Medical imaging departments are finding better ways to integrate information, increase efficiency, and improve patient care with software enhancements for digital technology.

Twenty years ago, physicians weren’t required to have the level of computer savvyness they need today to navigate complex medical imaging software. Radiologists want these studies to be readily accessible, along with high-quality images, but they don’t want to have to log into several applications to obtain comparisons, laboratory results, or allergy information. Some facilities store electronic medical records (EMRs) in different databases and require separate software applications to retrieve or view them.

“Radiologists want applications to be fast and as simple as possible. They want integration, single sign-ons. I think software vendors are really trying to accommodate that. Technology shouldn’t be cumbersome. It should be a tool that helps, not a tool that hinders,” said Dennis Garcia, operations manager of Imaging Informatics for UCLA Healthcare.

“The EMR is the holy grail in the medical arena currently,” Garcia said. “It’s difficult to create compatibility to put it all into one application to view the information all at once. Most large medical facilities are striving for that, but currently it’s still a work in progress.”

Garcia said advances in medical imaging equipment are forcing software developers to keep up. CT scanners, which are getting faster and better, already can take several hundred images of a heart while it’s beating.

Companies such as Vital Images, for example, are constantly updating their software that allows physicians to view CT, MRI, and PET images in two, three, and four dimensions. These images can be dissected, reconstructed, archived, and later retrieved by physicians on the Web. Because computer monitors have improved dramatically, these images are close to diagnostic quality.

Garcia said one free, yet powerful, software that allows reconstruction and fusion with PET scans can help smaller medical imaging centers read digital images without a lot of capital investment. However, the OsiriX software is only Macintosh compatible.

“As long as you have a Macintosh that meets the software’s requirements, you can just download it and start using it,” he said. “With the cost of health care, some small clinics just don’t have the capital investment to put up workstations and software. OsiriX is an arena of programmers with medical backgrounds trying to fill the void.”

Garcia said the growing trend is for PACS and radiology information systems (RIS) to be more user-friendly and efficient so the patient is the number one concern.

“We’re just trying to get to the point where everything is integrated. Time is also important. If all that information is readily available to all the people caring for the patient, it makes care that much better,” he said.

RIS software vendors can provide information, such as contrast usage and potential allergy reactions, but Garcia said it is not a substitute for standard safety measures in medical imaging.

“We really double and triple check. The application is able to provide that information for us, but we still have manual checks. The technology definitely helps us in that role, but it cannot replace due diligence and making sure you’re doing everything to ensure patient safety.”

In addition to integrating information systems into a single application, radiologists also are moving toward structured reporting and decision-support software.

Curtis P. Langlotz, MD, PhD, is vice chair for informatics for the University of Pennsylvania Health System’s Department of Radiology in Philadelphia. He also developed eDictation, a point-and-click, voice recognition software that creates, manages, and distributes medical imaging reports.

Langlotz’s work focuses on improving radiology records, reducing reporting time, and creating a structured database for the reports. He said structured reporting software gives medical providers critical test results sooner and standardizes the format and content of the information they receive.

“The radiology reports have traditionally been—and really arose as—a letter between colleagues describing what was done in the radiology suite. It really hasn’t changed that much,” he said.

He envisions reporting tools that will create radiology reports as quickly as dictation and transcription with information structured consistently to improve the quality and management of those reports.

Langlotz said he also is interested in decision support software that helps referring health care providers determine the best radiological tests for their patients. The software asks physicians for clinical information about the patient and then provides feedback on the appropriate tests to order.

“It makes sure the patient is getting the right test, and it helps optimize the utilization of imaging exams,” Langlotz said. He noted the software might also reduce duplication of imaging and enhance patient safety by not exposing them needlessly to radiation.

Decision support software also provides tools for radiologists to access educational and diagnostic resources, including teaching files, Web searches, and online text or databases of published research literature. He said the information helps radiologists make more complete and accurate interpretations.

Langlotz said there are two strategies for choosing imaging and reporting software. Radiology departments can go with the best of breed or select a single vendor for all their solutions. When choosing a single vendor, radiologists presume the various products will work well with each other and enable tighter integration between components.

Choosing the best of breed means implementing the best software, but it also requires significant effort to ensure the different vendors’ products comply with standards for the integration of products as recommended by Integrating the Healthcare Enterprise (IHE), an initiative in the health care industry to improve medical information sharing. IHE promotes established standards such as Digital Imaging and Communications in Medicine standards (DICOM) and HL7, a medical grammar and vocabulary that makes it possible for health care systems to share and understand clinical data.

“It’s just a way for different vendors to enable their systems to talk to each other and work together,” Langlotz explained.

Although hospital systems are integrating their own information systems, the ability to share patient information between institutions is still in its early stages. Langlotz said the day will come when a patient’s images at one facility will be available for a physician treating that same patient in a different health system, in a different state.

“The information will be transferred to them over a data network,” he said. However, the challenge will be developing a universal medical records system that can correctly identify patients. It also would require appropriate privacy safeguards and the ability for patients to give or withhold permission for data transmissions, he said.

Data storage is another key piece in the imaging puzzle as the size of archived image files increases with enhanced technologies. Garcia said a single CT study might take up to two gigabytes, so storage area networks now hold terabytes of information. However, the repository may be off-site, which is one of many factors that affect how quickly data can be retrieved. According to Langlotz, new structured reporting and data visualization software may help radiologists manage their increasing workloads more efficiently.

“There’s been an explosion in the number of images radiologists look at every day,” he said. “We’re going to really need those technologies.”

Patient confidentiality is another critical issue as medical images become more transmittable on the Web and via technological phenomena, such as the iPhone. Software developers already are creating image-viewing applications to work on iPhones, so physicians can access patient information from anywhere.

“It’s something a lot of people are working on. In the next few years, you will definitely see the iPhone playing a role in imaging,” said Garcia. That software, however, also must comply with the Health Insurance Portability and Accountability Act (HIPAA) to keep patient data secure.

“The security has to be in place before you see a big growth in the applications that allow you to view images. It would have to be over a secure VPN (virtual private network) connection so there is no interception of the data,” Garcia said. “I don’t think you’ll see a real jump in the number of applications available, in particular with the iPhone, until all the security measures are in place.”

The availability of advanced technology and the speed of service are becoming more of a factor for patients when choosing their health care provider in an increasingly competitive industry. Patients are more educated, more assertive about their care, and more impatient about waiting for test results.

“We’ve come to the realization that patients don’t come into the office blindly. They have an idea what technology out there exists to help them with their condition. They are savvier,” Garcia said. “While the turnaround time for a report 5 years ago might have been several days, it’s now possible for an exam to be completed and evaluated in 10 to 15 minutes.

“They know it shouldn’t take a week to get results on an x-ray or lab [test]. It’s my job to make sure we provide the tools to get those reports out as quickly as possible,” Garcia said. “We use that as a reason to make things better, make them more efficient. At the end of the day, the patient is our customer. We’re providing a service, and we want to provide that service as quickly as we can.”

Verina Palmer Martin is a contributing writer for Axis Imaging News. For more information, contact .