During the keynote presentation at Merge Healthcare's Merge Live 2012 Conference, Eliot Siegel, MD, professor of diagnostic radiology and nuclear medicine and associate vice chairman for informatics at the University of Maryland Medical Center in Baltimore as well as director of Baltimore Veterans Affairs Medical Center Radiology, discussed how picture archiving communication and other information systems need to evolve for the advancement of healthcare research and patient care.
According to Dr. Siegel, it is surprising how little has changed over the past 20 years in PACS and other information systems, especially when compared to how the Internet and other "intelligent systems" outside of healthcare are used. "One the one hand, [the healthcare industry] is in an area where technology is extremely advanced, but on the other hand, electronic medical records and other hospital technologies can be very 'dumb,'" said Dr. Siegel.
Why PACS and information systems fall behind
To represent the point that PACS systems seem to be behind the times, Dr. Siegel discussed the following ways his PACS system at Baltimore VA Medical Center is "dumb:"
• A physician cannot sign on to the PACS system unless all capital letters are used for the login.
• The PACS system will transcribe the craziest things without pause or question. "One time I told the system to enter '4.8' but it transcribed 'foreplay' instead. Why foreplay was relevant to the content was beyond me. The system should have a mechanism for a lower level of confidence for the word 'foreplay,'" said Dr. Siegel.
• The system will ask "are you sure?" over and over even though the answer is always yes. "I've spent the whole day saying yes to the 'are you sure?' question," said Dr. Siegel.
• The PACS will not talk with another PACS system, such as one for cardiology, even though it is from the same vendor.
• The system will let physicians ask for an old study but never let them know whether or not it found it or if it is still in the archive.
• The system has forgotten how to decode its own image data format from 19 years ago.
All of the elements Dr. Siegel mentioned showcase how PACS systems need to evolve. The lack of intelligence can slow down a physician's process and waste valuable time for treating patients. "The question is: What features do we need in a PACS system? How can we transform a system so that it will work better with other systems to be ready for the next generation?" ask Dr. Siegel.
While the system features may differ depending on the hospital and its services, Dr. Siegel pointed out two major ways in which PACS and other information systems need to evolve.
1. Add more intelligence to information systems. According to Dr. Siegel, there are a dozen of ways that PACS systems and other information systems can be more intelligent, which will help to reduce physician fatigue and implement patient safety initiatives. "There are so many examples of how to make PACS systems more intelligent, such as modifying the PACS protocols, adding speech recognition and creating interfaces that pull information from each other. If you want a system that does not create physician fatigue but has a mechanism for tracking and storing patient radiology doses to increase safety and reduce adverse interactions, you need to automate the system in a meaningful, efficient way. As the EMR gets smarter, the imaging system needs to get smarter" said Dr. Siegel.
2. Update ownership of patient data. If the ownership of patient data was updated or less restricted, it would be easier for physicians to share and move images for diagnosis and treatment. According to Dr. Siegel, images are currently shackled to a single vendor, which prohibits the free flow of the information, even to various versions of storage. Instead of vendor-owned, the patient images and data could be owned by the patient and/or the physician depending on the situation. "The software should not be tied to one vendor. If I can have control of my own images to display them on multiple or different systems, then I have a maximum amount of flexibility, which is the best for advancing research and patient care. With more vendor flexibility, physicians could use multiple imaging systems — one that is best for cardiology images and one that is best for radiology images," said Dr. Siegel.
There are many ways that the healthcare industry and imaging services can evolve. The above are just two suggestions that may lay a better foundation for incorporating cutting-edge, modern technologies into healthcare to advance patient care. "I'm looking forward to hearing how Merge and its customers can accept and tackle challenges and help lead the way in the industry to bring more effective, efficient and safer medical imaging to our patients," said Dr. Siegel.
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According to Dr. Siegel, it is surprising how little has changed over the past 20 years in PACS and other information systems, especially when compared to how the Internet and other "intelligent systems" outside of healthcare are used. "One the one hand, [the healthcare industry] is in an area where technology is extremely advanced, but on the other hand, electronic medical records and other hospital technologies can be very 'dumb,'" said Dr. Siegel.
Why PACS and information systems fall behind
To represent the point that PACS systems seem to be behind the times, Dr. Siegel discussed the following ways his PACS system at Baltimore VA Medical Center is "dumb:"
• A physician cannot sign on to the PACS system unless all capital letters are used for the login.
• The PACS system will transcribe the craziest things without pause or question. "One time I told the system to enter '4.8' but it transcribed 'foreplay' instead. Why foreplay was relevant to the content was beyond me. The system should have a mechanism for a lower level of confidence for the word 'foreplay,'" said Dr. Siegel.
• The system will ask "are you sure?" over and over even though the answer is always yes. "I've spent the whole day saying yes to the 'are you sure?' question," said Dr. Siegel.
• The PACS will not talk with another PACS system, such as one for cardiology, even though it is from the same vendor.
• The system will let physicians ask for an old study but never let them know whether or not it found it or if it is still in the archive.
• The system has forgotten how to decode its own image data format from 19 years ago.
All of the elements Dr. Siegel mentioned showcase how PACS systems need to evolve. The lack of intelligence can slow down a physician's process and waste valuable time for treating patients. "The question is: What features do we need in a PACS system? How can we transform a system so that it will work better with other systems to be ready for the next generation?" ask Dr. Siegel.
While the system features may differ depending on the hospital and its services, Dr. Siegel pointed out two major ways in which PACS and other information systems need to evolve.
1. Add more intelligence to information systems. According to Dr. Siegel, there are a dozen of ways that PACS systems and other information systems can be more intelligent, which will help to reduce physician fatigue and implement patient safety initiatives. "There are so many examples of how to make PACS systems more intelligent, such as modifying the PACS protocols, adding speech recognition and creating interfaces that pull information from each other. If you want a system that does not create physician fatigue but has a mechanism for tracking and storing patient radiology doses to increase safety and reduce adverse interactions, you need to automate the system in a meaningful, efficient way. As the EMR gets smarter, the imaging system needs to get smarter" said Dr. Siegel.
2. Update ownership of patient data. If the ownership of patient data was updated or less restricted, it would be easier for physicians to share and move images for diagnosis and treatment. According to Dr. Siegel, images are currently shackled to a single vendor, which prohibits the free flow of the information, even to various versions of storage. Instead of vendor-owned, the patient images and data could be owned by the patient and/or the physician depending on the situation. "The software should not be tied to one vendor. If I can have control of my own images to display them on multiple or different systems, then I have a maximum amount of flexibility, which is the best for advancing research and patient care. With more vendor flexibility, physicians could use multiple imaging systems — one that is best for cardiology images and one that is best for radiology images," said Dr. Siegel.
There are many ways that the healthcare industry and imaging services can evolve. The above are just two suggestions that may lay a better foundation for incorporating cutting-edge, modern technologies into healthcare to advance patient care. "I'm looking forward to hearing how Merge and its customers can accept and tackle challenges and help lead the way in the industry to bring more effective, efficient and safer medical imaging to our patients," said Dr. Siegel.
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