Health Services Research & Policy ■ Clinical Practice Management ■ Training & Education ■ Leadership
Health Services Research & Policy ■ Clinical Practice Management ■ Training & Education ■ Leadership
Health Services Research & Policy
■ Clinical Practice Management
■ Training & Education ■ Leadership

Information Technology: Increasingly Invisible and Absolutely Essential

Information technology projects are the new normal in radiology and beyond

Information Technology (IT) infrastructure is something so essential and focal to our lives that we often take it for granted, as we do many other modern life essentials. For instance, we can drive through city streets between two points, yet fail to appreciate the massive organizational and historical efforts that underpin this simple act; coordinated and completely dependable traffic signals; drainage culverts at complex collection systems evidenced only by manhole covers; the massive electrical grid existing side-by-side or below the transportation grid allowing power to flow to all necessary points; and even the roads themselves. So, too, with the IT infrastructure we use on a daily basis: there's more than meets the eye.

When we enter our radiology cockpits to maneuver through a list of challenging cases, we take the massive IT infrastructure for granted. Whether it is decision support, the radiology information system (RIS), the picture archiving and communication system (PACS), the electronic medical record (EMR), analytic software, or a post-processing workstation, the nuanced connections and sophisticated engineering underlying so much of what we do nearly always goes unappreciated (or underappreciated). That also includes the servers, optical linkages, switches, the help desk, the IT teams in the radiology department, the teams responsible for the EMR install or upgrade, and so on. IT infrastructure has rapidly developed over the past two decades, but not always in a strategic and outlined manner, and frequently has simultaneously experienced growing pains and exposed opportunities.

I recently read a thoughtful assessment referring to "managing scale and innovation in health IT." The authors drew parallels between IT, communication, and transportation, and made a distinction between large-scale and small-scale projects. For example, a large-scale project in the field of communication was the creation of television networks. Insofar as cost and effort are concerned, implementing an enterprise EMR in a health care system qualifies as a large-scale project.

At the same time, as we install large and complex systems, small-scale radiology IT needs still remain. Whether they manifest as a new post processing workstation, new software permitting an analytic approach to assessing radiology operations, or a new interventional radiology inventory system, implementing small-scale projects while simultaneously moving forward on large-scale projects is challenging.

Just as the authors of the aforementioned article pointed out, small-scale developments depend on large-scale infrastructure. Broadcast televisions stations had to first succeed at TVs being assimilated into most households, thus boosting consumer demand, before introducing cable and satellite TV with hundreds of additional channels.

How does one interdigitate large-scale projects that consume numerous personnel and resources and simultaneously provide small-scale projects that are equally essential and vital to patient care in radiology? Although perpetual updating is necessary for large-scale projects due to the frequency of technical obsolesce, small-scale projects cannot be relegated to variable pauses or gaps between large projects. The challenge for IT management and provider teams is navigating expanding lists of requests from multiple users and effectively triaging and prioritizing projects to minimize dissatisfaction, while also effectually deploying large-scale and small-scale projects.

As we look at population health and the opportunity to learn from the big data being collected from every patient, we realize that our needs for support, interactivity, ergonomics, and analytics will amplify dramatically.

Success in such complex IT infrastructure implementation and maintenance requires the inclusion of highly motivated and knowledgeable radiologists as essential members on the IT team. Only radiologists can capably assist in triaging these ever-expanding lists and serve on point for bidirectional communication. My friend Dr. Michael Recht, chair of radiology at New York University Langone Medical Center, believes the time has come where radiology residents may need a stronger foundational curriculum so that all future radiologists are well-versed in IT and informatics.

As radiology increases in size and span, touching more patients with algorithmically increasing amounts of data, another challenge we face is the need for tighter integration, strategically and operationally, with health system IT teams, as opposed to the expectation of limitless growth of radiology IT teams. Enterprise management is about managing scope and scale of service and minimizing redundancy. 

The current tendency is to have rapidly expanding IT teams seated in the radiology department and focused solely on serving the needs of radiology. However, as decision support is demonstrating, much of radiology's future growth in IT deals with how we connect with and educate other departments on how to, best utilize imaging, effectively connect those provisions to the EMR, and positively influence clinician behavior and ordering practices. If anything, more of the tools and extensions that we utilize will be increasingly sought after by clinicians for use on their desktops. If radiology departments choose to service such needs, they will find themselves far afield of their initial mission and housing department. From the health system perspective, developing parallel IT units living under the same roof as enterprise IT, can be needlessly cost intensive.

It may not be easy for radiology to deal with the gradual outmigration of IT resources from the department as generational project costs escalate and the need for systems integration increases. However, it will be exciting to be the architects of our IT future; a task that will demand the diplomacy of dealing with larger health systems while maintaining a sufficiently loud radiology voice; the nimbleness of juggling multiple and ever increasing projects of both massive and small scales; and the foresight of creating systems of such high dependability that they, ironically, become both as indispensable and invisible as our power grid.


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