How an enterprise imaging blunder nearly cost an expert his job before it even began

Undertaking a true enterprise imaging strategy means more than selecting a vendor with technology tailored to specific needs. It involves communication and outreach.

Nobody knows this better than Chris Roth, MD, PhD, the vice chair of information technology and clinical informatics at Duke University Medical Center.

In 2014, the North Carolina system’s radiology department bought an image exchange application that had been in use by two hospitals at the time. Roth, then beginning his role, led the search. Although the application was working well for the radiology department, the situation quickly deteriorated after he brought in other specialties.  

“Before I even started I almost lost my enterprise imaging role,” Roth said during a session at the Society for Imaging Informatics in Medicine (SIIM)’s 2018 annual meeting.

Radiologists and those in other specialties began to question his dedication to teamwork. The prevailing narrative around him became one of a young, brash leader who chose a system that worked for his department without consulting others. His CMIO began to question Roth’s competency.

Even his personal life was affected, which was “hard to overcome,” Roth said. He had his first two kids around this time period. He promised his family things would slow down, but they only became increasingly hectic.

The application is still in use today and working well, he noted, but it has a negative connotation with users.

He offered a few words of advice for leaders trying to execute on a similar enterprise-wide strategy, including his realization that communication and outreach is more important than speed.

“I had to learn this, and I have the arrow holes in my back to show it,” he said.

Turn and face the change

Roth, now director of imaging informatics strategy at Duke, was not the first or won’t be the last to stumble with through an informatics project. What truly matters, he said, is what comes after the fall.

He detailed a formalized governance measure Duke has put into place following the enterprise imaging debacle during a separate session at SIIM18.

The institution created an enterprise operations committee, which Roth sits on and is chaired by the CIO and CMO, to oversee the flow of money outside of Duke, Roth said. It has formalized the path toward starting an evaluation of new technologies and projects.

Once a specialty, such as cardiology, creates a communication document outlining its needs, the committee investigates existing systems and potential upgrades to infrastructure. If there is nothing that can be done internally, the team begins to look at defining use cases, technical demos and evaluations and eventually system selection, he said.

For Roth, although the informatics blunder still sticks closely with him, all the positive measures now in place were a direct response to those growing pains.

“This is part of the reason I’m so focused on governance today, because I really blew it,” he said.