Radiologists can create value with enterprise imaging for their organizations in a number of key ways, including sharing imaging technology and workflow knowledge, accessing all images to improve interpretation, and supporting image quality initiatives outside of radiology -- particularly for point-of-care ultrasound, said Petersilge, a radiologist and former medical director for integrated content and enterprise imaging at the Cleveland Clinic. She is also founder and CEO of consulting firm Vidagos Partners.
"[Radiologists] have been one of the leaders in those types of services, and we really should be extending our knowledge for the benefit of the patients," she said. "One of the critical shifts that we as radiologists, or in the radiology industry, need to think about is shifting our focus to the outcomes at the enterprise level or at a patient level, and use our radiology environment and [enterprise imaging] as tools to affect the enterprise outcome."
Applying imaging expertise
Radiology departments have been the masters of the PACS, RIS, reporting system, and integration with the electronic medical record (EMR), and have also been the forerunners of image exchange -- beginning with media such as CDs and DVDs, and now advancing to multiple other forms of digital exchange, Petersilge said. Radiologists can apply this knowledge and help their enterprises advance these services to all image-generating specialties in their organization.
"We need to be instrumental in helping other service lines adopt these technologies within their image-generating departments, and we can do that by being the leaders and extending enterprise imaging across the entire healthcare organization," she said. "We can help prevent redundancies, can help lead to cost-efficiencies, and we can show ourselves to be leaders in this arena, and thereby bring additional value to our organization."
Just as they had to manage the shift from film-based operation to PACS, radiologists need to embrace the next wave of technology evolution, which includes enterprise imaging and also artificial intelligence (AI).
"In healthcare, we're moving to more patient-centric care and we're also on that volume-to-value transition, really working hard to make sure that the value of the radiologists ... to continue to make that value apparent to the rest of the healthcare enterprise," Petersilge said.
In the future of the AI-enabled radiologist, a lot of routine tasks will be handled by AI. This will provide the opportunity for radiologists to direct their focus to more complex layers of thinking, she said.
"We need to maintain our role as synthesizers of information," she said.
Integrating diagnostic specialties
Petersilge also noted efforts are underway to recognize diagnostic specialties -- pathology, radiology, and eventually, genomics -- as the leaders in diagnostics and to consider whether they should be incorporated together in function.
"We're going to need radiology, pathology, and genomics all working together to arrive at an individual's diagnosis," she said. "And this is leading to the drive toward precision medicine. We really have great opportunity in that arena."
Many parts of radiology are already engaged in these types of collaborative activities, such as cardiovascular imaging labs. At many institutions, cardiovascular imaging labs are multimodality and multidisciplinary in nature, bringing together all of the diagnostic studies performed by the radiologists and the cardiologists into one lab to provide one diagnostic outcome for the patient, Petersilge said. Interpretation responsibilities may be shared amongst the various specialties in some form.
Enterprise imaging can also enable radiologists to compare, for example, prior point-of-care ultrasound studies, correlate findings, and avoid additional imaging if the condition is stable, she said. Similarly, gaining access to a patient photo of a skin rash could enable radiologists to better understand a patient's entire condition, and to make a more definitive diagnosis and recommend against a more aggressive and intervention-treatment pathway.
Challenges remain, however, including the time pressure on radiologists in today's world, according to Petersilge. A lot of radiologists might feel the last thing they want to do is go through the EMR or sort through more imaging studies.
"But we're going to have to do that; it's one of the things that brings us value," she said. "We can't confine our role to being solely interpreters of images that are presented in front of us. There are other clinicians out there that can garner enough information from those images and combine that with the clinical information they have to arrive at a diagnosis. But we who are going to derive even more information from those images and combine that with clinical knowledge are really going to be offering more in terms of providing care for that patient."
To accomplish this goal, these images and the EMR need to be presented to radiologists within their regular workflow. For example, all images in the archive need to show up in the comparison list.
"We can't be expected to open up another application that shows us everything that's in the archive or go to the EMR to look at the report list and then go to the images," Petersilge said. "We need to still work on more efficient workflows for the radiologists."
Radiologists should also be able to routinely access color monitors, she said. Furthermore, appropriate indexing terminology is needed to identify images as comparisons.
"We have things like RadLex that are standards that can be utilized, but even in [radiology] we haven't achieved one universally recognized standard," Petersilge said. "And anybody who incorporates outside images into their archive and into their list of radiology exams knows that lots of different variations on image study names exist out there."
Moving outside of the radiology domain into point-of-care ultrasound or photographs, for example, there is also a lack of standardized metadata. To help, the Healthcare Information and Management Systems Society (HIMSS)-SIIM Enterprise Imaging Data Standards Evaluation Workgroup is working to select an anatomic standard that they would seek to be universally adopted for all imaging modalities, enabling standardization of indexing by body part, she said. That workgroup aims to complete their work by SIIM 2020.
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