That's the opinion of Paul Chang, MD, vice chair of informatics and medical director of enterprise imaging at the University of Chicago Hospitals. But being behind is not a bad thing, Chang told attendees of the Society for Imaging Informatics in Medicine (SIIM) annual meeting being held June 3-6 in Minneapolis. The healthcare industry now has the opportunity to adopt the latest and greatest IT innovations and apply them to a new generation of imaging informatics products and electronic health records (EHRs).
In a keynote lecture that was a sobering call to wake up to reality, Chang told his colleagues to shed their attitudes of arrogance and myopic perspective relating to imaging informatics innovations, to stop being snookered by vendors talking platitudes, and to realize that one of the reasons PACS has made such performance strides is because radiologists' children, among others, like to kill aliens at lightning speed on high-definition flat-panel display monitors.
Consumer expectations from the industries that serve them have fueled and financed tremendous technological strides in the past 15 years. PACS and healthcare IT in general have benefitted -- and they can benefit some more if these two segments work together creatively to harness technology to radically improve healthcare delivery.
It's imperative that imaging informatics and healthcare IT professionals realize that they need to focus on the real threats to medicine, based on economic reality and population trend demographics, rather than the artificial threats of turf wars, Chang said.
"The services that we currently offer in imaging and EHR are immature with respect to offering the best possible healthcare to our patients," Chang said. "The modern EHR is an ecosystem. Today's challenge is to develop a fully leveraged electronic-based workflow and practice management ecosystem that supports first, a patient's needs, and second, the providers of healthcare services."
Chang believes that healthcare IT EMR and imaging informatics initiatives are incomplete and insufficient. He thinks that the healthcare industry can leapfrog across a massive virtual mound of IT-related technology innovation that has been taking place at lightning speed. If these innovations can be applied to the next major generation of products, it will enable radiologists and other clinicians to provide a level of previously unachievable value to patients.
But first, imaging informatics professionals must step out of the vacuum they have created through arrogance. "Yesterday we got excited by dashboards that had color gauges and the business intelligence analytics that make them function," he said. "We are adolescents, not grown-ups. If you go to any other complex industry, there are no dashboards. You have business logic deployed. If there is an anomaly, it gets identified. It gets fixed. "
Stronger systems and better integration are needed. The typical legacy-based IT environment requires people to integrate workflow. Data are presented for passive review, not actionable intelligence.
"Right now you need a physician to fully leverage data on existing systems," he said. "All the information is there, but physicians have to look and go sniffing around to see the data. This is especially true for EHR systems."
"The criticism that I have today about EHR systems is that emphasis is on results review, but there is no easy way to see the context of information," he continued. "Do radiologists have the time to go back to see what is on the EMR for a patient? No, they don't. You need to be Dr. Saint, a compulsive physician, to do that every day for every patient. The information from different systems should be clinically correlated and presented in the most intelligent way possible that is relevant for me."
"The goals that we should have in both the culture of IT and of imaging informatics are to design systems that optimize the performance of Dr. Clueless, Dr. Evil, and Dr. Lazy -- systems that prevent errors from being made and force a doctor to do the right thing. We are nowhere near there," Chang observed.
Destroying IT turf barriers; demanding more of vendors
In most hospitals, imaging informatics has existed in an IT world of its own. Because PACS is typically owned by radiology IT, from an enterprise IT perspective it has not been identified as an IT product. Historically, PACS, with its unique architecture and network-heavy requirements, has been identified as an image management problem. Radiology IT professionals are often viewed as myopic and rogue, not adhering to established standards and processes.
Hospital enterprise IT professionals are often viewed by radiology IT professionals as being process-prone and indifferent to the immediate, urgent needs of specialty departments. They are perceived as having a lot of knowledge about very little, especially knowledge that is domain-specific.
The cultural differences have created barriers of distrust. Chang said that he saw this clearly when he assumed a position that straddled both departments. Areas of overlap have been expanding, and it's time for the two groups to work together. They must adopt the mindset of becoming value innovators.
Chang, himself a co-founder of the Stentor iSite PACS, chided PACS vendors for self-resonance. Calling PACS-driven versus RIS-driven workflow a meaningless concept, he stated that this was a dangerous oversimplification. The important deliverable is workflow to optimize the needs of the radiology specialty.
To Chang, the concept of "one size fits all" is ludicrous and merely makes life easy for vendors. "Do we really want to be cookie cutter?" he asked. "Every other business wants a unique solution designed specifically for them. I am a darned good radiologist. Let me have the tools to show I have value and can differentiate my services from a faceless company 1,000 miles away. I don't want to have what everyone else has. I want to fight the threat of commoditization."
"We must be willing to reengineer ourselves in order to fully leverage the next-generation digital practice management systems. We need the informatics vendors to lower the barriers to provide true value," he concluded.
By Cynthia E. Keen
AuntMinnie.com staff writer
June 5, 2010
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SIIM opening session highlights advances driving informatics, June 3, 2010
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