Ace in the Hole

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Cheryl ProvalWhile the pols dicker about whose health-care bill will save Medicare, a changing of the guard commences at the Office of the National Coordinator, and the states take their concerns to the courts, one thing has become increasingly clear: Without health IT to turn the vast web of discrete clinical, administrative, and financial transactions that is health care in the United States into a interconnected whole, the challenge of improving the health of all US residents at lower cost will fail. This is hardly a new idea. Rather, it is a truth recognized at the highest level of government, with a large incentive program—the Health Information Technology for Economic and Clinical Health Act—standing ready to reward nearly 90% of US physicians who invest in electronic health records for their patients with a $44,000 incentive payment. Whether it will be the biggest boondoggle in US health care or a decisive investment in the quest remains to be seen. Either way, there is no question that money alone—whether $19 billion or $99 billion—cannot achieve this incredibly challenging objective. It will take an army of health IT professionals—hammering out standards, designing networks, building interfaces, and managing huge stores of data—to make this work. That is why I’d like to take this opportunity to issue a shout-out to all of the unsung heroes of health-care reform: health IT professionals (specifically, those in radiology), not just for how far they have brought us to date, but for where they will take us tomorrow. Among these heroes, I count the PACS pioneers in academia, as well as the current generation of imaging informaticists working to improve clinical quality, the informatics professionals working in the hospitals, the hospital and practice CIOs and their staffs, and the radiology-informatics vendors. As a matter of fact, Radiology Business Journal has partnered with the Society for Imaging Informatics in Medicine (SIIM) to launch a competition to recognize five innovative IT projects, but more on that later. Let’s talk about heroes first. PACS pioneers and imaging informaticists: Have we said enough about the contributions that these physicians and physicists have made to health care through their efforts to make images pervasive and PACS ubiquitous? I think not. How many unreimbursed hours have been spent on DICOM boards and Integrating the Healthcare Enterprise (IHE) committees, or in planning PACS implementations? What of their efforts in developing new media-appropriate reading styles to replace the old-fashioned stack mode? The discomfort caused by this tectonic change to radiologists’ practice patterns, in the transition from film to soft-copy reading, should not be underestimated, yet adoption of PACS is almost ubiquitous and film has nearly vanished from reading rooms. Hospital and practice CIOs: These are key positions in every health-care organization today. Not only are hospital and practice CIOs responsible for keeping the clinical systems operational in a mission-critical environment, but they increasingly will be called on to orchestrate the interoperability of clinical, administrative, and financial information systems, in a growing number of settings, as care extends into communities across the United States and health-care providers are induced to accept risk. May the force be with you! Imaging-informatics professionals: When you can’t get your computer to recognize your password or the CT study is loading too slowly, this is the person you call to fix the problem—sometimes, in the middle of the night. PACS administrators and other imaging-informatics professionals are the invisible seams in a seamless integration—the glue that holds the domain together. When the big, multimillion-dollar scanners arrive by train, plane, and crane, these are the people who bring the technology onto the network. It is not always painless. Imaging-informatics vendors: While successful vendors survive because they have a business model that works, the vendors in radiology informatics deserve recognition for their adoption of standards and support of the IHE framework, even when that means undoing proprietary solutions to problems that have already been designed (and financed). When a radiology department or practice goes shopping for an information system, a piece of technology, or an informatics appliance, it is possible to buy one that adheres to accepted standards. That is not so in any other department/specialty (please correct me if I’m wrong). The role of health IT is so critical, at present, that it is driving (and will continue to drive) mergers and acquisitions in the health-care market. The IT experience and intellectual capital that radiology has acquired over the past 15 years, in its transition to a digital workflow, will prove invaluable to the profession and health care in general in the years to come. Imaging IT Competition Over the next few months, RBJ and SIIM will cosponsor a competition to recognize the wealth of IT innovation in our specialty with “The Top Five Medical-imaging IT Projects of 2010.” We will look at projects in these categories: clinical, business intelligence/finance, communications, interoperability, and security. A jury of six members of SIIM, representing a broad spectrum of practice settings, will judge the entries based on ingenuity, on meeting a need that is unmet by commercial solutions, on quality improvement, and on potential impact. Winners will be announced at the SIIM meeting in Washington, DC, on June 2–5, and will be featured in the June/July issue of RBJ. The deadline to enter is April 1, 2011. The next time you pass your department or practice’s informatics champions, please encourage them to enter their latest medical-imaging IT project in the RBJ–SIIM “Top Five Medical-imaging IT Projects of 2010” competition at A pat on the back, a big thank-you, or a lunch at the Ritz also would be in order.