Breaking free: the digital transformation of radiology in Israel

Radiology in Israel forms an essential cornerstone of the country's healthcare system. As it has faced many challenges in a rapidly evolving technological world, Israeli radiology has maintained an up-to-date fleet of imaging modalities. Its latest challenge, perhaps the toughest yet, is to break free of the boundaries imposed by a film-based archive and to make the transition to digital archival and communication systems.

For years, radiology was primarily a modality-centric discipline. All available resources were channeled into maintaining and upgrading the imaging modalities. Consequently, the majority of radiology departments in Israel poses a state-of-the-art imaging armamentarium. Most departments have a suite of digital modalities that includes computed radiography, digital radiography, angiography, fluoroscopy, ultrasound, multidetector CT, and MR.

On the other hand, little emphasis has been placed on integrating these imaging modalities with digital archive and communications systems. As a result, only a handful of imaging centers have a functional PACS. Because most centers still rely on film-based archives, studies performed with advanced digital imaging modalities are archived in congested, overworked, and understaffed departmental film libraries. These libraries, relics of the past, are not able to cope with the ever-increasing workloads.

Moreover, the physical constraints of a film-based archive create problems unique to the Israeli healthcare system. Most diagnostic studies in the country are performed in imaging centers that are either hospital-based or part of the four public health insurance organizations. Outpatient care, on the other hand, is provided primarily at clinics distributed throughout the community. Thus, after a radiology exam is completed, the images are transported to the referring physician via a "patient sneaker net," meaning that the patient must carry all films to every consultation.

This system imposes an unnecessary burden on patients and forms a dreaded film trail between imaging centers and referring physicians. The recent introduction of CDs for storing patient studies has managed to alleviate only a few of the problems. The CDs retain the inherent digital properties of diagnostic images and significantly decrease the printing of film, but they do not provide an effective method for communication and archival of images.

It appears that radiology in Israel must undergo a major transformation to a digitally based archival and communication paradigm in order to resolve these issues. In view of these challenges, many Israeli radiological centers are realizing the tremendous benefits of PACS implementation.

The tangible benefits of PACS, including cost savings from decreased film use, are trivial in comparison to intangibles such as increased workflow efficiency and optimal communication and archival. PACS can make images ubiquitous and readily accessible anywhere in the healthcare enterprise, including a hospital ward, outpatient clinic, or even a physician's home. Implementation of PACS must not be viewed simply as a technological advancement but rather as an integral step to achieving optimal patient care.

As more medical institutions explore the means and methods for PACS implementation, demand is growing for professionals who possess the knowledge and experience of PACS technology. These professionals have a vital role to play in leading the digital transformation of radiology in Israel. This opportunity is one of the reasons I pursued an imaging informatics fellowship at Northwestern University in Chicago.

The fellowship is a one-year combined clinical and research program hosted by the radiology department at Northwestern Memorial Hospital. The fellow spends 60% of the time learning theoretical and practical aspects of PACS and other radiology information systems. The fellow participates in all PACS planning and technical meetings and is exposed to numerous other informatics issues and projects throughout the institution. The result is a thorough understanding of the complex structure of PACS and its integration with the other hospital information systems.

I believe that professional appointments in imaging informatics, which now exist in only a few institutions, will become the norm. I envision myself holding such a position, in which I can contribute the theoretical and practical knowledge I gained during my fellowship.

One of my goals is to advise and educate my professional colleagues. As radiology is maturing into its "information age," radiologists must truly understand the information technology advancements that are occurring at today's rapid pace.

My other goal is to increase awareness within the information management industry of medical professionals' real-world needs. With my training, I am well positioned to bridge the gap between the clinical and technological worlds and advise the industry on design and implementation of new information technology. Many nonmedical companies with brilliant information management solutions are unaware of their potential clinical applications. I see myself identifying these companies and helping them find their complementary clinical niches.

In these times of colossal change and immense challenges, it is truly exhilarating to be at the forefront of the informatics discipline of radiology.