Comment: PACS, I'd like you to meet RHIO and P4P

Over the years, we've grown comfortable and familiar with the digital revolution in radiology. Actually, in many quarters it is no longer a revolution but an accomplished fact.

Outside of radiology, however, another digital revolution is taking place, and it promises to bring as much change to the rest of medicine as PACS brought to radiology. Its elements will eventually reach into the digital radiology realm, both learning from it and altering it.

In early March, I attended the Health Information Technology Summit West, a conference sponsored by the Washington-based eHealth Initiative and a variety of vendors, nonprofits, and administrative and physicians' organizations, several of them in primary care. Unlike PACS conferences I've attended in the past, radiology played only a minor role. The talk at this meeting was not about moving images, but of exchanging the entire range of health information within and among larger organizations.

Some powerful forces are pushing this concept forward. Health system managers see it as a way to wring costs and costly errors out of our healthcare system. A few widely publicized studies (see "Health IT coordinator targets medical errors," page S-13) raised some doubts about how far along we are on the digital medicine path, but these are bumps in the road.

The federal government is playing an important role in this process. At the conference, presentations by the Agency for Healthcare Research and Quality and the Centers for Medicare and Medicaid Services demonstrated a commitment to the digital transformation of healthcare.

Last year, a California physician, Dr. David Brailer, was named to head up the government's health IT drive. Brailer's Framework for Strategic Action established the ground rules for regional health information organizations that could become the backbone of the nation's health IT effort.

It was apparent at the conference that the regional health information organizations, or RHIOs (pronounced like the Brazilian city), have the potential to link up disparate organizations to create large networks of health information. It was also apparent that these networks could be transformative in helping achieve the goals of better quality and more cost-efficient healthcare. (See "HIMSS tackles continuity of care with community EMR," page S-11) Pay for performance (P4P) is another concept that received a lot of attention at the conference. Primarily a reimbursement and management strategy, P4P rewards insurers and provider organizations for achieving particular objectives.

It figures into the IT setting because it imposes performance requirements-a basic one might be the rate of annual mammography screening exams among an insurer's 40-and-older female membership-that must be documented with data. Collecting those data is done most efficiently with IT systems. In addition, some P4P systems are making the achievement of certain IT goals part of their objectives.

What does this mean for medical imaging? Although PACS and radiology information systems have a solid foundation in medical imaging, they will increasingly be required to interact with other systems that are emerging under the health IT initiatives the federal government and medical system managers are promoting. Images soon may be in high demand within the RHIO. Similarly, certain services that medical imaging provides, such as mammography, could become P4P objectives.

Look for your experience with PACS adoption to take on new dimensions and qualities as the digital revolution extends its reach.