Imaging Informatics: A New Legacy
By Josh Hildebrand
Radiology Today
Vol. 25 No. 7 P. 26

Modernized image exchange puts patients’ needs front and center.

Image exchange is the fulcrum of the radiology field; It’s the way in which various health care systems send and receive images to better inform patient care. Typically, this kind of exchange is done digitally, with files and other digital media sent across networks between health care organizations. Yet, on the patient-facing side of image exchange, there exists a prominent reliance on legacy systems.

“There aren’t many hospitals that aren’t using some type of digital image sharing, provider to provider,” says Stacie Barnard, director of enterprise imaging informatics and integrated clinical systems at the University of Rochester Medical Center in New York. “It’s really where patients are involved that you end up with discs still.”

Indeed, before the “digital revolution,” patients were given film or CDs to share with their primary care physicians and, arguably, any followup appointments after being imaged. CDs superseded film, becoming the medium on which many health care providers still rely; however, now that newer, more modern methods of image exchange exist, experts are questioning why that is.

Inefficient Exchange
As reliance on digital and wireless forms of data transfer burgeoned, it’s no surprise how quickly the CD became obsolete. At the most basic level, it has become more difficult to view/write to CDs as technology has advanced beyond them. During the mid-2010s, computer manufacturers began shipping their products without optical disc drives to save space and make devices thinner, lighter, and more portable. Therefore, it is highly likely that patients receiving a CD have no way of viewing their images postappointment. And the “pain points” don’t end there, unfortunately.

The process of writing, labeling, and filing CDs requires dedicated staff. If a single person within the chain of command makes one error, regardless of how minuscule, there could be massive repercussions.

Seetharam Chadalavada, MD, an associate professor of clinical and vice chair of radiology and informatics at University of Cincinnati Health, explains that improperly formatted images, compatibility issues, read errors, and delays in arrival are just a smattering of the issues plaguing the continued use of legacy image exchange systems.

“Delays in being able to access or share images require significant clinical staff time to resolve,” Chadalavada says. “[This] can lead to real-world delays in diagnosis and developing plans of care, [leaving] patients and their families feeling frustrated and less engaged.”

Patients may lack the medical knowledge required to fully understand their medical images, but having access to them provides a level of comfort, allowing patients to share with family members and generate questions for physicians during follow-up. All of this only makes efficient image exchange and access that much more pivotal for patient satisfaction.

Looming Legacy
With such blatant inefficiencies, why, then, do many health care providers still use this outdated means of image exchange? The answer isn’t necessarily a simple one. For starters, there is familiarity with legacy systems. These are systems that have been in use for many years, systems on which staff members were trained. For that reason, integrating a new means of image exchange could cause disruptions in workflow and possibly a learning curve, depending on how complex the modernized system is perceived by users.

“Legacy systems are ‘functional,’ meaning they provide a service but likely not at value,” Chadalavada says. “[There are] costs and complexities associated with upgrading, and [the] new systems may not integrate well with existing workflows, [adding] significant costs with integration, migration, and security.”

Some within the field have expressed light concerns with older patients’ adaptability when it comes to modernized means of image exchange. However, Barnard believes that older patients are “tech savvy” enough to learn the newer systems.

“It’s about communication,” she says. “We’ll be having conversations where we say, ‘You no longer need a CD. Instead, we’re giving you this, and you’ll still have access to your images.’ I’m sure that will come with questions, but we’ll have staff able to help walk them through it the first time. We’re also tying it to the patient portal, as well, so [they won’t need] multiple accounts to access their images.”

A Patient-Centric Approach
A key principle driving the change to move from legacy systems to modern means of image exchange is “patientcentric care,” or care that puts patients’ needs at the forefront. Rishi Nayyar, cofounder and CEO of PocketHealth, a no-network, image-sharing solution, says that this is the way forward with modern image exchange.

“We’ve learned that the most effective way to manage image sharing is to put the patient at the center of the process,” he says. “A patient-centric design [allows] individuals easy access to their images, which improves patient experience and reduces administrative burdens for health care providers.”

To the uninitiated, the rollout process may seem daunting. There will be new costs; Staff will be required to learn a new system, and, of course, patients will be required to learn the new system, as well. But it has been demonstrated that the benefits far outweigh any potential negatives, especially regarding patient satisfaction.

“Switching out of our legacy systems can reduce operational costs and can easily improve workload on our staff, help[ing] with retention,” Chadalavada says. “It would make our patients and health care professionals happy because things would work better, have fewer errors, and fewer frustrations for all involved parties.”

The AI Question
AI isn’t directly involved with the transition from legacy systems to modernized image exchange. However, it does play a role in patient-centric care. AI has useful functionality for both patients and caregivers within the image exchange process. Chadalavada explains that AI’s augmentative capabilities allow image analysis to be automated and reports interpreted, integrating smoothly into professional workflows and making the entire process more efficient.

The other side of that coin is the ability of AI to bolster patient understanding regarding their reports and medical images. One such useful feature, Barnard explains, is the “translation” of medical terminology into layman’s terms, allowing patients to feel more involved in synthesizing information related to their health and facilitating conversations with doctors.

Tools that help organize incoming studies and integrate easily into existing PACS systems are useful, but having well-informed patients is invaluable, according to Nayyar.

“The biggest wins [in modernizing image exchange] are patients who are more engaged in their care,” he says. “When you make it easy for them to access and understand their records, satisfaction and retention naturally go up. This level of engagement leads to better health outcomes and stronger patient-provider relationships.”

— Josh Hildebrand is the assistant editor of Radiology Today.