Two years ago, at RSNA 2009—that year’s edition of the annual meeting of the Oak Brook, Ill.-based Radiological Society of North America, held every year the week after Thanksgiving at Chicago’s McCormick Place convention center, there was a palpable air of uncertainty, nay, even anxiety.

At that time, during the depth of the U.S. (and global) economic recession, all the harbingers of fate seemed to point in the direction of trouble for radiology, radiologists, and by extension, for imaging informatics. First, of course, there was the bad economy, which was causing healthcare consumers to lose their jobs and therefore very often lose their health insurance, leading to a dramatic falloff in non-emergency healthcare procedures. Then there was the run-up to the passage the following March of federal healthcare reform, which, as predicted, offered the potential for dents in specialist physician reimbursement; and finally, RSNA two years ago took place just before the release of the proposed rule for stage 1 of meaningful use. Not surprisingly, all the policy, reimbursement and economic/industry uncertainty lent an anxious air to the proceedings two years ago.

Well, a lot has changed since then. The passage of federal healthcare reform clarified a lot when it occurred in March 2010; and, in stages since two Novembers ago, the meaningful use process has been made clearer (even as significant uncertainties remain). As it turns out, the vast majority of radiologists qualify for HITECH incentive payments (which means, of course, that those radiologists could also be liable for payment cuts after 2015), which helps a bit, even though the fact that stage 1 meaningful use did not explicitly mention imaging had the effect of putting imaging informatics into the shade, and leading to a significant drop-off in PACS and RIS purchases, except for needed upgrades.

Yet even in the face of the ongoing challenges facing radiology and imaging informatics, the sense of malaise one got two years ago seems to have morphed over the past two years, and all that was clear on Monday at McCormick Place. Don’t get me wrong: considerable uncertainty still hangs over many elements of this landscape, particularly so since the collapse of the so-called super-committee in the U.S. Congress just a week ago. For one thing, it’s impossible to believe there won’t be particularly difficult Medicare reimbursement cuts facing radiologists.

But the very fact of looming Medicare cuts for physicians generally, combined with the mandatory healthcare reform-driven programs under Medicare (value-based purchasing, readmissions reduction, healthcare-acquired conditions reduction) and the voluntary programs created by healthcare reform (accountable care organizations and bundled payments), has clarified things considerably for healthcare and healthcare IT leaders. The bottom line is absolutely clear: healthcare purchasers, payers, and policy-makers are pushing hard on providers to become more efficient, cost-effective, accountable, transparent, and deliver higher-quality care, all at the same time. And clinical IT will be a key facilitator of healthcare system change.

All of this was top-of-mind on Monday as I met with healthcare IT leaders and vendors on the RSNA exhibit floor. Whatever the ostensible topic—whether vendor-neutral archive development, cloud-based storage solutions, clinical decision support solutions for more precise and safer radiation dosaging, or voice recognition solutions for more efficient radiological report creation and sharing—everyone I talked to was clearly aware of the challenges facing healthcare these days.

So if I were to sum up the atmosphere at RSNA this year, based on first-day impressions, it struck me as one of quiet determination allied to greater clarity. In other words, everyone knows, at some basic level, what needs to be done—and providers, consultants, and vendors are all working forward, often and encouragingly, together—to create the future—one of far greater connectedness, efficiency, patient safety, quality, and innovation. Does any of this mean the road ahead will be easy? Not by any means. But at least we have a clarity now. Call it a brighter shade of uncertainty—and keep moving forward.