In 1994, a hospital administrator would typically find the IT person in the hall on a ladder, sporting a tool belt and pulling cable through the drop ceiling. Cut to the present, the average administrator will find his IT person in a suit and tie working with a roomful of top people from all disciplines coordinating plans for sophisticated cloud-based software that pulls together all the information in a sprawling health care network and makes it available everywhere to everyone in a secure fashion on all devices, both those in network and those personal devices now carried by health care providers 24/7.

Welcome to Imaging Informatics 3.0. The one thing everyone seems to agree about in health care is that change is not a big enough word to describe the upheaval underway in the field. It is more than just new technology – it is really a story about change management in health care.

“When I go to clinical meetings, I’m the IT guy,” Matt Bishop with UnityPoint Health tells HCBN. “But when I go to an IT meeting, I’m the clinical guy. Now, I have to know enough about medicine to educate the IT staff to help them do their jobs.” Bishop, serves as an Enterprise Solutions Architect, IT for UnityPoint Health in Iowa. He is one of the people at the mega-hospital system, which extends across four states and includes 32 hospitals and 280 clinics, charged with centralizing disparate sources of institutional patient knowledge scattered around dozens of applications and technologies.

Informatics is not just for the IT or radiology departments anymore. Everyone – from doctors to nurses to administrators – must now be well-versed. Unlike the old fee-for service system that paid for inefficiency, the new Affordable Care Act-driven value-based purchasing (VBP) system will punish any providers financially – hospitals and physicians – who try to cling to the old ways.

“I’ve seen doctors and nurses my age (early 50s) or older, who take the attitude that they are not going to adapt to the new applications and protocols,” Bishop says. “They consider going to work at another hospital only to find out the same change is going on there too. There is just no getting away from what is happening in imaging informatics in hospitals. It is completely changing the way clinicians do their work.”

Don Dennison, an expert in medical imaging informatics, owner of Don K. Dennison Solutions, Inc. and a board member at the Society for Imaging Informatics in Medicine (SIIM), notes that the viewpoint anyone has is very much dependent upon their field of expertise. “The current imaging systems like PACS were built over many years to make radiologists happy and productive,” Dennison says. “But now everyone relies on images to take care of the patient.” This principle is why meaningful use was introduced; to motivate hospitals and doctors, through financial support, to offset the cost of installing medical records systems that now link to imaging informatics.

Dr. David Hirschorn, a radiologist based at Staten Island University Hospital, agrees with Dennison’s assessment and says there are definite improvements for the radiologist in the ongoing evolution of informatics.

“For 100 years, the radiologist didn’t have a patient’s medical record. A lot of the time, we didn’t even know what we were looking for on an image. Now, because our
radiology PACS system talks to the EMR, I can pull up the patient record, make notes to the ER or referring doctor – I can even see comorbid diseases and what meds the patient is on,” he says. Hirschorn says that while younger radiologists he works with can’t image without having the patient record, the huge improvements in the way the radiology PACS trades information back and forth with the EMR is sometimes a challenge for older radiologists.

“Radiologists got acclimated to not having the patient record and we set up our work around that premise. I have to remind some of my colleagues that, hey, we can look up that information now. It used to be that 95 percent of our calls to the referring doctors were to confirm some detail about the patient we were pretty sure about,” says Hirschorn. “Now, we call a lot less, but 95 percent of our calls to the referring doctor are meaningful. This reduces everyone’s frustration level.”

The evolution of Imaging 3.0
“We had 1.0 for 80 years looking at films on light boxes,” says Dr. Keith Dreyer, vice chairman of radiology at Massachusetts General Hospital and chairman of the recently formed Informatics Commission at the American College of Radiology (ACR). “Then we became extremely efficient within the radiology department with 2.0, when we started using PACS. But now, we are at what we at the ACR [refer to as] Radiology 3.0. Radiologists have to reach outside our department to the referring doctor and patient in a more meaningful way, beyond just having access to the images.”

Dreyer says the advent of such metrics as Meaningful Use (required , to get government financial offsets for EMR costs) and Value- Based Purchasing (new metrics to compensate hospitals and physicians for outcomes rather than volume), gives rise to technology and applications to keep imaging in a leadership role as the Affordable Care Act rolls out.

Human behavior aside, much of the advancement in informatics is making the interface between many technologies and applications better, or in IT slang, “play nicer together.” There is no moment more poignant in a hospital administrator’s career than when they realize that they just spent hundreds of thousands of dollars for new computers or software that make the rest of their systems obsolete.

“We have 600 IT employees in our system with 18,000 computers, 8,000 of which run a virtual dedicated system. As we move forward, we have to think about not just how to store all of these millions and millions of bits of patient records today, but how we are going to ensure the systems integrate in the future. And we’re doing all this while we constantly bring new hospitals and clinics online,” says UnityPoint Health’s Bishop.

He says UnityPoint maintains their own cloud-based server system to store this data rather than outsource it to a third party vendor. This makes it easier for the medical staff to access their patients’ medical information, including radiology images, from their homes, offices and even mobile devices.

To this end, Dreyer reports that a focus in his work with the ACR is to set standards for vendors envisioned by radiologists, rather than the vendor setting standards to which the radiologists must adapt. Such proprietary specifications in vendor products have historically caused nightmares when integrating different information system applications across the patient care network.

Patients also increasingly expect imaging informatics and electronic medical records to make their lives easier. Chris Shepperson, director of Clinical Operations for Ivy Ventures, and a former hospital PACS administrator, notes that patients expect ease-of appointment scheduling and pricing information through mobile devices.

“Technology affects the bottom line. And it’s not just who’s got the best technology, such as MERR (Multimedia Enhanced Radiology Reporter), which includes user-friendly hyperlinks and plotting automation. It’s also about what patients want,” says Shepperson. “Patients are technology savvy and hospitals and clinics have to meet that need. We’re seeing our clients start to introduce these kinds of low cost patient amenities to work across the EMR.”

Dennison echoes this sentiment. “I have a friend in California who will only go to a specific health care provider. He knows no matter what hospitals or doctor he goes to in the system, they will always be able to pull up his prior images and medical records,” he says. Dennison terms such market-based technology developments as enterprise solutions.

“Where the EMR and PACS intersect, hospitals have to ask themselves what is the long-term value of the imaging record and how do they best integrate that need to the medical record,” says Dennison. “And more and more it’s about accessing relevant patient information, including images, through a secure web page providing much more extensive information from the EMR, not a dedicated workstation or server driven by proprietary software.”

He said that SIIM members are the boots-on-the-ground force responsible for the change management demanded to integrate imaging records in a rapidly changing health care environment. “There are two kinds of hospitals,” says Dennison, “those that will acquire other hospitals into their system, or those that will be acquired. Imaging informatics is being driven by the reality that a system cannot have dozens of different imaging systems across 20 different hospitals. Hospital administrators have an ethical and fiscal responsibility to get this right.”