Imaging’s 21st-century Challenges: Decentralization, Digitization, and Distribution

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In many ways, the challenges facing imaging in the 21st century are similar to those facing other industries: decentralizing both staff and workplaces; digitizing data; and distributing those data in a way that is efficient, cost effective, and secure. Anthony Toppins, MD, musculoskeletal radiologist with American Radiology Associates, Dallas, Texas, brought the imaging perspective to bear on these issues while consulting on the development of a new image-sharing solution, Health Image Share. Anthony ToppinsImage Share is a service included in the Symantec Health offering from data-security firm Symantec Inc (Mountain View, California). It provides long-term, on-demand storage for those struggling with the soaring cost of medical-image archiving. “We now use the Internet to pay our bills, order our prescriptions, interact socially, and conduct our various work-related activities,” Toppins says. “It is an integral part of our lives, well beyond email and Web surfing. Medicine and medical imaging, in particular, are natural extensions of this technology.” Having witnessed firsthand the rapid analog-to-digital transformation of the imaging profession, Toppins sees both trials and opportunities for innovation on the horizon. “During my 14 years in radiology, I have seen a dramatic shift from a hard-copy, film-based system to digital acquisition and CD-based distribution, with an evolving trend toward fully electronic distribution. The digital environment is challenging from a capital-expenditure standpoint; in the long run, however, these systems pay for themselves if convenience, image reproducibility, data integrity, and image manipulation capabilities are factored in,” he says. Imperative to Evolve Just as the innovations of the information age have vastly improved both image quality and the means through which images are read, so they have created a new set of challenges for the industry, Toppins says. He ranks decentralization as one of the leading issues that radiologists will have to surmount. “The decentralization of imaging has affected imaging centers in numerous ways,” he says. “There is more competition; customer service and timeliness of report and image delivery have become increasingly important. In addition, there is decentralization of patient care, as many clinical physicians have multiple practice locations during the week, or even during a day.” Radiology practices must also be able to aggregate images from multiple locations and route them to the appropriate referring physicians—and do so in a way that will engender repeat business. “Referring physicians can range from primary-care physicians to highly specialized physicians, such as reconstructive joint and oncologic surgeons,” Toppins says. “These differing environments provide a heterogeneous mix of human resources and technology availability, which is why it’s critical to have a solution that will work well across the continuum of care.” The imperative to develop and deploy more effective sharing solutions is underscored by imaging’s ever-decreasing reimbursement. “Reimbursement reductions are the most worrisome challenge we face,” Toppins notes. “We must improve efficiency in all aspects of radiology to reduce the impact of the DRA and other reductions.” Storing, Securing, and Sharing Data Through the Cloud The Symantec Health solution addresses these challenges, Toppins says, by providing long-term image archiving, coupled with the benefit of image sharing in software-as-a-service form, enabling imaging centers to distribute images to referring physicians without the kind of capital outlay associated with a sophisticated IT infrastructure. “An outsourced solution such as Image Share has many advantages,” he says. “For example, outpatient imaging centers and small hospitals typically do not have the IT/PACS human resources to provide on-site support, at physicians’ offices, to maintain their access to a PACS and train new users. With the Symantec model, these functions are removed from the imaging facilities.” There are also tangential economic efficiencies to be attained with this model, Toppins says. “Image Share may alleviate the need for sites to provide full PACS access for referring physicians, which can be burdensome from an IT-support standpoint,” he notes. “In one of my imaging centers, the job of burning CDs for patients and physicians is a full-time position; this solution would reduce it to a fractional position, allowing this person to perform other tasks.” Most important, Toppins believes, outsourced sharing of images has the potential to improve patient outcomes, a top priority for both radiologists and the clinicians they serve. “Patient care comes not only from accurate image interpretation, but also from convenient, timely access to images and reports,” he says. “This solution can provide immediate image and report access from virtually anywhere. This dramatically improves the continuity of care for the patient and is extremely convenient for the clinicians involved—and will be likely to result in more referrals to the imaging center.” Embracing the New With reimbursement tighter than ever, any potential capital expenditures must be reviewed closely by imaging centers for both effectiveness and potential to help grow the business. In evaluating new products for his own practice, Toppins says, he asks six questions. Can I justify this solution in terms of improved patient care? Will this solution have a positive impact on the retention of current referring physicians and help me grow our imaging practice with new referrers? Can we afford it, based on proposed/calculated return on investment, with reduced onsite IT support and other human resource savings? Is the solution secure and reliable? Will the vendor be more like a partner, accepting feedback and continually improving the product? How do current users of the product (if applicable) rate it, and how good is customer support from the vendor? Although members of the health-care profession often take a cautious approach to adopting new technologies, based on these criteria, Toppins sees no reason not to embrace cloud-based storage and image sharing as a service. “Internet reliability is better than ever, with redundancies at various levels of information delivery,” he says. “Security protocols for the encryption of protected medical information are well established and regulated—and security and HIPAA compliance are further enhanced, in this paradigm, due to access logging, encryption, and access control. It could be argued that this type of solution is actually more secure and reliable than having patients and physicians traveling around with unprotected CDs.” He adds that Symantec’s experience with data security adds another degree of confidence. “This is no longer cutting-edge technology, but rather everyday technology,” he says. “Symantec has a strong background in data security and recovery, and it understands the strict requirements of medical imaging.” Cat Vasko is editor of and associate editor of Radiology Business Journal.