The New Informatics: Productivity Meets Collaboration

Expect 2013 to be a big year for informatics... like every other year for the past decade or so.

But this time, analysts say, it's informatics with a difference. These IT tools could bridge the gap between radiologists and referring physicians, opening up the possibility of real consultation without disrupting workflow.

And the new developments are coming just in time, because the informatics tools that helped radiology thrive over the past several years may also be contributing to its precarious position now.

"The first phase of IT deployment in radiology has made radiologists more productive, more independent, more mobile, and it has allowed them to provide a service without the need for all the surrounded added value," said Nadim Michel Daher, principal analyst for medical imaging at Frost and Sullivan. "This next generation of its deployment has to keep in mind the role of the radiologist, because they feel the future is at stake."

Virtual talk

One of the biggest breakthroughs in informatics this year isn't coming from the radiology side. It's coming from the client side.

"Mobile devices - with tablets, and their battery life, resolution, internet connectivity - mean the human-computer interface has gotten to the point where we can now bring back consultation and bring back our relationship with our referring physicians," said Paul Nagy, PhD, SIIM, director of quality at the Russell H. Morgan Department of Radiology at Johns Hopkins University.

About 70 percent of physicians use tablets in their practices, Nagy said, and that gives radiologists a tool to communicate with them in real time but in virtual space.

"Basically what we're talking about is like Skype for PACS,” Nagy said, referring to an Internet phone and chat service. “You're both logged in to the same session, you're both shared into the same video chat and you're actually sharing the images, looking at the same slice and the same nodules. You're both looking at the images together and having a conversation about them. You're guiding them in the image interpretation process and helping them interpret the results."

That's a huge improvement over the reports radiologists could send out via their PACS, Nagy said.

"Before PACS was really an asynchronous technology: The radiologist reads the image and the referring physician reads the report. There's not much collaboration going on as part of that, nor is there much feedback."

Leave no footprints

The rise of tablets, and the demand for greater collaboration, is both fueled by and is promoting the growth of zero-footprint clients. This technology uses standard, ubiquitous web technology to deliver images and communication.

"It's only HTML, CSS and JavaScript, so nothing else has to be loaded on your computer," said Jim Philbin, PhD, co-director of the Center for Biomedical and Imaging Informatics at Johns Hopkins University. "The application is downloaded automatically by the browser without storing anything on the [device]."

That's a huge plus to a referring physician - and for that physician's IT department. Before zero-footprint clients, Philbin said getting software updates pushed out to all the different departments at Johns Hopkins could take up to a year. Now? Any updates and necessary maintenance can take place instantly at the source. The referring physicians aren't disrupted at all.

This seamless delivery should only help the relationship between radiologists and their customers, Philbin said. "Zero clients are all pushing hard on the collaboration front so that you can do electronic consultation and the equivalent of an electronic curbside consult," he said.

The neutral zone

All that collaboration means the push toward an easy way to share data is heating up. So this may be the year when the data breaks free of competing standards.

"Most of the industry is now using digital PACS - certainly more than 90 percent of radiologists' sites are now digital," Philbin said. "I expect this year will be a large leap in Vendor Neutral Archives (VNAs), and I expect that trend to continue in the future."

When that data can be easily shared between different platforms, the ideal of a truly comprehensive patient record could become a reality. "[There's a] whole movement toward having search within radiology," Nagy said. "The radiologist can do a Google-like search within the medical records... and be able to do search of different disease characteristics, to look at the relevant priors quickly, to be able to understand where this patient is and where this patient is going, to be able to put that in context to be able to make their diagnosis."

But the real potential benefit may be in giving patients the keys to all of their medical data.

"The biggest problem we have in the industry is the lack of an aggregated medical record, and the fact that it’s very difficult to share information across enterprises," Philbin said. "The best things we can do for patients is create an aggregated patient record ... so patients can start controlling who has access to their images, and also so they would get ready access to their medical imaging or other medical information through a website without having to do the aggregation themselves. It's all stored anyway, we're managing the cost of that. Just providing the patient access in a secure and controlled way is not a significant expense and would improve patient care significantly."

Big impact from Big Data

All that data can also help improve the way radiologists run their businesses. "Radiology has been at the forefront of technology adoption in healthcare, and because of that, we're now sitting on mountains of data: about our referring physician utilization, about how we utilize our scanners and about how we provide services to our customers," Nagy said. "People are beginning to really mine their databases from the RIS and from the PACS, and are building graphical dashboards as a support tool to help them improve service. That's going to be a big deal for building a competitive practice that can reduce costs and improve service at the same time."

But it takes more than one system's data to get the biggest bang for your informational buck, and that amplifies the need for VNAs and other common standards. "The challenge is you need to know more information than just what's in your PACS," Nagy said. "You need to know more about the RIS and maybe the order entry system to have a holistic view of your department. The trick is to be able to aggregate that data in a way that's constant so you can build models around how your patents are experiencing service within your organization. That requires a data warehousing strategy where you're able to extract the data into a common area, translate the format and the able to put a graphical dashboard tool on top of it."

Radiologists and referring physicians are leading the charge for this - but vendors are taking notice. "A real differentiator between the different vendors is how interoperable they are," Nagy said. "Are they trying to hoard the information, or are they trying to provide an open architecture where [physicians] can reuse that data for other purposes?"