Web Exclusive: Radiologists Gain Equality at HIMSS ‘08

Talk about data mining – the Healthcare Information and Management Systems Society conference - HIMSS 2008 - was a great place to unearth some of the leading trends in the healthcare industry and in radiology, which was the target audience for about 25 percent of the offerings on the show floor.

Here are some of the discoveries radiologists could have dug up at this year's HIMSS:

Radiologists Gain Equality: After some notable disappointments with the first and in some cases second generations of PACS, word on the trade show floor was that radiologists are now much more, if not equally, involved in selecting the next generation of PACS. According to Mike Cannavo, known in the industry as ‘The PACSman’ and a member of the ITN Advisory Board, the decision-making pie divides up nicely for radiologists with IT representing 36 percent, hospital administrators 15 percent and radiology 49 percent.

Anywhere PACS: Because healthcare wants 24/7 access to radiology reads, web-enabled and web-based PACS that provide robust tools are key features for replacement PACS.

Single is Sensible: There may soon be a meeting of the minds between radiology and cardiology as hospitals reconfigure their storage into a single repository into which radiology PACS and cardiology PACS, as well as data from other departments, will filter in and store clinical data. Cannavo added, “SAN players…will be the biggest area of growth in the healthcare field medical imaging, incorporating off-site archives with disaster recovery and data migration.”

VMware Everywhere: ‘Storage virtualization’ is said to ‘turn hardware into software.’ Sounds like alchemy. Well, VMware is the reason SAN players are getting more action. Virtualization-ware pools physical storage from multiple network storage devices into what appears to be a single storage device that is managed from a central console. Commonly used in a SAN, it helps administer backup, archiving and recovery more easily, and in less time, by disguising the actual complexity of the SAN. Users can implement virtualization with software applications or by using hardware and software hybrid appliances.

Dreams of Interoperability: The IHE’s dream that one day all of the disparate systems will be connected – via DICOM and HL7 - is several steps closer to becoming reality. The IHE was busy monitoring the successful interfacing of best-of-breed systems on the HIMSS show floor. But Cannavo cautions us to curb our enthusiasm, with a reminder that we won't "see this until 2010 at the soonest. 2012 or 2013 is more reasonable.”

Analytics Alerts: Monitoring trends and extracting them from a vast repository of common data will unveil new meaning from existing data. As data mining shapes up into the form of ‘decision support’ or ‘evidence-based data’ at the point-of-care, this mechanism will help and, albeit useful, annoy radiologists. I wonder if you can convert that the decision support alert into a mini-Einstein.

DRA is a PACS Pusher: The DRA is pushing the industry toward greater efficiencies in practice management and workflow management systems. Analytics and digital dashboards promise to improve data management by tracking performance and are stirring up the competition amongst PACS and storage providers. Hopefully this will drive the desired end result of better systems at lower prices. In fact, Cannavo pointed out, the DRA is said to have actually helped PACS sales because of efficiency improvements.

Personalized Medicine: Mike Leavitt, Secretary of Health and Human Services, described it as ‘an exciting outgrowth of our better understanding of the human genome.' Molecular diagnostics and imaging will initiate a new era of personalized medicine where molecular biology and clinical history is used to design treatment.

Oodles of Ologies: It’s not just because it's fun to say ‘ologies,’ but ologies have become a buzzword for connecting disparate systems 'enterprise wide' – the other term of the moment. Watch as radiology, cardiology, orthopedics, pathology and other departments connect their systems within a hospital. “Hospitology is next - sure beats CHINS and RHIO,” commented Cannavo.

EMR Explosion: In the spirit of the industry’s battle cry ‘enterprise wide’ the tool that will make it happen is the electronic medical record (EMR). Healthcare providers hope the EMRs will improve efficiency, cut costs and result in better patient outcomes.

Who’s in the Driver’s Seat?: While many may argue that it’s the other way around, according to Vijay Tanjore, senior marketing manager, GE Healthcare IT, you can expect “in the next five years, 15-20 percent of PACS will be driven by an EMR.” If imaging is no longer a departmental solution but used enterprise wide, then, like RIS data, EMR will feed into PACS. Sounds like PACS blasphemy to those who argue that because hospitals have invested so much in PACS, they want to get their full return on investment out of the system and will drive the enterprise from the PACS.
This begs the question: Does it matter who’s driving? “Each system feeds off the other. HIS feeds RIS, RIS feeds PACS, EMR feeds HIS and RIS and the CPR (Clinical Patient record),” Cannavo noted. “IT makes the decision on the CPR solution, so technically IT is the driver and we’re just Miss Daisy.”

PHR: Google, Microsoft and the Revolution Health web site (the latest project by AOL Founder Steve Case) have bet big bucks on Personal Healthcare Records (PHR) because they realize that patients are consumers. So why not shop for the best healthcare? It does not mean healthcare will become commoditized – for most, survival trumps monetary cost. And with their medical records compiled neatly in their own digital vault, patients will leverage that data to get the best care and, hopefully, the best coverage too. This may finally help to put some checks and balances on payers. Some PACS developers are already using SOA (service oriented architecture) to prepare for this transformation.