Are silicon and Ethernet the answer to medical error and personnel shortages?

Medical informatics are being touted as the potential cure for some very high- profile health care problems, and, yes, it would be nice if it were that simple. But those in radiology know, more so than those in any other clinical department, that information technology is just partalbeit a necessary partof the cure. We have watched the resources and attention of the information technology department shift from one “urgent” informatics initiative to the nextfrom Y2K to EMR to CPOE and now back to the EMRduring the past 5 years. While that department races to achieve the big win, radiology, like Aesop’s proverbial tortoise, has slowly and systematically made real and measurable progress toward achieving some very specific communications and operational goals: first, in converting the department to a digital environment and, second, in providing referrers access to the digital files containing the requisite diagnostic information. In a growing number of institutions, radiology has been the springboard from which enterprise-wide communication efforts are being launched via Internet technologies such as web browsers, portals, and Wi-Fi. These advances, it should be stated, would not have been possible without the assistance of information technology department personnel. Many individuals in the medical and vendor communities have spent years and invested millions to make this revolution in radiological communications happen. You know who you are, so give yourselves a round of applause, you deserve it. But there is more to be done. Computerized physician order entry for radiology could provide much-needed decision support and utilization management. Bringing structure to the reporting process would potentially save precious time and provide radiology and medicine at large with access to a mother lode of diagnostic data for research purposes. And, last but not least, by embracing and adopting industry-wide standards for the seamless communication among the multitude of devices, applications, and systems in the radiology department, radiology will build a bridge to the enterprise that accommodates two-way traffic.

For those in radiology who are planning to put information technology to the service of their departmental missions, here are a few guidelines culled from the experiences of the many contributors to this edition of Decisions in Axis Imaging News, dedicated to imaging informatics:

1. Know what you want to accomplish. Technology is an enabling tool to get where you need to go.

2. Educate yourself. You cannot write an RFP if you do not know what is possible. A good place to begin is A Nontechnical Introduction to DICOM on the Web site of the Radiological Society of North America, written by PACS pioneer Steven Horii, MD. This will provide a basic understanding of one of the most important building blocks in medical communications. It can be accessed at:

The next stop is the Integrating the Healthcare Enterprise technical framework also posted on the RSNA Web site: By understanding the work of this organization, buyers can influence the adoption rate of vendors.

3. Allocate the necessary personnel resources. More than one PACS project has floundered because the sponsors failed to initiate the proper planning and to designate an experienced and/or passionate person to the endeavor. This is hard work and it requires the efforts of many people. With resources stretched as thin as they are in most organizations, there must be one person with the vision and mission to see each project through to its conclusion.

The flashy, top-down informatics projects promoted by the dream weavers and vaporware vendors are tantalizing, but at the moment they are little more than science fiction. It is the bottom-up projects rooted in clinical reality and based on industry-wide standards that are adding real value to the health care enterprise.

Cheryl Proval

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