From the January/February 2014 issue of HealthCare Business News magazine

By Dr. James Whitfill

Imaging informatics continues to undergo a profound transformation from a ground breaking and disruptive technology to a mature staple of the modern health care enterprise. As a result, the management of such systems has been progressively moving out of the radiology department and into the sphere of Enterprise IT within hospitals. As this process evolves, many staff that traditionally supported these systems in a manner which allowed for great independence and primary focus on the immediate needs of the end users may have trouble adjusting to an environment which understands that at great scale, process and system management are critical to maintaining stability. In addition, physician end users who have grown accustomed to providing direct oversight of system management find challenges with having to get in line behind other members of the enterprise. Particularly, over the past several years, surveys performed at the Society for Imaging Informatics in Medicine (SIIM) Annual Meeting have demonstrated that hospital CIOs increasingly view PACS as an established technology in a maintenance phase while scarce resources need to be deployed to solutions like CPOE, EMR, MU, and ICD-10.

Understanding the historical development of PACS begins to provide some context of understanding the departmental approach to imaging informatics in the past. The first PACS grew out of workstations attached to radiologic modalities and were sold, installed and supported as such. Early computer networks had separate networks just dedicated to PACS. Many certified imaging informatics professionals (CIIPs) today still come from a clinical background such as a radiologic technologist. While most corporate IT solutions were not uniformly supported by an onsite vendor representative since the 1960s or 1970s, PACS even today, often has vendor-provided field engineers to support their systems. This fundamental approach to a tight connection to a clinical department caused imaging informatics to develop in a very small business office type of manner even though this happened within a larger institution. Many vendors are moving toward a software support model, but still the echoes of this origin still can be found in the approach to support these systems today.
The difference between the management of these systems does not only affect the IT systems themselves. The cultural gap between CCIPs and other enterprise IT staff can often result in stunted career growth for CIIPs as well as frustration with job satisfaction as they move from the radiology department into the IT department. CIIPs may be used for making immediate changes without having to consult a change management committee or considering a backout plan, while many CIOs would take the position that a department that is not supported with an ITSM approach like ITIL, which is one that is destined for chaos and failure. With the issues of scale that arise from widespread adoption of PACS, those who support these systems now have to deal with issues of regulation, security, and enterprise or even community wide user bases. These issues often overwhelm a more departmental approach to PACS. At SIIM, we have been working to bridge these two worlds and bring the perspectives of hospital senior IT executives to the attention of our members so that the latter can understand that PACS and RIS are no longer the dominant IT systems in the hospital today.At this year’s SIIM Annual Meeting, May 15-17, 2014 in Long Beach, CA, many sessions and learning tracks explore the changing role of the imaging informatics professional, bridging imaging with the enterprise, and learning the culture of enterprise IT.

About the author: Dr. James Whitfill has more than 20 years experience with the union of information technology and health care. He has served in leadership roles within a variety of settings including large academic institutions, large private practices, as well as Clinically Integrated Organizations. His focus has been on the use of business intelligence for clinical and operational improvement within health care organizations; leadership and team development; workflow focused information technology; as well as technology and cultural issues within corporate mergers. Dr. Whitfill is a nationally recognized expert in Medical and Imaging Informatics. Dr. Whitfill received his AB from Princeton University, and his MD from the University of Pennsylvania. He did his Residency and Chief Residency in Internal Medicine at the Hospital of the University of Pennsylvania and was the first physician to complete a fellowship in Medical Informatics in the University of Pennsylvania Department of Medicine. He is currently a Board member for the Society of Imaging Informatics in Medicine and a faculty member at the Radiological Society of North America annual meeting.

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