RSNA: Informatics will drive patient-centric radiology

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CHICAGO—Radiology informatics is in its infancy, and new technologies combined with continued governmental oversight, will  bring radiologists into a more patient-centric, less department-dependent environment, according to a Nov. 28 presentation by Keith J. Dreyer, DO, PhD, vice chairman of radiology at Massachusetts General Hospital in Boston at the 97th Scientific Assembly and Annual Meeting of the Radiological Society of North America (RSNA).

The increased governmental influence, particularly through meaningful use incentives to promote the use of EHRs, has had and will continue to have tremendous impact on radiology workflow, noted Dreyer.

“For radiologists, the goal of meaningful use is to have more patient-centric medical records, as opposed to department-centric medical records,” he said. “Even though we as radiologists like to think of ourselves as wired up, most of us can’t access records from the provider down the street, so we aren’t really wired in the way the federal government is directing us.” He added that the ultimate governmental goal is give patients access to their records. 

He also suggested that several trends have been driving these changes, including consumerism, computing growth, high-speed internet growth, intelligent mobile devices and advanced interactive capabilities.

Also, economics forces are driving to decrease healthcare costs due to the federal debt, and as a result “imaging is in the crosshairs, with the goal of decreasing the cost of imaging exams and managing the utilization of imaging volume,” Dreyer said. He recommended this could be done appropriately with clinical decision support (CDS), as opposed to the radiology benefit manager. The American College of Radiology has made a CDS tool available as a web service that can be integrated into an EHR.

Finally, accountable care is going to rely heavily on quality, according to Dreyer. For radiology, quality will relate to image interpretation and reporting. “We need to improve patient clinical information that is provided to the radiologists, so we can discontinue the practice of ‘clinical correlation advised,’ and CDS will be integrated into the interpretation process.” Also, he said that image access and alert notification will change and improve, probably through federal mandates.

Existing technology refresh
“The main problem with current RIS technology is that it is a department-centric system,” said Dreyer, who suggests that it needs more integration into the EHR. 

He added that there is no innovation coming out of PACS technologies. “With PACS, we essentially are storing film in a bottlenecked system,” he said. “I think we’ll look back on PACS as a swing and a miss. We need to better use this concept as a multi-vendor component architecture, with multiple vendors adding software to a core product.”

In addition to RIS, he suggested that other radiology technologies will undergo a refresh:

  • Imaging archiving: The vendor-neutral archive will transition into standards-based archive and then to cloud storage. “We shouldn’t be creating silos of storage systems,” he said.
  • Image display will become storage independent with web or mobile access and the proliferation of medical imaging applications will continue.
  • Imaging management, “which really needs an overhaul,” will continue to be less tied to the department workflow, and more focused on patient-centric workflow,” Dreyer said.
  • Speech recognition will be much more cloud-based.

New technologies

“Cloud computing will be a major component of new radiology informatics, having a role in image storage, image sharing and speech recognition,” Dreyer said. Also, there will be a movement to smaller devices, such as mobile computing and tablets.

In addition to the greater utilization of CDS, he said that there will be a gradual advancement of personal health records, which Dreyer called “very new, but it will continue to move forward.”

“All these changes will lead radiologists to become more virtual, which could be a good thing or bad thing. The negative factor could be a further distance from the referring physician,” he concluded. “Radiology informatics is in its infancy and systems were initially deployed at an amazing rate. Refresh of installed technology will occur slowly and new technologies will occur more rapidly."