Defining the top ten trends in imaging informatics is somewhat objective and depends on the perspective. For example, what is a top issue for an institution such as Brigham and Women’s might be a non-issue today for a community hospital and never become an issue for an outpatient clinic. In any case, here is the view from Kathy Andriole from the Brigham and Women’s hospital in Boston, and my modification to this list.
- Dose matters, meaning that it has to be registered and managed. This issue is reported on in another write-up (See our detailed report on Dose Issues in Radiology), but I would not necessarily list this as the number one trend. As a matter of fact, in many countries, notably Germany, the registration has been a legal requirement for a while, and manufacturers have been accommodating these requirements. One might conclude that it is about time that the US also takes action.
- Meaningful Use, definitely a US requirement which is related to implementation of electronic Health Records in meaningful manner as a result of the HiTech act. Unfortunately, the requirements for the different stages as defined by the US government is very vague about the specific radiology impact, and the various speakers on this topic at the conference were not able to give much insight in my opinion either. Therefore, yes this is an issue as hospitals need to get their EHR's certified, however, the impact on imaging seems to be uncertain, not well defined, and in any case minimal.
- Business Analytics, an important tool as a result of data mining. I can agree with this aspect as there is a big pressure on improving quality, increasing efficiency and reducing reimbursements and this can only be done if there is quantitative data to manage the processes.
- Clouds, “with a change of images”, another buzz word that seems to be a requirement in every vendor’s marketing brochure, not realizing that it is just a new name for outsourcing your image storage to a virtual 3rd party, and something that has been implemented for many years successfully by many commercial vendors under different names such as ASP, or SSP. I would categorize this trend more as a new term rather than a new technology.
- Lexicon of workflow: This is identical to the business analytics trend, but stressing the fact that there needs to be definition of terms and metrics about what and how to measure. Take for example the exam turnaround time. Is this measured from when the patient arrives in the ER, from when the information is entered in the information system, from when the order is placed, when it is received, or when the patient is retrieved for performing the exam. The same applies to the complete status, is it when the radiologist signs off, the report is received at a RIS, or when it is retrieved and available for a physician. This is only one metric, there are several others that are important.
- Image sharing: I don’t have an issue with this trend, as a matter of fact, I would rate this one in the top three as institutions are starting to get large amounts of image son CD’s and wrestling with the issues on how to connect imaging providers to accept images electronically both on a regular as well as ad-hoc basis.
- Quantitative imaging: No argument here as there is definitely an increase in dynamic imaging and an increase in the measurements, especially for cardiology.
- Mobile technologies, another trend that I would have listed in the top three as the first tablet PC was approved for image display not too long ago. As the majority of the physicians most likely have a smart phone or device by now, the distribution of alerts and clinical information will become ubiquitous.
- Personal Health Records: I agree with this as well, although these are still implemented only by a couple of large organizations such as the VA and Kaiser and large employers such as Walmart. I believe that it will still take a while before there is a critical mass and many consumers are able and willing to manage their own healthcare information, and more importantly, that physicians and institutions are able and willing to interface to the many PHR providers out there.
- Last but not, least Artificial intelligence, a trend which I also agree with. In particular the many new applications for Computer Assisted Diagnosis or CAD, which is common for digital mammography and increasingly popular for breast MRI as well. New applications are being announced and implemented that look at chest nodules in CT and CR and other semi-automated detection of pathologies are getting popular.
There are a couple of trends which I would have listed, the most important being:
- Vendor neutral archiving: one of the least understood, poorest defined and over-rated new trends as each vendor seems to have a different opinion and definition. Talking with several users, it appears that there are still many implementation issues around the concept of a true neutral, enterprise-wide archive. See our detailed discussion and white paper on Vendor Neutral Archive.
- Structured reporting, especially for Ultrasound. This might not necessarily be an obvious trend, but based on the number of inquiries and issues that come across my desk that are related to the integration of DICOM structured reports from the modalities to the PACS and reporting systems, this is definitely becoming a major trend. It appears that almost all new Ultrasounds are now shipped with this capability and therefore the implementation of this is starting to get critical mass.
- Cardiology integration. Cardiology has traditionally been implemented as an “island” with its own database and workstations, however, the back-end, i.e. archive is increasingly being integrated, and the front-end, i.e. cardiology and radiology information system (CIS and RIS) now is also shared. For example, it is not uncommon that a Ultrasound modality is used for a cardiology exam, managed by the CIS and also for radiology exams, requiring the reconciliation of different modality worklists. At the viewer, a physician also wants to be able to see the images and other information from both departments.
- Ology integration. Expanding beyond radiology and cardiology, there is a need for digital mammography to be integrated, ophthalmology, dentistry, speech pathology, and to relate pathology and radiology information
In conclusion, there are many new trends in imaging informatics, some of them more or less applicable based on the specific environment and view of the beholder. It is important to track these trends and learn about the issues and implementation challenges in order to be properly prepared.
Herman Oosterwijk
VP & CTO Health Imaging Hub