A few things are made absolutely clear as one attends sessions, strolls the exhibit floor, and listens to conversations among attendees at the SIIM 2008 Conference being held here at the WashingtonStateConvention Center. Among them are:
Ø There is a widespread realization that diagnostic imaging management is no longer simply about radiology and radiologists, but rather, about all physicians and clinicians whose work is tied to images.
Ø IT executives, especially and including CIOs, are now tasked with the responsibility of selecting, implementing, and maintaining access to and use of systems that manage and share diagnostic images and related patient data, 24/7, as one key element in overall clinical computing and patient care operations in their organizations.
Ø The world continues to change at the same time as imaging IT professionals, and IT professionals in general, work assiduously to accomplish the above tasks. Changing modality technologies (think 256-slice CTs, 3D and 4D representation, and pre-surgical electronic mapping) are altering the speed, bandwidth, storage, and responsiveness calculations even as IT professionals rush to catch up and move forward.
All these are elements in the current stew in this sector of health care. The question is: are vendors up to the task of change? The question remains unanswered. Indeed, one of the most commonly heard statements by presenters at SIIM this year has been this: all the vendors that can are claiming to offer integrated RIS/PACS solutions, and even integrated RIS/PACS/EMR solutions; but the reality of “integration” remains in most cases clunky and challenging interfacing (sometimes at best). This has been brought out particularly well in the discussion of that still-tricky place where DICOM-compliant images meet (or don’t meet) HL7-based data.
Thus, all the talk at SIIM about SOA (service-oriented architecture) and “orchestration” of disparate images and data to end-users on the desktop. Still, given where things actually stand at the moment, some provider organizations are opting to go with EMRs and PACS and RIS systems that are either from single vendors or are truly integrated/interoperable in the sense of bidirectional message communication. That’s the choice that James Busch, M.D., director of informatics and PACS at Diagnostic Radiology Consultants, P.A., a 10-radiologist physician group in Chattanooga, Tenn., and his colleagues recently made. “SOA is here now, but the vendors aren’t producing anything related to it yet; they’re still working with HL7 and DICOM,” Busch told me on the SIIM exhibit floor. Thus, they chose their RIS and PACS from the same vendor, and are now implementing an EMR from a partner vendor that has that needed bidirectional communication. All this gives one pause. Even on a relatively compact exhibit floor like that at SIIM (with its 132 vendors, versus the several hundred exhibiting every year at HIMSS and RSNA), one wonders how many standalone RIS and PACS vendors will be around two years from now, particularly as the Holy Grail of true integration/interoperability becomes a clearer target for the industry.
Intelligent tools emerging
Meanwhile, the concept of business intelligence, and the related idea of clinical intelligence, are coming to the imaging IT area just as they’ve been emerging in clinical computing across patient care. Two vendors with intriguing offerings announced at SIIM are the Chicago-based Exogen Healthcare, and the Burlington, Mass.-based Nuance. Exogen introduced a new software application called Blue Ocean™, which is already helping the folks at Aurora St. Luke’s MedicalCenter in Milwaukee, Wis., to do such things as improve door-to-stroke care time management (including speeding time to diagnostic imaging report production) and other tasks, using live, in-process operational performance metrics that aggregate data streams across the hospital enterprise. On the dictation/transcription analysis side of things, Nuance’s new RadCube Business Intelligence is helping hospital organizations including Mount Sinai Medical Center in New York and Massachusetts General Hospital in Boston analyze modality utilization, physician ordering patterns, radiology reporting, and patient outcomes. The emergence of such new tools for business and clinical intelligence is an encouraging sign, as the industry struggles to move forward on multiple fronts to optimize patient care quality, workflow, and efficiency. Let’s hope more smart tools like these are on the horizon.