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April 2015


Radiologists: Embrace InformaticsThe Future Is NOW!   

 Marc D. Kohli 


In "Rethinking Radiology Informatics" in the April issue of AJR, Indiana University School of Medicine radiologist Marc D. Kohli says that the rapid growth of informatics technology makes it imperative for radiologists to collaborate with their information technology (IT) departments.

Informatics has evolved from paper and pencil to IT technology over the past 20 years. How have radiologists fared? 

Radiologists have fared very well with the paperless transition. We are lucky in that the two work products of radiology—images and reports—are both very easily digitized. PACS reduced the need to purchase film, increased efficiency in finding comparison exams, and nearly eliminated lost jackets. Voice recognition cut turnaround time and transcription costs. Where we haven't progressed is in building new functionality; rich text reports with images are available in only a few institutions.

You note in the article that, contrary to what one might think, imaging informaticists are finding radiology IT more difficult. Why is that? 

I see two reasons: radiology is a victim of its own success, and more physicians are required to use technology. PACS has become critical to the enterprise, not just radiology. As such, when we want to change or upgrade PACS, we have a much larger user base to consider.

When we first started using PACS, radiology was one of the few specialties whose job was defined by IT. In some of our institutions, radiology installed the network equipment in the hospital because no one else needed it at the time. With the adoption of the electronic medical record (EMR), as well as other ancillary systems (lab, pharmacy), nearly every provider in the hospital is required to use IT resources throughout the day. Faced with declining reimbursement, most health care systems have chosen not to increase IT staff size in proportion with this massive and growing user base. Radiologists are left competing against the entire system for increasingly limited resources.

Of course, emerging technologies, such as EMR, offer a wealth of valuable new tools to the radiologist. Can you give us an example or two? 

Access to high-quality clinical information is critical to the accurate interpretation of imaging exams. Just as PACS spread imaging throughout the hospital, the EMR is making all kinds of clinical data—from daily inpatient notes and lab values to outpatient and operative notes—easily available at the radiologist's fingertips. I see tremendous opportunity in image sharing. I find it ridiculous that, in this era of global technologies, it is easier to share baby pictures from Kenya via Facebook than to get a chest radiograph from the other side of town.

In our locale, we've been successful in connecting hospitals to a cloud service that allows us to pull comparisons from across the state, which has been dramatically beneficial for patient care. We're making progress, but we haven't yet realized the full value of image sharing.

Collaboration with IT professionals will become even more important as the technology develops. Where would you rank that necessity on a list of imperatives for the future? 

As radiology is pulled into the enterprise, it is critical for radiologists to build relationships with IT professionals. I think that should be our #1 priority, as our continued relevance as a specialty depends on our ability to deliver the right imaging procedure to the right patient at the right time. Technology can help or hinder our ability to continue to provide a high level of service; it is up to radiologists to participate in enterprise governance to ensure that solutions meet our needs.

What can radiologists do now to prepare for the future of informatics? 

I encourage every radiology practice—academic and private—to invest in physician informatics training. You don't need everyone in the group to understand how networking and servers work, but having one or two physicians who can bridge radiology and enterprise needs is critical. Your professional societies are a great place to get started.