Transition of Imaging Informatics Can Give Radiologists Value

The decision to transition from departmental PACS to enterprise IT is not always a popular choice, but larger scope brings more opportunity for radiologists.

Since its implementation, PACS has been a trademark for radiologists. They had good times and bad, but regardless, PACS was always theirs, and separate from IT. Until now.

Image sharing- and EMR-talk is inescapable. It was only a matter of time until PACS was invaded, and now everyone wants access. Controversy ensues when processes are changed but this may not be a bad thing, according to experts at SIIM 2014.

Radiology pioneered the use of IT, Albert Oriol, vice president and chief information officer, Rady Children’s Hospital, San Diego, said at SIIM 2014. He explained that clinicians in other specialties have their own systems and are happy, but as EMRs are put in place, other people want access to the system and want to inter-operate. “Doing that when all of these systems are one-of-a-kind and managed independently becomes really complex, really expensive, really quick, so that drives some of the convergence,” Oriol said.

“I like to argue that although there is a lot of fight sometimes about imaging informatics and who owns it, we all come from the same place,” said James Whitfill, MD, chief medical officer, Scottsdale Health Partners. PACS is outgrowing a departmental solution, Whitfill explained, and is coming under the jurisdiction of enterprise IT.

An increase in users outside of radiology, other departments wanting to store their images in PACS, new regulations and declining reimbursement have also contributed to the push to enterprise IT, Whitfill said.

The world of radiology has changed dramatically over the last 20 years, Whitfill said. Radiologists are having to do more with less, and looking at economies of scale and sharing resources across common IT systems has advantages, he explained.

At SIIM 2013, 30 percent of the audience reported that PACS was now in enterprise IT, while 37 percent claimed that PACS remained in the radiology department. The rest of the respondents reported a mix or other structure.

One of radiologists’ biggest fears of enterprise IT is presumably the loss of control.

“Radiologists want to grab on to PACS with their hands and put chains on and attach themselves to the racks because [they] have this fear that with all the security and controls, [they’ll] end up having to fill out a support ticket, the ticket will go into a phantom cube and they’ll never see anything with it,” Whitfill said.

“It’s important for radiologists to know we are no longer the favored child,” Whitfill said. It’s not the end of the world, he explained, we can either worry that we don’t get to be the dominant feature on the IT storing agenda, or we can figure out how to be part of the solution.

“We need to understand the perspective of enterprise IT, we have a lot to learn from each other and a lot to contribute to each other,” Whitfill said.

IT groups don’t have the clinical alignment that you have, said Louis Lannum, director, Cleveland Clinic Information Technology Enterprise Imaging and MyPractice Imaging solutions. “IT wants that clinical alignment, they want to be partners in a clinical space, [radiology professionals] know how to do it, you’ve been doing it for years as PACS coordinators or system analysts in your departments,” Lannum said.

Lannum’s organization recently underwent a transition to an enterprise focus and he suggested that radiologists get in front of all imaging activities that are going on in their organization.

There is an opportunity to get out front because IT guys don’t want to touch imaging, they want to manage the run, Lannum said. “IT has infrastructure, but you have clinical connections.” There is a space to become imaging experts in your organization, no one is managing imaging and it’s starting to explode outside of radiology and cardiology, he said.

The opportunities for convergence, Oriol explained, are in the underlying architecture, factors like network, storage, presentation and interface. The need to scale also offers opportunity.

 “I can try to make better utilization of my resources by sharing and pooling them and studying where those peaks hit and, for the most part, what we see is that when you consolidate the sum of those peaks, it’s way bigger than what you need when you have something consolidated,” Oriol said.

Lannum admits the transition wasn’t easy, but he seized opportunities by making himself at the forefront of the process and bringing to the table a more strategic planning approach and a clinical alignment strategy.

It’s important to remember that even if other organizations struggle with the transition, that doesn’t mean that all organizations have difficulty. The comfort in the transition is that enterprise IT does not need a centralized structure and can accommodate different organizations that have different cultures, different needs and different constraints, Oriol said.

“As you think about how you move forward with your organization, you’re going to need to prioritize what tools you put in place to get you there, it’s an evolution and the thought here is that you have to move at the pace that is right for the organization,” Oriol concluded.

“A lot of IT organizations are trying to be a lot more flexible in what they’re doing,” Lannum explained. He recommended developing a forum where clinicians and their IT colleagues can exchange ideas and learn from one another.

Oriol’s advice to those transitioning to enterprise echoes Lannum’s, “you guys are the experts, and while IT might have the expertise on managing databases and managing storage and doing the hardcore technology, that understanding of how the workflows function, how things that work in one area can be leveraged in another…is priceless.”

With a larger scope comes more responsibility, Oriol said, but also comes more value.