SIIM2007 Opening Session

Welcome
Curtis P. Langlotz, MD, PhD Chair, Society for Imaging Informatics in Medicine University of Pennsylvania Health System Bradley J. Erickson, MD, PhD Chair, SIIM Annual Meeting Program Committee Mayo Clinic, Rochester

Keynote Speaker
John P. Glaser, PhD Vice President and Chief Information Officer Partners Healthcare Systems, Inc. The Evolution of the Role of Imaging Informatics in the Health Care Delivery System
In the years ahead, imaging informatics will play stronger and more diverse roles in health care provider organizations. These roles will encompass: • Growing diversity of modalities and a larger span of medical disciplines; • Increased utilization of imaging annotations and feature extractions to support care improvement and research efforts; • Inclusion of images in regional, state, and national clinical data exchanges; • Increased utilization of order entry and electronic medical record decision support algorithms to guide provider ordering behavior; and • Expansion of imaging to support advances in molecular medicine-based research. This talk will discuss these roles and their likely evolution. Strategies for facilitating this evolution will also be discussed.

The Evolution of the Role of Imaging Informatics in the Health Care Delivery System
John Glaser, PhD
Imaging Informatics plays a crucial role in the efforts of a health care delivery system to improve the quality and safety of patient care and the efficiency of care and operations. In the years ahead, Imaging Informatics will need to evolve as the delivery system responds to its strategic challenges and as changes occur in the broad landscape of information technology use in health care. Health care will continue to face a variety of pressures, including: • Elevated focus on the cost of care; • Continued movement of care to outpatient and non-acute settings; • Managing inpatient capacity and throughput; • Growing dominance of the treatment of the chronically ill in the health care cost and quality discussion; • Gradual movement to various forms of provider payment based on quality and efficiency and increased quality and financial transparency to the public; • Increased patient service and care participation expectations; and • Sustained challenges in incorporating new advances in medical science, e.g., molecular medicine. Trends in Patient Care In an effort to respond to these pressures, provider organizations will make investments in clinical information systems such as the electronic medical record (EMR) and computerized provider order entry (CPOE). In an effort to maximize the value of their investments, providers will devote substantial resources to deep and broad process change and the implementation of decision support to guide care decisions. Inter-organizational systems will become a staple of the health care environment. The current generation of Regional Health Information Organizations (RHIOs) and clinical data exchanges will confront significant sustainability challenges. These challenges may lead to the demise of most of these efforts. However, forms of “RHIO 2.0” will emerge and there will be multiple types of targeted, niche exchanges. Examples include eprescribing, clinical messaging, hospital-sponsored electronic health record extension into physician offices and inter-organizational clinical systems integration to support specific clinical relationships between providers. Provider organizations will increase their focus on “connected care” as a means to address the needs of the chronically ill, improve patient service, and reduce the costs of care. There are many forms of connected care and all of these forms will become more prevalent. Personal health records will link patients to their physician and enable patients to view their medical record and perform transactions such as request a medication renewal. Remote monitoring of patients with congestive heart failure, hypertension and COPD will be implemented in an effort to reduce the cost of care and improve the clinical management of the disease. Some visits will be conducted remotely, for example dermatology visits conducted using the camera in the cell phone. Personalized medicine, which enables a more targeted diagnosis and the tailoring of treatment based on knowledge of the patient’s genome, will become an integral component of patient care over the next 5 to 10 years. Academic health centers will need to develop the infrastructure needed to support research into the genomic bases of disease. Many of these infrastructure efforts will bring together phenotypic data (including images) collected from the organization’s clinical information systems and genomic and proteomic data including molecular images. Service Oriented Architecture The increase in the clinical information systems investments, the maturation of regional and national clinical data exchanges, the acceleration of the use of connected care and the remarkable advances in personalized medicine will be accompanied by a major movement of information technology (IT) to a Service Oriented Architecture (SOA). SOA enables the organization to view applications as composites of components or services. A service can perform discrete functions or provide access to data. Overall, SOA offers the potential to achieve targeted standardization of data and applications, efficiency in application development and gains in interoperability between third-party applications. The accelerated adoption of information technology by health care delivery systems will be facilitated by a growing sophistication of information technology management within these organizations. Provider senior leadership is becoming increasingly comfortable with and sophisticated about the IT conversation. As a result, the linkage between the IT strategy and the organization’s strategy will become more nuanced. The discussion about the value of the IT investment will become sharper. Tolerance for IT performance problems will be reduced. And the strategic criticality (and risk) of major IT initiatives will increase. Impact on the IIP How will all of this affect the Imaging Informatics professional? A key objective of PACS has been to provide a data access service to the physician. Future investments in these technologies will be accompanied by a more significant emphasis on leveraging the technology to make deep process changes, heightened interest in using systems such as CPOE to reduce inappropriate procedure utilization, and greater scrutiny of the value proposition and results of the investments. Traditionally the range of PACS has been largely confined to the walls of the delivery system and key referring physicians. These systems will become a component of RHIO 2.0 and part of a larger connected care strategy that seeks to integrate regional providers, patients, and strategically important business partners. PACS efforts have largely been separate from systems used to support clinical research. In the future, imaging infrastructure will become a critical contributor to databases that merge phenotypic and genomic data for research purposes. Current imaging architectures will evolve to a services model that will enable faster development, more targeted standardization and easier (but not always easy) interoperability. Health care delivery system IT governance and management prowess should become more sophisticated and demanding, raising the stakes for Imaging Informatics performance and value delivery. The changes outlined above will not happen quickly. However, over the course of the next 5 years, the change will be dramatic. John Glaser, PhD, is Vice President and CIO of Partners HealthCare in Boston; he will be the Opening General Session Keynote at the SIIM 2007 Annual Meeting.