I doubt any of us will forget 2016. Events, both tragic and bizarre, have owned the headlines and have provided more than a little water cooler fodder. As we close another year of activity within our own world of medical imaging, we too have had plenty to talk about. From acquisitions to rebranding; from new product releases to updated vendor platforms. There was nary a week that went by without something interesting hitting my feeds. Here are some important developments that I believe are making waves and setting the course for imaging, specifically enterprise imaging, as we move further into the second half of this second decade of the 21st century.
The tension between enterprise drivers and departmental concerns are forefront in many organizations that have developed an effective governance structure and are implementing a strategy or road map for the future of imaging within their enterprise. While we should all understand both concerns are important, determining who wins the small battles often comes down to who holds the power. Information technology (IT) has adopted the imaging efforts in most organizations — some at the request, others to the dismay of the operations or clinical departments. Understanding we have a problem, and admitting it, is the first step to reconciliation. With better communication and a clear list of preferred outcomes and decision criteria, we can better collaborate and achieve the best interests of all parties participating in the enterprise imaging effort.
Whether it is greater access to patient information via the EHR or better tools to communicate and collaborate at the point of care, workflow innovation is providing better, safer and more secure ways to ensure critical information is captured and gathered and results are distributed. We are realizing ways to deliver departmental-level workflow optimization in ways to accommodate the specific needs and requirements of specialists and sub-specialists as well as technologists, nurses and the referring community. We no longer need to impose radiology orders-driven workflow upon those who work in an episodic workflow environment who create and store image objects. In addition, radiologists have new tools to assist in gaining visibility into the overall delivery care model that is critical for those participating in accountable care organizations (ACO) or bundled payment models.
As one radiologist recently told me, “We’ve done much to solve the interoperability problem, now we need to solve the efficiency problem.” Tools and software now can eliminate what were formerly manual process steps within the organization. Tools in diagnosis that provide smart tag or terminology recommendations within the reporting process are helping achieve better quality and improved billing. Viewers are getting better at content management, hanging protocols and federating data from multiple picture archiving and communication systems (PACS) to a single workstation or viewer. Critical results can be automated with clear alerting, feedback loops and auditing capabilities. Collaboration tools allow radiologists to consult real-time with specialists and referring physicians. Attaching non-DICOM images to a patient jacket has become much easier with the introduction of QR codes and other similar options. Patient portals are allowing for patient-driven scheduling, which reduces clerical staffing requirements and improves patient satisfaction. Patient matching across disparate systems is becoming smarter and more trustworthy. These are all ingredients that will be required to help radiologists and those who use imaging to diagnose and treat patients to achieve greater efficiency and efficacy in an age of declining reimbursements.
I have observed what I perceive to be a cultural shift in how vendors and their customers interact. The age of antagonistic relationships — which were due to years of frustration caused by broken promises, disappointing innovation and costly implementations that failed to achieve outcomes — has melted into a spirit of collaboration. I am watching vendors become transparent in their processes, costs, and pricing and commitment to customer success. The innovation cycle has improved exponentially and the voice of the customer is driving how and where solutions are adding features and improving functionality. This is partly driven by the success of many smaller and mid-market sized companies, but this is not limited to that segment. Many of the large vendors have retooled their organizations to become more nimble and responsive to the market and the direction of the industry.
Gone are the days of the one-size-fits-all imaging strategy. PACS is not dead, but it’s no longer the PACS we used to know. Whether an organization is moving toward PACS-centric enterprise imaging or a deconstructed PACS model, the process, path, design, deployment and use cases are different everywhere I go. While the problems we all face are similar, the nuances and differences are affecting how organizations approach completing the patient record with imaging across the enterprise. It’s making this effort fun again. Tackling the problems, prioritizing the needs, determining how to leverage existing systems, and building bridges of integration or interfaces to meet the goals of both the enterprise and the departments are requiring open-minded thinking. It’s nice to have gone quite some time since I’ve heard, “We have always done it this way.” There will always be those stuck to an old paradigm and slow to adopt new models, but by and large there are a lot of “what if” conversations going on. And it’s nice to see both providers and vendors (and consultants) collaborating in this dialogue.
Not long ago the idea of sharing images was frowned upon. We built walls around our patient information and made our patients navigate obstacle courses to get access to or copies of their information. It’s encouraging to see that the idea of patient-owned information is growing as a value within our imaging world. Image-sharing platforms abound that allow for both real-time collaboration, patient managed platforms and non-affiliated provider access. The concept of “hooking” our patients into loyalty is never a long play. Winning our patients’ loyalty through better service and outcomes is always the better path, and that seems to be catching on.
Progress can oftentimes get in the way of achievement. Celebrating success and early victories is important to a long-term initiative, but it cannot create a sense of complacency. No doubt the innovators will continue to deliver new and exciting solutions. Providers will continue to work toward better care delivery, outcomes and patient satisfaction. And patients will continue to drive new ways of how they engage with their medical and healthcare.
It’s great to see imaging regain its value within the enterprise, and it’s exciting to see how we are tackling both old and new problems in new ways. We still need to improve in our analytics and decision-making. We have lots to achieve in engaging patients in their care decisions. We still have issues with data integrity and access. So let’s keep getting better, and have some fun along the way.