Radiology IT Forecast: Cloudy, with Collaboration

CHICAGO - The field of radiology has come a long way since the days of paper and film, says one of the profession’s leading thinkers on the evolving relationship between diagnostic imaging and information technology. And it’s only getting started.

Keith Dreyer, DO, PhD, Massachusetts General Hospital’s vice-chairman of radiology, described a future of vastly enhanced data sharing and virtualization in his talk Monday morning at RSNA 2011. The future lies in radical advances in software rather than hardware, with cloud-based patient data and clinical decision support as well as stronger, more nimble devices at the network’s edges among the key defining features, Dreyer said.

“I think systems were deployed at a ridiculously accelerated pace in the last 20 years,” Dreyer said. “But if you want to see what’s going to happen in your department, I think consumer technology is setting the curve, and radiologists will clearly take advantage of these trends.”

Dreyer noted several forces driving the changing face of IT in radiology, including:

- Increasing government influence, including the press for Meaningful Use (most clearly manifest the promotion of electronic health records) and accountable-care organizations. “I would ask you, in your ‘super-wired system,’ can you find out if your patient had an exam five miles away from you?” Dreyer asked. “If not, then you’re probably not where the federal government wants you.”
- Consumer technologies, most vividly embodied in smartphones and tablets on the fringes of the Internet.
- Patients’ increasing ability – and desire – to stay informed about their own health, notably using online resources.
- Economics, a.k.a. the drive to cut costs, both in terms of doing individual imaging exams for less and managing utilization of imaging volumes by reducing the number of images. “When I spend time on the Hill, imaging is in the cross-hairs,” Dreyer said. Two tools that will help the profession lower costs include radiology benefit management companies and clinical decisions support tools, he said.

Underlying the status quo in radiology IT is the inherently department-specific nature of PACS/RIS systems, he said.

Today’s PACS systems are insular, slow-to-innovate systems, Dreyer said. They need to be more capable of communicating broadly and keeping pace with a complex and evolving brew of government, patient and provider needs. To do that, he said, these systems need to emulate Apple: one platform, thousands of software providers.

“That doesn’t typically happen within our industry in IT today,” Dreyer said.

Dreyer envisions cloud-based storage enabling mobile image access and easy (yet secure) sharing of medical records to enable a true patient-centered workflow, in which the radiologist has a sense of the patient’s health-care ecosystem and her other providers have similarly broad perspectives. In such a system, a patient’s request to send her medical records to an outside provider might take little more effort than friending someone on Facebook does today, Dreyer said.

This combination of cost pressures, cloud-based storage and processing, a focus on software over hardware in PACS/RIS, and more leveraging of devices at the edge of the network will have several effects on radiologists, Dreyer said.

Interpretation will trump raw image data, such that users on thin clients/mobile devices can act on more distilled information “rather than two pages of report and 5,000 images,” Dreyer said. Clinical decision support systems will also become more important in this context. The trend toward virtual practices will continue, with further separation of acquisition and interpretation. One might see a move of medical devices toward the patient – “from the hospital or imaging center to a Walmart,” combined with a move of interpretation processes to optimize quality and cost, he said. Ultimately, Dreyer said, quality and cost will become increasingly transparent, first to departments, then hospitals, clinicians, and to the patients.