Why EMRs will not replace imaging IT

Why EMRs will not replace imaging IT

October 17, 2019
Health IT
By Steve Holloway, Signify Research

The growing influence and uptake of electronic medical records (EMRs) in healthcare has driven debate over the future role of specialist clinical and diagnostics software. With interoperability in the health sector still a major challenge, many health providers are looking to simplify their IT systems, consolidating to fewer software platforms and few vendor partners. With recent extensive and long-term investment in EMR systems, some healthcare providers are considering the EMR as a potential candidate to extend into diagnostic imaging. In this summary we identify the challenges with this approach and discuss why we believe dedicated imaging IT software is a long way from being replaced by EMRs.

Complexity
Radiology is often viewed by hospital leadership as a singular entity. It is really a collection of a subspecialist systems, each with its own unique requirements. At a large acute care hospital there are dozens of different imaging modalities in operation (usually from a selection of different vendors), conducting thousands of different scan types, around the clock. These images must then be captured and routed, processed, analysed, annotated, reported on, archived and exchanged.

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Unlike much of healthcare, radiology has been digitising for over 30 years; radiology IT software that is available today from market leaders is the product of decades of experience. For example, seamlessly integrating digital tomosynthesis breast scans (comprising many hundreds of images) into conventional radiologist reporting workflow is not easy; it requires specialist software. The number of images, size of the study (most are ~200 MB compressed), requirement to be able to review different planes and necessity for the radiologist to “slab” images, thereby consolidating some images together, as well as share studies or even report remotely, makes it a big challenge from a technical standpoint. Add-in specialist reporting and registry requirements for breast imaging, the growing use of additional AI-based quantification or decision support tools and the need to include other modality images (such as conventional 2D mammography, automated breast ultrasound (ABUS) and MRI) and the complexity is clear.

Few, if any, EMR systems today can support multi-modality breast imaging in their core clinical module offerings; unsurprising perhaps, given that may of the world’s top imaging IT vendors are also still grappling with the challenges of DBT for breast imaging. But this is just one example of the myriad challenges posed by modern radiology — each subspeciality (abdominal, breast, cardiac, emergency medicine, musculoskeletal, neurology, paediatric, thoracic, vascular etc.) in radiology has a unique and specialist blend of imaging types, user requirements and diagnostic tools. Amassing these into a single coherent software platform has taken leading vendors decades and billions in investment.

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