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Radiology, Meaningful Use, and Consumer-Driven Healthcare: How Do All the Puzzle Pieces Fit Together?

August 28, 2012
by Mark Hagland
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Eliot Siegel, M.D., offers his perspectives on the future of imaging informatics and on the EHR usability gap for medical specialists

On Aug. 27, Eliot Siegel, M.D., a professor of diagnostic radiology and nuclear medicine at the University of Maryland School of Medicine, and director at the Baltimore Veterans Affairs Medical Center, in Baltimore, Md., delivered the opening key note address at the “Merge Live” client conference sponsored by the Chicago-based Merge Healthcare. The conference, held at the Swissotel in downtown Chicago, brought together several hundred leaders from Merge Healthcare customer organizations. Dr. Siegel shared with attendees an update on the work he’s currently involved in with the IBM Watson project, working to translate some of the Watson concepts into the medical environment. He also shared with his audience his perspectives on where electronic health records (EHRs), picture archiving and communications (PACS) systems are in terms of meeting the needs of practicing radiologists and other medical specialists, and what the journey ahead might look like.

Following Dr. Siegel’s keynote address, Merge Healthcare chairman Michael W. Ferro, Jr. presented to attendees his vision of Merge’s direction going forward, which he said would be strongly driven by the combination of the increasing demands on the part of patients and healthcare consumers for more convenient scheduling and other satisfaction-related factors, and of steadily improving technological capabilities, the leveraging of which, he predicted, would make all the difference between successful providers and their less-successful competitors.

For example, Ferro noted, the suite of capabilities that Merge is completing development on, known as “MergeClear,” will soon allow a physician to press a button on her or his smartphone, using a new Merge app, and will instantly be able to facilitate a patient’s making a diagnostic imaging appointment. Combined with kiosk technology at the front desk of an imaging center, he said, radiologists and their staffs will soon be able to greatly ease the challenge patients face in arranging imaging appointments and going through the check-in process. The suite of technologies involved, he announced, would be available by the first quarter of 2013, under an allied site called

“It is us against them,” Ferro said of Merge Healthcare’s vendor competitors. “All I care about is Merge customers. If you’re a hospital, you’re my customer. If you’re an imaging center or physician practice, you’re my customers. I want to make sure you get more customers and win. Because there are going to be a lot of losers in this space.”

Looking at diagnostic images more broadly

After the morning’s presentations, Dr. Siegel sat down with HCI Editor-in-Chief Mark Hagland to discuss his perspectives on the future of imaging informatics and the large gap between EHR reality and the need for greater usability on behalf of medical specialists. Below are excerpts from that interview.

When you look at EHRs, PACS, and other clinical information systems, what is your perspective on where the various clinical information systems are right now in their evolution, and how they need to evolve to meet the needs of medical specialists, including radiologists and referring physicians?

On the one hand, we are in an era where the technology is incredibly advanced and sophisticated; and on the other hand, the imaging informatics and EMR systems we have are incredibly dumb. I brought up the example that when I try to sign into the PACS system at my own hospital, I’m required to type my full name in capital letters. If I type my name in, in any other way, it won’t sign on, but won’t explain why. Or the system will give me a message or notice to the effect of, are you sure you want to do that? And I’ve been spending the entire day working on that issue, but it still asks the same question over and over. And, while I’m dictating my notes for transcription, I can say a measure of 4.8 centimeters on an aneurysm, and the transcription system will type out, “foreplay.” It should have a mechanism to tell me that its level of confidence for that is significantly lower than normal. So, we talk about our pets and kids training us instead of us training them; and [in clinical informatics], we put up with so many things that are so counter-intuitive and dumb.

Eliot Siegel, M.D.

And, as a result, we end up with clinicians being resistant to using those systems, correct?

Yes. I helped achieve the first filmless radiology department in a hospital, at the Baltimore VA. We were the first hospital in the world, in 1993, to go filmless. And what we were really trying to do is to have a way to not lose the images, and to make the images available to everyone. Back then, that was incredibly revolutionary; and we weren’t sure whether it would take the radiologists longer to read the images. We weren’t even sure whether it was legal, because the state at the time had mandated that you keep film for seven years. And the resolution on screen wasn’t equivalent to the resolution on film.

But now, it’s 19 years later, and being able to have images digitally is really pretty much taken for granted. And, at my hospital, we’re in the process of replacing that original system. And in 2012, how can we transform what seems to be an incredibly dumb system that really doesn’t talk very well to other systems, and prepare for the next generation?

Paging Mrs. McGilliguddy

You have an interesting story to tell regarding a visit you made to the Mayo Clinic in Rochester, Minnesota, years ago.