Puzzling Over the Pictures: Is Imaging Informatics at a Genuine Inflection Point Right Now?

Sept. 22, 2014
It was fascinating to participate in this year's RSNA Conference, and to observe the landscape around imaging and imaging informatics shifting quickly towards "new healthcare" demands for cost-effectiveness, patient safety, and better service for referring physicians, patients, and communities

The RSNA Conference, held every year the week after Thanksgiving at Chicago’s vast McCormick Place Convention Center complex is always a whirlwind experience for everyone. With 49,000 people, more or less, tromping back and forth across the bridge over Lake Shore Drive, dashing hither and yon, meeting and learning and networking, all in one place, the world’s largest annual medical conference (and in past years, it has actually been more than 60,000 people) inevitably ends up being a vortex of a conference for most.

Having participated in quite a large number of RSNAs, I’m very familiar with the dynamics of the conference. I’ve also had the opportunity to observe some of the major shifts that have taken place over the past nearly quarter century of the conference. Two decades ago, when even PACS (picture archiving and communications system) systems were still in their relative infancy, RSNA was mostly about modalities, clinical topics, and clinicians. Back then, the vast majority of non-vendor attendees were practicing radiologists and managers of radiology services in hospitals and medical groups, and most of the exhibit hall space was taken up by modalities—displays of the latest CT, MR, radiography, and later, PET and PET-combination, diagnostic imaging machines.

These days, informatics displays take up at least equal space on the exhibit floors, and, at a time of straitened reimbursement and a saturated modality market, a lot of the attendees strolling the floor are informaticists and other non-clinician executives. Of course, even the PACS and RIS (radiology information system) markets are now saturated, and at this point, the imaging informatics world is evolving rapidly, under the influence of healthcare reform and other pressures.

Indeed, what was fascinating to me this year at RSNA was the degree to which some of the current shifts are making themselves visible. And what’s most interesting is how several different trends all seem to be converging now, with all the pressures around cost and quality in U.S. healthcare (and really, internationally as well, though expressed differently abroad) shifting the landscape under both imaging and imaging informatics. Suddenly, after years of predictions about the new healthcare, the new healthcare—a system demanding greater cost-effectiveness, higher documented care quality, improved efficiency, transparency, and accountability—is here. The Affordable Care Act is forcing the issue on trends that had already been building strongly in the private insurance world—value-based purchasing, readmissions reduction, cost control, and utilization management, among others—meaning that redundant and unjustified diagnostic imaging are now in the crosshairs of payers and purchasers.

What’s more, a closer attention to patient safety and a demand for better service on the part of referring physicians, are both pushing forward the need for such innovations as automation-facilitated critical test reporting mechanisms, and automation-supported radiologist peer review.

Most of all, the need for the efficient, effective remote sharing of images in order to improve patient care and service is pushing imaging informatics squarely into the realms of health information exchange, accountable care, and population health, with the result that universal/unified viewing, vendor-neutral archiving, and other innovations are no longer just “nice-to-haves,” but within the next few years, will become “must-haves,” for both individual practicing physicians, and for patient care organizations of all types—hospitals, medical groups (radiological, primary care, and multispecialty), integrated health systems, health information exchanges, accountable care organizations, patient-centered medical homes, and every other agglomeration of clinicians.

Speaking with industry leaders like Rasu Shrestha, M.D., of the UPMC health system, with radiologist leaders from all types of medical groups, with leading consultants like Joe Marion, and with thought-leaders at vendor companies like Rik Primo, it is clear to me that something fundamental has finally shifted at RSNA and in the imaging informatics world—and I say “finally,” because this is a shift that I personally have long hoped for. Now, for the first time ever, healthcare leaders are seeing diagnostic imaging and diagnostic images, and the people who produce, interpret, and rely on those diagnostic images, as part of a bigger picture, of a true Gestalt, in which diagnostic imaging is no longer a kind of separate “island” of healthcare activity, but rather an integral element in an integral healthcare ecosystem. And that realization has been a long time coming.

The theme of this year’s RSNA Conference, as mentioned in the association’s president’s keynote address on Sunday, and as plastered across signage everywhere, including on the stairs of McCormick Place, was “the power of partnership.” So often, such  conference “themes” tend to be abstract and detached from any realities on the ground. But could it be that this year, that theme actually did fit the radiological Zeitgeist, the spirit of these times? One can only hope so—and look forward to RSNA 2014 to see whether some of the potential of that theme will be realized in the coming year.

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