Radiology IT expert Rik Primo—principal with the consulting firm Primo Medical Imaging Informatics, and a former software developer with Siemens, Philips and Agfa—discussed three key trends with Radiology Business.
Primo's observations on imaging IT were shared after attending the Healthcare Information Management Systems Society (HIMSS) 2023 meeting, and the Radiological Society of North America conference at the end of 2022. He shares his thoughts in the video above and the article below.
1. Movement to the cloud in radiology
"When it comes to infrastructure, cloud is now a fully accepted position of many of the IT vendors," Primo explained.
Every PACS company at HIMSS had a cloud option to demonstrate on the expo floor, he said. But very few had programming written specifically for cloud operations to optimize their functionality. Instead, most PACS vendors do a “lift and shift” of their existing PACS programming to bring it into a cloud platform.
At least one PACS vendor has a cloud-native solution for sale, Primo said, and other PACS vendors seem to be headed in that direction. However, this movement may take some vendors years to complete because there is a lot of work involved. Health systems interested in a cloud-native option, especially for enterprise imaging, should learn which vendors meet their needs.
"The vendors want to combine cloud with the concept of enterprise data management, so we are not just talking about images by themselves, but also many other data sources such as non-DICOM imaging, labs, dermatology, pathology and data from many other departments," Primo said.
Health systems wanting to upgrade their IT infrastructure are looking at both on-site data storage for hyper-fast access with FLASH or other fast media technologies. Other health systems are considering transitioning some or all of their data to cloud providers such as Google, Amazon Web Services or Microsoft Azure. The primary use of cloud now is for less critical fast and long-term archival and backup data storage. Primo said there are some health systems moving their entire enterprise to the cloud, but these are rare exceptions. However, cloud will likely become the standard approach over the next decade.
2. Adoption of AI to help automate imaging workflows
Primo said there is an increasing focus on automation of imaging workflows via artificial intelligence.
"AI is not just a trend, it is reality and it is here," Primo explained. "AI is no longer a question of if, but what does it do and when will it be available. With that, we can start to see the AI market is becoming mature."
The FDA has already cleared over 500 clinical applications, with the vast majority tied to medical imaging. In addition, there are now hundreds of nonclinical AI applications running in the background of PACS and related IT systems.
AI for image interpretation is seeing rapid adoption in emergency rooms to identify acute findings. AI also determines if a stroke is ischemic or hemorrhagic, which is critical in speeding up delivery. This allows emergency physicians to initiate treatment prep while a radiologist confirms the findings.
AI also is performing tasks that are tedious, time consuming, or lost during patient handoffs, Primo said. This includes automatic measurements, but it is expanding to automated workflows for incidental findings and completing other time-consuming tasks typically handled by support staff.
Workflow orchestration also is gaining ground in radiology. Rather than allowing radiologists to cherry pick what they want to read next, AI can create customized work lists for each radiologist. The AI can consider many variables, including radiologists' subspecialty qualifications, RVUs, turnaround times, contractual parameters, the complexity of each patient, and load-balancing a mix of exams between several radiologists.
While large PACS vendors tried to develop their own AI algorithms, it quickly became apparent that single vendors cannot create all types of AI. This has led to partnerships where a third-party algorithm is seamlessly integrated into the PACS vendor's workflow.
3. Cybersecurity a bigger topic of concern
"More vendors are adopting the philosophy of referring cybersecurity to the companies that are specialized in it. There are some major market leaders in PACS that are already there," Primo said.
The role of cybersecurity is becoming part of the overall IT infrastructure. There also is a bigger focus on training employees how to identify cyberthreats before opening email attachments—a common entry point for cyberattacks at healthcare facilities.
Cybersecurity has become a bigger issue in recent years, with more healthcare systems becoming ransomware attack targets.
Dave Fornell has covered healthcare for more than 17 years, with a focus in cardiology and radiology. Fornell is a 5-time winner of a Jesse H. Neal Award, the most prestigious editorial honors in the field of specialized journalism. The wins included best technical content, best use of social media and best COVID-19 coverage. Fornell was also a three-time Neal finalist for best range of work by a single author. He produces more than 100 editorial videos each year, most of them interviews with key opinion leaders in medicine. He also writes technical articles, covers key trends, conducts video hospital site visits, and is very involved with social media. E-mail: dfornell@innovatehealthcare.com