Information and Image Management in Radiology: Present State and Future Directions
Written by Peter C. Buetow, M.D.
Table of Contents
Introduction
Part 1. Background
Part 2. Networks for Electronic Radiology (Coming January 2000)
Part 3. Computer-Aided Diagnosis (Coming January 2000)
Part 4. Evaluation of Radiology Systems (Coming February 2000)
Part 5. Radiology Systems Architecture (Coming February 2000)
Part 6. The Process of Implementation (Coming February 2000)
Part 7. Conclusions (Coming February 2000)
References
Introduction
Economic pressures combined with accelerating technological advances have led to the reorganization of health care delivery. These changes have been dramatically witnessed in the field of radiology, due at least in part to its intimate connection with technological advances. Hospitals (and eventually all patient care centers) are beginning to move toward the elusive goal of an electronic medical record (EMR) system. Radiologic images will be part of this EMR, and the modeling architecture used in image management will serve as a model and major component of information technology systems.
The radiology practice of the future involves similar processes used in today's practice of radiology, but is arrived at through different means with the use of information technology and computers. Imagine, for instance, the following scenario:
1. A new patient arrives in the radiology department for a magnetic resonance (MR) scan of her brain.
2. Upon arrival, her electronic medical record is accessed.
3. The record is automatically scanned to access the clinical guidelines and appropriateness of the examination regarding the patient's tentative diagnosis.
4. The request for the examination has also arrived electronically and has been screened appropriately-defining the problem and pertinent clinical information.
5. Guidelines regarding the appropriate image sequences to be used and appropriate post-processing have been standardized and forwarded to the technologist.
6. The images are interpreted by the radiologists with the use of decision aides and educational resources.
7. Images from prior studies performed on the patient are automatically retrieved for comparison from the image database.
8. Comparison is made to other cases of other patients who had similar findings or diagnoses.
9. A diagnostic assessment integrating these findings, the patient's specific information, and the experience of the radiologist is compiled.
10. These results, along with pertinent images, are then forwarded through a central network to the referring physician's office, where both images and the consultation can be reviewed.
11. While all of the above is taking place, the methods and pathways by which information is processed is automatically and continually monitored and improved by the network.
12. Outcomes analysis and cost effectiveness data from each evaluation is fed back into a database, which will be applied to future analyses.
Although this hypothetical scenario is somewhat futuristic, radiology information systems are evolving in this direction. Different institutions are incorporating such changes with variable expediency due to a number of pressures ranging from cost savings, efficiency, accuracy, efficacy, and the ability to accurately and continually assess outcomes.
This paper attempts to provide an overview of the present state and future directions of information and image management in radiology, with emphasis on network architecture and computer-aided diagnostic tools.
1. Background
Cost reduction and cost effectiveness are the two primary beacons that have guided the health care reform we see today. Health Maintenance Organizations (HMO) and other managed care plans were established in order to decrease the costs paid by a business to fund their employee healthcare plans. The market leverage assumed by HMO's motivated health care providers to respond: Healthcare workers began to consolidate into informal networks or actually merge; radiology groups, physicians, and hospital-based organizations combined. These mergers provided the expanded ability to negotiate larger service contracts with HMO's. Additionally, such mergers provided cost savings resulting from the consolidation of administration and other expenses. These regional mergers reflect the direction of medical information and imaging technology towards a unified patient care system without boundaries [1-3].
In motion now is a shift in the focus of radiology computing and information systems from the department level to a multi-hospital based enterprise level. (The integration of these systems will be discussed later in this paper.) The data accumulated within such a system provides information regarding the cost effectiveness and efficacy of specific radiologic studies. Such information is useful for both health management organizations and healthcare providers. In addition, such information may be used for educational and training purposes and may, in the future, be applied in the remodeling and design of work within the radiology system.
The speed at which information derived from radiologic studies is communicated, and the impact such information will have on patient decision-making, health and economic outcomes will be of the utmost importance in the future. As these networks evolve, there will be anticipated improvement in quality. The integration of image technology will be utilized not only in diagnosis but also in treatment. For example, visualization of anatomy by surgeons prior to operations will become commonplace. As cost effectiveness and quality become governing principles for deciding an appropriate course of action there will be more intimate interaction between image-oriented specialties and the therapeutic arm of interventionists and surgeons. Radiologists will therefore need to identify themselves in terms of quality service and expertise in consultation. The expectations of patients and referring physicians will also be raised to a new standard [1,3].
References
1. Greenes RA, Bauman RA. The era of health care reform and the information superhighway: Implications for radiology. Radiol Clin North Am. 1996;34:463-463.
2. Bramson RT, Bramson RA. Confronting the realities of a radiologist's life: A primer on survival in the managed health care market. Am J Roentgenol. 1994;163:783-787.
3. Deibel SRA, Greenes RA. An infrastructure for the development of health care information systems from distributed components. J Am Soc Info Sci. 1995;46:765-771.
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