SIIM vets discuss issues facing imaging informatics

A question from the radiology news media-What are the biggest challenges facing the field?-led some Society of Imaging Informatics in Medicine veterans, participants on a panel assembled by the association, into discussion of a list of issues facing radiology informatics. Their comments produced insights into hot topics to watch.

Not all the answers were exactly new. Image overload and better integration between disparate PACS/informatics systems have been topics of interest for years. But they seem to be taking on more urgency as technology advances and the demands on imaging increase.

Other issues were more cutting edge. How radiologists report their imaging findings will need to change.

• Reforming the radiology report. SIIM is known for PACS information, but the next wave in imaging informatics will change the way radiologists report their information, said Dr. Curtis Langlotz, outgoing chair of SIIM. Key will be whether radiology reports can be integrated into the electronic medical record and cross-referenced with other information.

Researchers may want to mine the reports and correlate findings with biomarkers. How the reports are designed will be critical to these activities, he said.

Financial incentives are already in place to encourage radiology report reforms. Under its Physician Quality Reporting Initiative, the Centers for Medicare and Medicaid Services is offering a 1.5% bonus to practices that report specific types of data, including whether they observe guidelines for reporting carotid stenoses and certain stroke findings, Langlotz said. That program will be expanded, and what is now a bonus could become a holdback for practices that fail to meet reporting standards.

George Bowers, MBA, of Health Care Information Consultants, has worked as chief information officer at a large radiology practice and a big academic medical center. CIOs are concerned about the relationship between radiology and the electronic health record, he said. One of the big challenges for SIIM will be defining what imaging informatics is going to mean for the electronic health record.

"It's not just images popping up electronically; it's much more complex than that," he said.

• Pay for performance. Now, payers are not holding radiologists accountable for meeting quality standards, but that won't last much longer, said Dr. Eliot Siegel of the University of Maryland. As time goes on, radiologists will be required to collect data and report them in a standardized way that no radiology department is able to do at this point.

One possible measurement is radiation dose, he said. Practices would probably need to capture dose information and store it. This is not easy, and, as the pay-for-performance concept progresses, practices will need informatics solutions to gather and provide those data.

• Clinical validation. Getting validated data sets will be particularly important as informatics moves from displaying images on a screen to having a computer help figure out what's going on, according to Dr. Bradley Erickson, incoming SIIM chair.

"If I do a measurement-whether it's the size of tumor or vascular disease-I need to have a mechanism to know whether that's accurate," Siegel said. "I need rigorous science to make sure we move from radiology as an art form, which means producing good-looking images to be subjectively reviewed, to something we can actually use in the digital age."

Right now, software systems often provide widely varying figures for measurements of volumes or carotid stenosis, he said.

• Systems integration. "When I go in to work, I have to log on to three different systems; I have two keyboards and a mouse with each. It's too much," Langlotz said.

Systems integration is something computers ought to do well, but finding ways to cope in a multivendor-or even single-vendor-environment is a challenge, he said.

Sharing images concerned Siegel. The problem is resolved now by putting images on CDs, but these are often incompatible with different PACS. The issue has roused even the American Medical Association to put forward a resolution, particularly supported by neurosurgeons and oncologists, calling for a better system.

• Imaging overload. Katherine Andriole, Ph.D., director of imaging informatics research at Brigham and Woman's Hospital, cited the issue of imaging overload and expected the solution to involve finding new ways to navigate the data. Some concepts for doing this may be imported from the gaming industry and Hollywood, she said.