The Next Big Thing
From integrated systems to natural language processing, radiology will see countless technology trends in the next decade aimed at improving patient care.
The early implementation of PACS in the 1990s revolutionized radiology by replacing film images and paper reports with digital files. The more efficient workflow, coupled with the fee-for-service payment system, facilitated a volume-based model of care focused on the quantity of exams performed and interpreted.
Now, as radiology begins to transition to a value-driven model centered on the quality of care, new technologies are emerging to support the shifting paradigm — a slate of which are expected to be available within the next five to 10 years.
Many of these future technologies will be geared toward fostering image and data sharing within and between health care institutions, empowering patients to take ownership of their health records, and assisting radiologists with identifying exam findings and producing better reports. While the technologies will be new, many will integrate with existing systems to improve efficiency and communication. “It’s a very exciting time because there are many changes going on with technology that will allow radiologists to better achieve their mission of providing high-quality care,” says Roger S. Eng, MD, MPH, FACR, president of San Francisco–based Golden Gate Radiology.
Many radiologists expect mobile and cloud-based systems to play a significant role in the next generation of imaging technology. They also anticipate system integrations, natural language processing, and computer-aided diagnostic software to streamline radiologists’ workflow for more comprehensive care. “Some of these technologies will continue trends that are already occurring, but I think we will also see some unexpected trends that are going to significantly impact the way radiologists practice,” says Eliot L. Siegel, MD, FACR, professor of diagnostic imaging at the University of Maryland School of Medicine and chief of radiology at the VA Maryland Healthcare System.
One of the most highly anticipated technology trends involves integrating the systems that radiologists access daily. Eng says that currently he must log into 10 different systems to collect all of the information he needs to provide comprehensive patient care. In the coming years, he says, an integration package will tie all of those systems together, making them accessible with a single login. “In the next five to 10 years, those systems will integrate better and look more like a single system to the end user,” Eng explains. “There may actually be multiple systems on the backend — a RIS and PACS as well as electronic health records (EHRs) and laboratory pathologies from the hospital and outpatient offices — but they will plug in together so that we can access all of that clinical information in one location.”
“It’s a very exciting time because there are many changes going on with technology that will allow radiologists to better achieve their mission of providing high-quality care.”
— Roger S. Eng, MD, MPH, FACR
Once all of the systems are integrated, the previously siloed data within those systems will also be synthesized. Rasu Shrestha, MD, MBA, president of the UPMC Technology Development Center and chief innovation officer at the University of Pittsburgh Medical Center, notes that the combined data will result in better analytics, including diagnosis and outcome trends, that could be used to improve patient care. “It will give us the ability to analyze the data and predict things before they happen by studying outcomes and care pathways and examining the data in a much more intelligent manner than we’ve done in the past,” he says. “That’s when you can obtain insights that change behavior, affect care delivery, and promote the visualization of intelligent information at the point of care.”
Along with system integrations, the coming years are expected to bring the next generation PACS. Siegel says that this new PACS will feature significant improvements over the existing system, which has changed little since its 1990s debut. He predicts that future PACS will have greater storage capacity and will serve as a repository for modality-specific images and data that are now stored in multiple archives. And he anticipates that current pilot initiatives will be accelerated to facilitate the direct digital transfer of images to patients and their providers.
As patients demand more control of their medical records, mobile technology is expected to become more integral to health care.
“The vast majority of imaging providers are still burning CDs, but that practice is plagued with numerous issues, including difficulty installing accompanying software, lack of adherence to standards, and major difficulty tracking CDs, which present security and privacy challenges,” Siegel says. “The RSNA’s National Institutes of Health–funded image sharing initiative has demonstrated the large-scale ability to digitally transfer images directly to a patient’s personal health record or to another imaging provider with the patient’s permission.” In addition to communicating findings, the next PACS and reporting system will automatically acknowledge and record the receipt of the findings and follow up to determine whether additional imaging studies have been requested based on the recommendations, Siegel adds.
