The future is here—it just hasn’t made it to radiology yet. A restless pioneer spirit continues to drive radiology into the future, even if that future is lagging well behind advances achieved by Internet commerce companies. “This is not novel; this is how IT works in every other vertical setting except medicine,” Paul Chang, MD, FSIIM, explains. “We’re 10 years behind the rest of the world. We are arrogant and ignorant—it’s OK to be one, but it’s bad to be both.”
Chang is talking about service-oriented architecture (SOA), a way of creating customized applications by incorporating software in existing vendor systems and linking them to achieve specific purposes. With SOA, he says, the radiologist of the future will be able to access information from various sites so that it all comes together on the workstation. “The big future now is interoperability,” Chang says. “We’ve got the PACS, the RIS, and the electronic medical record (EMR), but they’re all little islands. I don’t want that. I want the best parts of all of them, in an experience optimized for me.”
Chang uses the example of ordering from Amazon to explain how SOA works. “When I push the button to order something, Amazon is talking to 20 different systems—UPS, Toys”R”Us, and so on,” he says. “If we are forced to order something in the hospital, we have to log in to all the different vendors. The technology that allows Amazon to contact them simultaneously is SOA. We need the same thing for patient care.”
SOA is so important to Chang that he uses it in one of his titles. He is medical director for SOA infrastructure at the University of Chicago Hospitals; he is also professor and vice chair for radiology informatics at the University of Chicago School of Medicine. Chang says that one thing that SOA will bring to the radiologist’s cockpit of the future is the ability to integrate clinical data seamlessly into the radiologist’s workflow as he or she sits at the workstation.
“I’m an oncologic body imager,” he says. “It’s important for me to understand the clinical context before I render an interpretation.” He adds, however, that the clinical information that comes with a requisition for imaging is very limited. To get better information, Chang says, the typical radiologist must log into the hospital’s EMR database and search the clinical history under that patient’s name. “It takes time, and the application is designed for the primary care physician; it’s not meant for me,” he says.
At the University of Chicago Hospitals, where Chang has already partially implemented SOA, the patient’s medical history from the EMR shows up with a click on the PACS. “SOA allows me to mash up or create any arbitrary application for the user,” Chang says. “That’s my PACS. When I look at my PACS, instead of forcing me to go to other applications, it pops it up the way I want it, in an appropriate, idiosyncratic manner. It makes it look like the PACS pops up laboratory reports.”
SOA is only part of the delivery system that radiologists will use in the future, Chang says. “Even today, we’re pretty efficient in the reading room,” he says, “but talking about report turnaround or patient throughput is too limited a view. The clock starts when a physician decides an image is needed, and it ends when he or she gets information from that image that pertains to patient care.”
If technologists have to struggle with manually composed imaging protocols at the scanner, that creates inefficiency. It adds to the referring physician’s wait for results. “That’s the lack of interoperability,” Chang says. The University of Chicago Hospitals are already experimenting with attaching radiofrequency-emitting identification chips to patients that track them through the care-delivery process, including the radiology suite. As soon as the patient enters the facility, the protocols for the scan can be entered electronically into the scanner, saving time for the technologist and, down the line, the referrer.
“We’re ready to deploy that now,” Chang says. “Cutting 10 to 20 minutes off the scan time is huge. Now, the whole complex protocol takes one second. The next theme is to look at the whole cycle.” Chang’s team is also working on automatic prompts that will remind radiologists to call referrers for follow-up for tiny tumors that need to be watched. Another prompt requires emergency-department attending physicians to acknowledge discrepancies that radiologists