ATLANTA – Can't we all just get along? It would seem that these words fall on the deaf ears of imaging departments and information technology (IT) departments when it comes to their relationship in most hospitals in the U.S.

It's not that the two groups dislike each other, but more so that there is a huge divide between the two – one so great that it threatens to impede the U.S. implementing a competent healthcare information technology infrastructure, according to Janice Honeyman-Buck, PhD, editor in chief of the Society for Imaging Informatics in Medicine's (Leesburg, Virgina) Journal of Digital Imaging.

Honeyman-Buck, also a former radiologist and current independent imaging informatics consultant, called for the two groups to work closer together and said that attempts at interoperability with technology should not initially leave imaging out of the equation.

"There is a lot of emphasis on the new health IT programs at the government level, but maybe not quite the emphasis we need to plan for imaging," she said during a session at the Healthcare Information and Management Systems Society (HIMSS; Chicago) conference on Wednesday.

"A line has been drawn," the former radiologist told the crowd. "On one side we have radiologists and on the other side we have health information technology [specialists]."

Honeyman-Buck said the split started from storing data to the hospital's network. Throughout the years, the issue has evolved, and the ultimate result is that imaging takes a backseat to other health information technology (HIT) needs in the federal push for interoperability.

"So why do we have this line," she asked the audience. Honeyman-Buck pointed to the functions of each department that seem to add to the conflict.

HIT departments typically handle fast processing of data; have a secure and private network; and use the Health Level 7 (HL7) standard for data communication and storage.

Imaging departments typically use the storage and manipulation of images; use network access for decision support; and use the Dicom standard for communication and storage – a standard that Honeyman-Buck says looks nothing like HL7 and adds to the split.

"What we want to do is build a bridge between imaging informatics and hospital IT to work together to create a system with meaningful use that includes imaging," she said. "We also want to promote collaboration between HIT and Imaging professionals. This split cannot continue."

She said she was encouraged by a system called Vista that the U.S. Department of Veteran Affairs used, which was more of a blend of both text and images. She also said that she was encouraged by many vendors offering up stronger solutions that include data and text.

But those shining examples of success are few and far between, according to Honeyman-Buck.

She cautioned that if the split does indeed continue then the hospitals won't be able to accommodate the needs of imaging in the federal push for interoperability.

"Imaging has to be considered from the beginning of an upgrade, not as an eventual add-on," Honeyman-Buck said. "I'm afraid that people who have incentive money for hospital information upgrades will put imaging on the backburner. If it's not considered at the beginning then you're going to have to reinvent the wheel."

The reason, she says, is because hospitals will be unable to handle the sheer enormity of the space of these medical images on their databases.

"Archiving is going to be a key issue," she said. "Storing images for a 600-bed hospital can easily exceed 25 terabytes a year. But the actual storage is not expensive, the management of that storage is. Storage needs to be secure and sometimes redundant. What do I mean by redundant – well simply that you're going to have multiple images per patient and sometimes per patient condition."

Cardiology, which has huge data sets, often requires a lot of space on the network for images. She pointed out that this was a key branch of medicine that could see the biggest problems in the future if imaging needs aren't addressed upfront in the interoperability standards.

Ultimately, she pleaded with members of the audience to keep the conversation alive and to demand that imaging take a greater role in interoperability plans. She also said that any papers members could get published to journals would be helpful in combating this issue.

"Healthcare reform demands interoperability and EHR [systems] must contain a way to display images," she said. "This is a problem that we can't live with. We need the images, the text and information about the patient."

Omar Ford, 404-262-5546;
omar.ford@ahcmedia.com