Other technology trends that are expected to improve access to patient images are cloud computing and the increased use of online electronic medical records by medical and surgical outpatient practices. “More facilities are going to begin taking advantage of the inherent efficiencies in data and software access using cloud-based providers for patient medical records as well as image management,” Siegel says. The promise of improved system operations will also encourage the proliferation of cloud computing, Shrestha notes. “For clinicians to never have their systems go down again would be a big boon. Through the power of cloud-based system virtualization, system dependability is a reality that can actually become mainstream.”
Cloud computing will also play a role in another emerging technology: patient health records (PHRs). Some radiologists predict that within the next five to 10 years patients will receive, store, and manage their health records, including radiology images, in cloud-based accounts. These accounts will allow patients to share their records with their physicians or trusted family members and friends, as they see fit. For instance, patients might give their cardiologist access to their chest radiographs but restrict access to their HIV test results. Siegel anticipates that within the next decade personal patient health records may slowly supplant the use of health information exchanges (HIEs). “There’s a good chance that rather than HIEs, we’ll have the emergence of PHRs, where patients will have full access to a consolidated set of their patient information, which they will be able to share with their providers on a need-to-know basis,” Siegel says. Read more about HIEs at http://bit.ly/ACRHIE.
As patients demand more control of their medical records, mobile technology is expected to become more integral to health care. Shrestha says that application interoperability between vendors such as Apple and Android will give radiologists and other physicians the ability to deliver health information directly to patients’ smartphones and other mobile devices. As an indication of where mobile health care is headed, Shrestha references the federal government’s Blue Button Initiative, a system that allows patients to download their health records from participating providers. “Purpose-driven mobility will be one groundbreaking technology trend that will really impact the delivery of health care directly to consumers,” he says. “It will empower patients to take control of their health and incentivize them to actually promote wellness as opposed to simply managing diseases.”
Other forthcoming technologies will help radiologists read images more efficiently and produce better reports. One such technology will be computer-aided diagnostics, which will partially automate findings detection in imaging exams. As a radiologist reads an imaging exam, the computer will automatically scan its database for patients with similar findings and similar histories and then suggest diagnoses based on that information. “It will be the equivalent of an electronic radiology resident or fellow that gathers data from the electronic medical record in an intelligent manner and allows us to synthesize those data to come up with relative probabilities and different diagnoses,” Siegel says, adding that while he doesn’t expect computers to supplant radiologists, he does believe “an increasing number of tools will help make the way we practice smarter, more productive, and safer.” The ACR is currently developing ACR Assist, which will provide evidence-based guidelines and aid in actionable reporting.
Another development that will help radiologists produce better products is structured reporting. Standardized reports will make it possible to capture currently unattainable analytics, including outcome and quality trends. “We will see a change toward increasingly structured reports with required elements that are tied to the perceived quality of the report as well as payment,” Siegel says.
“Purpose-driven mobility will be one groundbreaking technology trend that will really impact the delivery of health care directly to consumers.”
—Rasu Shrestha, MD, MBA
As reports become more structured, natural language processing (NLP) is also expected to emerge as a new technology trend. While NLP is already used for coding and other backend functions, radiologists say that it will soon assist in report creation. “There are a lot of opportunities to bring NLP from a back-office to a front-office function, allowing us to dig into the specific insights and trends that were previously buried away,” Shrestha says.
Applications are also expected to emerge that will modernize radiology workstations. Instead of using a mouse or track ball, radiologists will begin using touch screens and even gesture-sensing technologies to navigate and annotate imaging exams, Siegel says. Additionally, automated workflows will reduce the time it takes to calibrate equipment for exams. “Currently, the technologist must do a lot of typing to enter a protocol into a CT scanner, for instance,” Siegel explains. “But in the coming years, the systems will be integrated in such a way that a requested examination and subsequent radiologist-directed protocols will automatically be populated to the CT scanner, which will then translate the protocol for the specific scanner. The technologist will then just agree or disagree and edit that recommended protocol.”
As radiologists transition into the next era of health care, vendors are developing a host of products to meet their changing needs. But ultimately it will be up to radiologists themselves to use the technologies to add value to patient care. “By leveraging a lot of these technology trends, we have the opportunity take action to improve the quality of the care we provide,” Shrestha says. “That means that we have the opportunity to cross the threshold into the new paradigm of value-based imaging.”
By Jenny Jones, freelance writer for the ACR Bulletin