Q. In your RSNA session you talked about a “new age for radiology,” can you briefly describe that new world?
As patient centric initiatives such as the CMS Meaningful Use program take hold in radiology our services (and subsequently our IT systems) will need to expand beyond the wall of the department or imaging center. Even beyond our provider enterprise to integrate to other care providers and patients themselves. Currently, PACS systems are silos providing merely an electronic version of film with limited communication capabilities. RIS systems are also inward facing and do little to provide meaningful interactive communication beyond the department to our ordering clinicians and our patients. In a patient centric world, our systems provide very little other than to serve as limited edge devices for EHRs and PHRs.
Q. How will PACS and EMRs be integrated and how will that affect PACS administrators?
Currently, most PACS are capable of serving up their image data, via a URL, to affiliated EMRs. The challenge is in providing a richer interaction between radiologists and clinicians ordering radiologic services. These existing one-way links to image data are not fulfilling those needs and other methods for communication (and thus integration) will be required.
Q. You mentioned that PACS need to "better exploit the new paradigm," and follow the lead, for example, of models such as Apple's app store. What is the new paradigm, and how do PACS follow the model of an apps store?
PACS need to take the role of an imaging department's software framework and not its only imaging application. Companies that provide PACS that serve this purpose will advance more rapidly than monolithic PACS due to the development of third party software designed to run on top of their architecture. Similarly, customers of these new systems will enjoy the benefits of software choices without the need to completely replace their existing PACS. This is similar to the way Apple and Google encourage third party development via their SDKs and app stores, which has spurred the creation of thousands of software companies dedicated to creating applications specific to their hardware and software platforms.
Q. How will radiology be affected by clinical decision support? Personal health records?
Clinical Decision Support (CDS) will play a big role in medical imaging over the next decade. Demonstration projects sponsored by the federal government are currently being conducted to demonstrate the efficacy of CDS for imaging. At MGH, we have already demonstrated the value of such systems in the management of image utilization. The American College of Radiology has created an extensive library of Web Services to its Appropriateness Criteria, designed to interface directly with EHR systems. Currently the system is in use for a CMS demonstration project at the University of Wisconsin using EPIC EHR and Henry Ford Health System in Michigan.
As PHRs grow throughout the country there will be an increasing demand for patients to access their medical image data. Nearly all of the PHR systems today have methods to receive and store patient image data. As the demand for the PHRs increase, so will the access to medical image data by patients.
Q. How will mobile computing affect radiology in general and PACS in particular?
Mobile computing provides a new way for radiologists to interact with their remote referring clinicians. There is an opportunity for a paradigm shift from conventional PACS workstations and one-way enterprise distribution, to a new, highly interactive experience integrating the expertise of the radiologist with the mobility and clinical awareness of the clinician. At MGH we have considerable research and development underway exploring the value of such a highly interactive, mobile communication offerings to our physician customers. Later, our attention will be directed toward offering that same level of communication to patients.
Q. When you talk about further separation of acquisition and interpretation how does that affect young people going into medicine and in particular those contemplating radiology?
Acquisition of medical image data from the patient will migrate to become more convenient to that patient. It might not be unusual in the future to see acquisition devices being placed in retail or drug stores. While the acquisition of data becomes more convenient to the patient, with greater transparency in the system, those same patients will demand interpretation from the best rated specialists. Radiologists that build a reputation in particular subspecialty domains will become sought after. And, with the ability to securely move medical image data anywhere in the world, those experts will not be constrained to geographical boundaries. I think young people considering radiology as a profession need to be aware of the fact that this will change the existing landscape and will probably do so in pretty short order.
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