This content is part of the Essential Guide: Conference coverage: RSNA 2013 annual radiology meeting
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Hot at RSNA 2013: Clinical decision support, mobile clinical workflow

Exhibitions, IT presentations at RSNA 2013 shine spotlight on clinical decision support, VNA image storage and mobile devices to enable new workflows.

Radiologists will be partnering with IT departments to step out of dark reading rooms and into the light, using mobile devices for some parts of their clinical workflows, if the content of the presentations at the Radiological Society of North America's (RSNA) 99th Scientific Assembly and Annual Meeting is any indicator.

They also will be using another type of health IT tool, clinical decision support, to help fix a longtime problem: Radiologists know the use cases, as well as the pros and cons, of each modality (MRI, CT scan, X-ray, etc.), most of the time better than the referring physicians who send patients their way. Radiologists can often see opportunities to substitute less-expensive tests that expose a patient to less radiation, but aren't often invited to consult when a referrer orders a test for a patient. Radiology clinical decision support embedded into the electronic health record could change that.

According to David Hirschorn, M.D., radiologist and RSNA informatics subcommittee member, this year several presentations will show research evidence that decision support from radiologists can assist physicians in ordering the safest, least expensive test the patient needs. The tools are based on the American College of Radiology's Appropriateness Criteria guidelines. Some of these clinical decision support tools go as far as asking referring physicians to explain why they might overrule the recommendation before letting them order a test.

Referring physicians, Hirschorn said, will likely be more receptive to immediate, automated advice than taking the time to wait for a callback from a consulting radiologist. Especially, he added, in an era when public and commercial insurers are cutting reimbursements and rewarding organizations who spend less overall for healthcare.

The truth is, the clinical decision support system knows more than any one radiologist does, anyway.
David Hirschorn, M.D.,radiologist

"The truth is, the clinical decision support system knows more than any one radiologist does, anyway," said Hirschorn, who helped choose the IT-oriented presentations that ended up in the RSNA program from about 400 submitted abstracts.

"A radiologist can give an expert opinion, but that's just an opinion versus the Appropriateness Criteria, [which] is an algorithm that's [about] 500 pages thick," he added. "You take the knowledge base, plug it into the computer, and when your situation comes up when you have a patient with back pain and diabetes and whatever their age and gender are, you go to order the test and it will help you pick the right one in a painless way. Doctors want that, if it's done right."

Mobile looks more feasible to radiology

Radiologists are used to dark reading rooms equipped with calibrated monitors and proprietary viewing software to make their diagnoses. Mobile devices like iPads and iPhones, however, are enticing these specialists just as they are other doctors across U.S. healthcare settings. This year, presentations explore the feasibility of inserting mobile devices, in conjunction with calibration tools, into the radiology clinical workflow.

Some modalities still require a reading room, Hirschorn believes, because doing work on a mobile device is just too cumbersome. Others can be done on mobile devices, but considering how slow the systems can be and the limitations of screens and operating systems, radiologists will probably only want to do a few readings at a time in certain modalities only. For now.

But mobile devices have a place in those workflows, he said, and they can no longer be dismissed out of hand by clinical leaders married to the notion that all reads must be done in specialized environments.

Hirschorn is optimistic that the variety of tablets on the market, including new Microsoft Surface models, will make mobile devices more appealing to a wider audience of radiologists and the IT staffs supporting them. "This stuff is still evolving," Hirschorn said, "and people want to know, 'Can I use these devices for imaging?'"

Exhibit hall hopping for IT-minded attendees

Meaningful use of EHRs supports the notion of radiologists sharing images, with referring physicians and with patients themselves. But many facilities' IT infrastructure that supports radiology typically involves closed systems that are not particularly interoperable or EHR-friendly. Vendor-neutral archives (VNAs) can be a first step toward opening those systems by standardizing access and keeping images in a single repository, instead of being scattered throughout a facility or multiple health system campuses.

While radiology as a specialty for years has been moving toward EHR connectivity between imaging and treating physicians, Hirschorn believes that the meaningful use initiative to connect imaging and patient portals is making VNAs attractive systems for achieving it.

His employer, North Shore-LIJ Health System, is shopping for a system-wide diagnostic viewer and a VNA, Hirschorn said. He will be roaming the RSNA 2013 exhibit hall, gathering intel on various vendor offerings. "I've got quite the shopping list, myself," Hirschorn said, adding that public requests for proposals have already been issued. "This process is well under way, and we're going to be doing vendor selection in a few weeks. So we're in prime RSNA-let's-look-at-everything mode."

Let us know what you think about the story; email Don Fluckinger, news director, or contact @DonFluckinger on Twitter.

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