an infinite loop at order entry.

CDS integration also should be mindful of workflow by not interrupting a user if the selection is deemed appropriate, advised Langlotz. Only if CDS recommends a different procedure should an alert be displayed.

Lastly, he suggests providers consider the tradeoffs between comprehensiveness of CDS and inclusion of only high-quality evidence. There are hundreds of procedures in a given order catalog, and not all have strong evidence-based guidelines. While some procedures will have appropriate use criteria from a given organization, it is up to a provider to determine whether the criteria is worthy of inclusion in the CDS process or merely the opinion of a small panel that may be beneficial to consider but is not based on extensive evidence.

Bringing radiology & IT together

Radiologists rely on quality IT professionals to keep systems running, but breakdowns in communication and misunderstandings between the two groups can lead to barriers and a less than cordial work environment.

Speaking at SIIM, Adam H. Kaye, MD, MBA, of the Hospital of the University of Pennsylvania, revealed the results of a survey of radiologists and IT staff at his institution that showed both groups had much to learn about each other.

The survey, completed by 95 radiologists and 14 IT staff members,