Debate portends radiology's shift from clinical to informatics-based

Some time in the not-too-distant future, your radiology department may report to the hospital's chief information officer. A drastic change? You bet, but the pediction was in tune with a strong undercurrent at the May Society for Imaging Informatics in Medicine meeting in Seattle.

From the plenary and scientific sessions to the educational presentations and hot topic debates and roundtable breakfasts, a sense that radiology is becoming as much an information discipline as a clinical one permeated the conference. Although radiology's product is still fundamentally clinical, these clinical data need to be shared with others in the healthcare enterprise more effectively, the argument goes. Making that happen requires informatics skills that bring radiology more in step with other medical specialties that are seeking to join the digital revolution.

Several factors could drive this shift:

• Multiple specialties are looking to store their data electronically. Radiology has led the way here, but as more specialties enter the picture, IT departments and CIOs will look for ways to consolidate the archive and make it easier to share elements among all the players. As was suggested in a debate at SIIM-"Who Owns PACS? IT vs. Radiology" (see article, page S-11)-centralizing the medical data archive offers economies of scale, and if data are centralized, they are going to be under IT.

• People factors are playing a role. In a roundtable breakfast, a group of PACS administrators, most of them from an RT background, discussed the challenges of bringing other specialties into the PACS archive. One of the issues is political.

Suppose you're managing a radiology PACS and a cardiology PACS, and there's a problem, said Charles Socia, of RIS vendor Empiric Systems, the roundtable moderator.

"Somebody in administration has the chief of radiology and the chief of cardiology screaming at him, and that guy says, 'Hold on, that PACS administrator reports to me now. You guys go back to your divisions, and we'll make sure it works.' That's how it happens," he said.

Besides cardiology, others with a need for digital data storage mentioned at various points in the meeting include dentistry, orthopedics, pathology, dermatology, and ophthalmology. Other specialties will surely join the queue. Dr. Paul Chang, an informatics expert who wears both radiology and IT hats at the University of Chicago, took the IT side in the "Who Owns PACS?" debate. He sees an opportunity for radiology to sit at the table with other medical specialties in IT discussions and to share the specialty's knowledge. As long as IT fosters and supports domain expertise, that expertise can be leveraged for the benefit of all.

Dr. David Channin, a radiology informatics expert, took the radiology side and warned of losses in autonomy if radiology does not control its informatics infrastructure. Domain expertise is the key, and it must take precedence over IT expertise. IT expertise is a toolbox, and tools don't drive the domain, he said.

Socia is the one who suggested that radiology could report to an IT department. He sees radiology as bringing a strong informatics background to this discussion. Radiologists are doing internships in informatics and studying informatics topics in residency and are thus well poised to lead in any transition.

That is, if there is such a transition. Socia also noted that several years ago, there were predictions that all of radiology would be well into a filmless era now, and we're not fully filmless yet.

But while none of this is certain, it's a good bet that all of radiology eventually will be filmless. In the same vein, it's wise for radiologists to give some careful thought to where an all-digital medical enterprise is going to take them.