University of Pennsylvania Health System: Inside an Imaging-informatics Incubator

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By observing the quantity and quality of informatics innovation emerging from a radiology department, it is possible to identify those institutions that are nurturing the next wave of informaticists in radiology. One beacon is the University of Pennsylvania Health System (UPHS) in Philadelphia, where R. Nick Bryan, MD, PhD, is chair of radiology.

Bryan is quick to attribute the department’s success in this arena both to his predecessors and to others in the department, beginning with former chair Ronald Arenson, MD, (instrumental in the development of the first RIS, in the 1980s) and including Steven Horii, MD; Reuben Mezrich, MD, (during his time at UPHS); and, most recently, Curtis Langlotz, MD, PhD, vice chair for informatics.

Bryan reports that focus, organization, and culture have made imaging informatics a hallmark of the radiology department at UPHS, and that immediate health-care exigencies are influencing current activities and priorities.

Reinforcing Tradition

A continuous line of faculty with expertise and interest in informatics has made informatics an innate part of the department, Bryan says, attracting—in turn—a consistent flow of young people interested in the field. “Having people with those levels of skill and knowledge just reinforces informatics within a department,” he says. “They impress and attract young people who want to follow their path.”

To maintain the informatics edge, Bryan has had to dedicate appropriate resources, in the form of recruiting both clinical and nonclinical staff. “Informatics and health-services research, a near neighbor, are viewed as one of a number of main academic fields of interest of the department,” Bryan explains.

A strong medical-informatics group, headed by Dan Morton, PhD, provides critical support for researchers. “That group has had strong intellectual leadership and good on-the-ground people to support the faculty,” Bryan says.

More recently, with the recognition of the need for increased efficiency, Bryan has strongly encouraged some of the younger staff members to invest their time in informatics. “Informatics is the key to gaining the efficiency we will need and, at the same time, the means to provide the quality of care and document it,” he says.

He continues, “Staff members are rewarded on the basis of their presentations, publications, and patents—all of the incentives of the traditional academic environment. In some cases, they gain additionally if they link that to commercial activities, but most of them are doing this because it is what they like, this is what they are interested in, and that is the academic part of their career.”

Three years ago, Bryan formed a new committee on departmental efficiency and appointed Woojin Kim, MD, as the chair. Under Bryan, the already sizable informatics group has grown 10% to 20%, he estimates. Traditionally, the department has two or three senior faculty for whom informatics is the main focus. A combination of natural interest and encouragement by leaders has resulted in an increase in the number of trainees and junior faculty interested in this area. “We have three to four junior faculty members who are focusing on this area, and that is more than we have traditionally had,” Bryan notes.

The Hit Parade

Among the recent activities of the department, Bryan highlights involvement in the CMS Medicare Imaging Demonstration for electronic decision support as part of a consortium with Brigham and Women’s Hospital (Boston, Massachusetts); Geisinger Health System (Danville, Pennsylvania); and Weill Cornell Medical College/New York–Presbyterian Hospital (New York, New York). “Curtis Langlotz is leading the effort on our campus, and we actually have that turned on and running,” he reports.

He also cites the RADIANCE project of Tessa Cook, MD. “In terms of quality issues, I think Tessa’s RADIANCE is a very good example,” he says. “We now have an automatic system for retrieving our patients’ radiation exposures, and for documenting and reporting them in a variety of fashions, so that people can make use of them in their patient care.”

A third project that Bryan cites is Presto, the UPHS name for the management tool developed by Kim; William Boonn, MD; and colleagues. “It indexes data from multiple information systems and provides a very effective user interface to extract the data and create reports online that we use every day in the management of our department,” Bryan reports.

Moving forward, Bryan predicts