“It is vast, and it is subjective.” I heard these words to describe the future of medical imaging from Dan Kerpelman, senior VP of Eastman Kodak Co (Rochester, NY) and president of Kodak’s Health Imaging Group, at a recent event in San Diego. I had the opportunity to attend Digital Transformation: A Symposium for Radiology and the Healthcare Enterprise, which was jointly sponsored by the Institute for Advanced Medical Education (Rye, NY), Ardent Learning Inc (Rochester, NY), and Kodak.

Kerpelman’s presentation highlighted trends for the future of this industry, including a projected PACS adoption of 61% by 2007, an expected 14% increase in US IT capital spending annually over the next 5 years (with the highest intent to purchase on DR, HIS, and CPOE), and the anticipated role of molecular imaging to be fused with anatomical imaging to create a molecular diagnostics market that could reach $10 billion by 2007. “It’s a dynamic environment with lots changing,” he said. “It’s a good time to be in healthcare to forge a future that is very different.”

And he’s exactly right. The technologies that this industry has been discussing, testing, and improving upon over the past decade have clearly emerged as true workhorses. In response, facilities have had to start singing another tune in terms of technology. No longer is the question “Will it work for us?” Instead, radiologists, technologists, and the IT staff alike are asking, “How do we refine this technology to work for us?”

One institution asked those questions early on, and many lessons can be learned from its headfirst launch into a filmless environment. Eliot Siegel, MD, professor and vice chair of image information systems at the University of Maryland School of Medicine (Baltimore), presented on the topic, detailing an 11-year “case study” of the Baltimore VA Medical Center, where he is the chief of imaging. The center, which performs about 90,000 examinations per year, opened in January 1993 as a fully digital facility.

Filmless from the start, the facility has noted major workflow and productivity increases, such as radiologists reading 15% faster with PACS for CT, CT technologists increasing productivity by 40% and reducing workflow from 11 steps to five, and reducing the image rejection rate by 84% after the transition to CR. Siegel noted that the facility has plans for upgrades and changes to the system, including the addition of full-field digital mammography to PACS and incorporating speech recognition into the process.

In listening to Siegel’s speech, I noted an important area, often overlooked, where facilities must make the technology work for them: workflow. It seems painfully obvious, but a common error when implementing a PACS and a digital workflow is that facilities try to emulate their film workflow rather than adopting a new process with the new technology. For example, 4 years before opening the center, Siegel’s team carefully analyzed the workflow associated with an inpatient chest radiograph that was performed in the radiology department. With film, it took 59 steps; with digital, the steps decreased to 47-not a huge improvement, especially when new steps, like voice recognition and digital dictation, might be incorporated.

However, through further reevaluation, the integration of various information systems, implementation of an electronic medical record system, and, as Siegel explained, by “using the technology as a tool to automate the previously manual steps,” the facility was able to reduce the number of steps to just nine.

Clearly, workflow is just one area where facilities can make the technology work for them and in a way that optimizes both the users and the technology. More important, however, is the notion of embracing new technology, learning from it, and adopting it in your facility. Vast and subjective, this essential technique is the key to smooth sailing in the future.

Andi Lucas