Attendees of this year's annual meeting of the Society for Computer Applications in Radiology (SCAR) in Vancouver were greeted with a message: healthcare information technology and practice automation are critical for controlling healthcare costs, and physicians must drive that change.
In his keynote address, Dr. Leo Black, retired CEO of the Mayo Clinic Jacksonville (MCJ) in Florida said today's healthcare cost situation will only worsen in the future, thanks to new technology and the burden of treating an aging population.
At the same time, the quality of care needs to improve, and achieving these quality gains is becoming more data-driven, he said.
Migrating toward EMR systems and PACS integration
The solution, Black believes, is moving to an electronic medical records (EMR) system that includes an emphasis on cost reduction; this system also needs to provide a cost-efficient infrastructure necessary to improve quality. The adoption of information systems has been maddeningly slow, however.
Black said that if the EMR is to be widely implemented, doctors and nurses have to lead. It's unfair to delegate this goal to the IS department and expect them to do it quickly, he said.
The integration of PACS with EMR systems was the subject of another SCAR talk, with researchers from the University of Texas M.D. Anderson Cancer Center highlighting its benefits for improving image interpretation workflow. In addition, the integration of PACS with EMR systems is of vital importance in maintaining the future clinical relevance of radiologists, said Dr. Kevin McEnery.
Radiologist workstations must evolve to include ancillary clinical data sources that are critical to the workstation's functionality, and radiologists must transition into a role as a radiology consultant and not just as an interpreter of images, he said.
Mobile computing technologies highlighted
The increasing utility of mobile computing devices for PACS applications was also displayed at the meeting. During the R&D Committee Symposium, Wyatt Tellis of University of California, San Francisco (UCSF) described how PDAs could be used to improve communications between emergency and radiology departments.
UCSF replaced an existing fax-based process of communicating urgent exam results to the emergency department with a new approach utilizing PDAs, which were used to notify emergency doctors that results were available. Full access to text of wet reads and final reports were provided, as well as reports for prior exams on the same patient.
The new system produced reductions in timing metrics, as well as extremely positive feedback, Tellis said.
In other wireless-related presentations, researchers from the National Taiwan University Hospital in Taipei reported success with wireless-enabled tablet PCs. The study team concluded that the tablet PCs could yield equivalent performance to high-resolution monitors for clinical image review, but were unsuitable for diagnostic reading applications.
Spotlight on system security
Security is on the mind of every PACS administrator these days. No matter how many layers of digital security are employed by a conscientious RIS/PACS manager on their system, given enough resources, a determined intruder can still hack a protected network. More often than not, this is accomplished through the unwitting accomplice of the network users.
Wireless network users must address authentication and encryption, according to Dr. Paul Chang of the University of Pittsburgh Medical Center in Pennsylvania. For wired users, the best defense against intruders is a combination of security technology and ongoing user education, said Dr. Thomas Warfel, also of the University of Pittsburgh Medical Center.
Warfel recommends that strong authentication be used, combining both password and a physical token or a biometric element. For those administrators embracing biometric technology as an unbreakable authenticator, he advised caution.
All network-attached devices, such as modalities and workstations, that share the same operating system (OS) need to have patches applied promptly when the OS vendor releases them, Warfel said.
The combination of human monitoring of system events, a help line with competent assistance, and education on social-engineering technique (by which hackers compromise users to release network access information) for all computer users may help reduce the incidence of system compromise and facilitate recovery once compromise has occurred, Warfel said.
Budgeting for PACS
It's no secret that PACS can be expensive. But by taking advantage of off-the-shelf hardware and scaling a project appropriately, PACS doesn't have to be a budget buster, according to Paul Nagy, Ph.D., of the Medical College of Wisconsin in Milwaukee.
As a rule of thumb, Nagy recommends spending about 30% of the PACS budget on hardware. The remaining 70% should be dedicated to software and support.
To save money, Nagy points to commercial color LCD monitors as an optimal solution for medical imaging applications that don't require very high resolution. Digital storage is another area that offers an opportunity for savings; PACS storage can be performed on a commercial IDE or serial ATA RAID level 5 hard-drive system, he said. Nagy also recommended that a facility buy only the storage it needs in six-month increments, as the price of storage continues to decline by half just about every 18 months.
Current PACS users could also find value in a data migration paper presented by the University of Pennsylvania Medical Center (UPMC) in Philadelphia. A UPMC study team discussed its experience with an automatic conversion algorithm, which the institution found facilitated a smooth PACS data migration process.
The algorithm produced a correct match in 94% of the 138,984 PACS image sets migrated by UPMC, with a 100% confidence that the image data is matched with the correct RIS record, according to UPMC's Regina Redfern.
Talking about speech recognition technology
In a presentation on speech recognition (SR) technology, Stephen Harman of the University of Toronto and the University Health Network, Mount Sinai Hospital in Toronto said that the technology has matured to the point that it is user-friendly for most people. However, success is based on a clear understanding of the reality of these systems, and what they can and cannot do, he said.
Herman, who has used a SR system at his practice since 1994, noted two main benefits accruing from the technology: faster report creation and the need for fewer or no transcriptionists. As SR technology permits report creation as the case is viewed, the final report can then be completed in as little time as a few minutes after a diagnostic read is finished.
However, SR users must assume editorial responsibilities for their creations, a task which radiologists may resist despite the fact that they already do it. Content creation within the report body must also be more carefully crafted. Speech dysfluencies, including stammering or the use of pause sounds such as "uh" or "ah," need to be minimized or eliminated, he said. A benefit of the increased attention by the radiologist on the report creation process is shorter, more concise reports.
Herman also advocated that SR adopters maintain a clear and unequivocal path toward the technology for a successful implementation. When there is no dictation/transcription alternative available, users will dedicate themselves to making the system work.
By Erik L. Ridley
AuntMinnie.com staff writer
September 10, 2004
Copyright © 2004 AuntMinnie.com
