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The Elastic Universe and its Impact on Imaging Informatics

November 13, 2014
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The information system universe is changing. Who will be the next force to shape "universe" of radiology?

I’ve always been fascinated by the universe, galaxies, milky way, etc. and the vast size of it all, plus the forces that are forever creating changes within it.  The same might be said of imaging informatics, particularly as they apply to radiology.  In anticipation of the upcoming Radiological Society of North America (RSNA) meeting in a few weeks, this is one trend that will be getting close scrutiny!

The issue for radiology is the changing landscape of information systems.  Some within the industry have written off the Radiology Information System (RIS) in the wake of the Electronic Medical Record (EMR), as the order management and scheduling processes shift to the EMR.  Those in this camp believe that the remaining RIS functions will be absorbed into the Picture Archive and Communications System (PACS).

Others believe that there is a continuing role for the RIS, given smaller facilities and imaging centers that may not have a need for an EMR.  International requirements also favor the continuation of a RIS as they are not be under the same meaningful use (MU) constraints as in the United States.  And, there are those who feel that the RIS will evolve into a workflow engine for radiology operations, as new functionality such as dose management emerges. 

Besides the technology turmoil, there is the changing landscape of informatics companies, most notably Cerner’s acquisition of the Siemens Soarian product.  Recently, there has been speculation as to whether ongoing discussions between Siemens and Cerner will result in further extension to include the Siemens syngo Workflow RIS.  This is a particular dilemma for facilities that might be on both the Soarian Clinicals and syngo Workflow platforms.  Should such a facility switch to Cerner Millennium for clinicals, it would most likely also include switching to the Millennium RIS.  Alternatively, if they have a tightly coupled RIS-PACS, does it make more sense to go in this direction?

These changes present challenges to prospective RIS-PACS acquisitions.  Should anyone in the market today be considering a RIS in light of EMR, PACS, and potential radiology workflow developments?  How does one decide who will prevail?  Who is best to address this?

From the user’s perspective, it probably doesn’t much matter – as long as the systems interoperate and provide what is necessary to interpret studies and manage the department.  There are some interesting perspectives to this however that should be considered.  For example, PACS have classically been simply about acquiring, displaying, and managing image studies.  The reporting and management aspects have historically evolved around the RIS.  Are PACS vendors knowledgeable enough to take on these added functions?

The argument can be made that PACS vendors are closer to the imaging devices, and therefore have a better understanding of the workflow requirements for interpretation and administration of radiology operations.  The counter argument is that Information Systems companies (such as Cerner, SMS, IDX, etc.) filled a void between hospital information system and PACS applications that was not being addressed by the PACS vendors, and that they are more knowledgeable of workflow requirements. 

Many believe that prior systems did not adequately address information the way clinicians need it.  For example, a radiologist sitting down at a PACS workstation does not necessarily want to start by viewing images.  Instead, they may want to view the patient history and reason for the order before reviewing the exam.  This might be of particular interest when the patient has an underlying condition such as cancer that is not taken into consideration before the exam is read, nor reflected in the report. 

The long and the short of it is that vendors vying for whatever remains of radiology information systems will need to focus on departmental workflow and providing solutions that present all the information necessary to the diagnostic process and departmental management.  How will the forces of the universe shift?  Who will take charge this time and shape the future “Universe” of Radiology?

I will be spending my time at the upcoming RSNA getting a sense of which companies get it and those that don’t.  Stay tuned to see if my perspective has shifted following the meeting.