As healthcare takes steps toward the Affordable Care Act’s mandate for patient centricity, information technology also has some ground to traverse. Take PACS, for instance. Technology developed as a departmental workflow tool must transition to a system that contributes to a holistic view of a specific patient rather than supporting the interpretation of a specific study. Access to the data that radiology generates must be enhanced for everyone, including patients.
As a former chair of radiology; one-time National Institutes of Health investigator with the Annotation and Image Markup Project; and a computer programmer, David S. Channin, MD, has as intimate an understanding of the capabilities and shortcomings of imaging informatics as anyone. Now president of the recently launched health IT consulting firm Insightful Medical Informatics, Channin addressed the above question, as well as the important roles that vendors, IHE and the federal government all have to play as this system continues to evolve.
What are the inherent technological obstacles to adapting PACS for patient-centered care?
Channin: The first obstacle that comes to mind is integration with the EMR. We certainly have some degree of integration now, with most EMR systems talking to the RIS and talking to the PACS. To be more patient-centric, the level of detail of the interactions between those systems has to be increased.
For example, people have done some prototypes where you can pull information from the EMR to display to the radiologist while they are reporting a case, and I would say that is in the Stone Age right now: it’s primitive. That needs to be improved so that the radiologist has the best picture of the patient possible while they are reporting that study, and that has to be provided in a very rapid, easy-to-use way so that it does not slow down the radiologist.
Right now, the radiologist might have access to the EMR, but they have to go poking around to get to the information they want. It’s very cumbersome. And that’s on the input side.
On the output side, I think patients like to see their radiology reports, but clinicians are very leery about patients seeing their radiology reports, especially before they see the reports. If you want to be more patient-centric, you have to think about how to report the study in a way that is explanatory to the patient.
Having tools that let the radiologist report a study in an appropriately clinical, scientific fashion that can also be understood by the patient is tricky. I think that’s one of the unrealized potentials of structured reporting.
Does it impact a radiologist’s reporting if he or she knows patients will be reading their own full reports through a patient portal?
Channin: I do think radiologists think about this while they are reporting a study. Does that have a significant impact on the speed? I don’t think so. But they are thinking about how they are writing for two or more audiences.
They are used to writing for the clinician, the lawyer and the patient already, but the goal of technology is to reduce the anxiety and uncertainty that comes with doing so. If they know an appropriate translation of their meaning is going to be provided, it does help them remain focused on other things. It will also yield more consistency in the reports.
What is the functionality necessary for a more patient-centered PACS?
Channin: This goes back to this theme of the EMR and the RIS/PACS needing to work together better. Right now, when the EMR gets the radiology report, even if the report is structured, it typically only gets an HL7 representation of that structure. That would be a functionality that needs to develop.
For example, if I say “liver,” I go into the LI-RADS vocabulary, and I’m describing a specific liver lesion; or if I am making an AIM annotation, that description brings me to a specific inference about the type of liver lesion. The structure of those observations and inferences needs to be preserved so that the EMR knows those comments refer to the liver. Then, when it presents liver laboratory tests, for example, it could provide those comments to a surgeon instead of just referring them to the entire radiology report. Being much more clever about how the information is structured and used is a very patient-centered focus, because the radiology report right now is “study” focused.
The other functionality necessary is better communication between the radiologist and clinicians looking at the