SIIM: RIS/PACS and EHR need to work together

Interesting article off except that it seems to associate medical imaging informatics only with Radiology and that PACS only works with RIS (well, its reflective of what I’ve been saying and if this is representative of SIIM’s viewpoint, then the industry is in big trouble).


MINNEAPOLIS—As healthcare leaps, or is pushed, toward next-generation EMRs/EHRs, imaging informatics and enterprise hospital IT need to work together, learn from each other and leverage the expertise of other industries, said Paul Chang, MD, vice chairman of radiology informatics at University of Chicago Medical Center during the SIIM 2010 Dwyer Lecture.

The traditional view of PACS and EHR—a de-militarized zone with a tiny overlap area—no longer suffices for health IT needs, cautioned Chang. The advent of web images, enterprise PACS viewers, CPOE, communication and alerts is the tip of the health IT iceberg that will force imaging informatics and enterprise IT to interact.

Two cultures
The two systems developed separately, and departments cultivated skills to meet specific needs. The EHR is owned by enterprise IT and managed by generalists with enterprise perspective. It requires alphanumeric data management and modest supporting infrastructure, Chang said. The EHR emphasizes passive consumption–results review with a bit of CPOE and decision support–and it requires the physician to act as the discovery agent, he said.

RIS/PACS, in contrast, is owned by radiology. The perspective is departmental with strong domain knowledge. It requires multimedia data management and poses challenging infrastructure requirements. PACS/RIS focuses on workflow and uses IT infrastructure to facilitate tasks.

“The two cultures share one characteristic,” Chang stated. “Neither technology is adequate to accomplish what is needed in healthcare. We need a better weapon.”

Cultures collide?
IT needs to support the radiologists’ changing role, said Chang. Current systems are one directional; the imaging informatics process starts with a patient and adds interpretation and knowledge with the radiologist’s job ending at diagnosis. The line needs to loop back to the patient with an actionable decision, he said, but current systems don’t support the complete cycle. Such challenges require re-engineering of informatics systems.

Some components to support re-engineering and revision do exist. On the infrastructure front, networks are integrated and more capable, with wireless reaching near ubiquitous penetration. Workstations are more powerful and more economical, and hardware is commoditized. Archives are less dependent on hierarchical models, and capable, cost-effective storage options are readily available. The trend toward commoditization and virtualization also supports the new model. Outside industries provide a host of robust integration models for healthcare to adopt and adapt.

These trends help both cultures concentrate on what they do well to meet today’s challenge: fully leveraged electronics-based workflow and practice management and the end goal of measurable improvements in efficiency, productivity, cost- effectiveness, accuracy and patient outcomes.

Lessons for imaging informatics and enterprise IT
Both imaging informatics and enterprise offer essential skills for the impending health IT challenges. Imaging informatics demonstrates the value of a rich understanding of a specific domain, processes for using IT systems to support optimized workflow and techniques for developing workflow to integrate data. Enterprise IT shows the advantages of formal governance and coordination, the importance of an enterprise perspective and the necessity of sustainability and reproducibility in process and service. Other industries like banking and the military also provide useful models for leveraging IT to support workflow. “It’s a benefit to be behind other industries because healthcare can learn from them,” noted Chang.

He also identified a few long-standing and dearly held myths that could stall progress:
“PACS-driven versus RIS-driven workflow is a myth,” stated Chang. Workflow pervades a variety of IT systems. Healthcare needs information from the EHR and other systems to constantly re-evaluate and re-establish workflow.
Dashboards are not an end solution. “We need business intelligence, but technology should fix the problem instead of telling humans about it and requiring human intervention,” he said.
Healthcare should not settle for one-size-fits-all systems. IT should adapt to user’s needs and preferences.

The foundation for the next generation EHR and imaging informatics
Next-generation solutions should incorporate an array of capabilities, said Chang.

For starters, they should provide rich interoperability to support complex workflow models. Neither current PACS nor EHR systems optimally address user requirements. Instead, they force humans to integrate workflow. For example, in many cases, physicians are required to log in to multiple systems to make well-informed clinical decisions.

Next generation solutions should incorporate an enterprise integration model or a middle layer that connects various health IT systems for the end user. In this model, the end user doesn’t have to create the connections between systems and data.

Finally, healthcare will transition from a web 1.0 model characterized by passive data consumption to a web 2.0 model that not only enables but also leverages virtual collaboration and active participation, Chang said.

With current and impending economic and regulatory challenges, PACS and EHR can no longer operate in a vacuum. They need to learn from each other and grow together to adequately the challenges of the next decade, he said.

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