From the Chair: Hitting the Reset Button - SIIM News Winter 2010

Bradley J. Erickson, MD, PhD
Chair

“Hitting the Reset Button” is a phrase that has recently been applied to topics from world politics to the careers of some of my friends. We all have a good idea of what it means -- essentially an attempt to clear out a backlog of hindrances and start over fresh. In some cases, this is a good thing, and in others, it is just delaying facing a problem.

SIIM must also look at “hitting the reset button,” because it appears that we cannot continue with business as usual. The current downturn in the economy appears to be producing changes that are resulting in permanent alterations in how business is conducted. While there have been downturns in the economy in the past, most have only been temporary setbacks. But occasionally, there are true changes that occur, and many economists suggest that this is one of those times. Many businesses are announcing plans that indicate they will not be hiring back all the staff they had before the downturn. A more critical review is being applied by many businesses to what were previously ‘no-brainer’ decisions about staffing models.

SIIM is also facing some challenges and must make changes, but this is not new to us. Most members know that SIIM (the Society for Imaging Informatics in Medicine) has not always been SIIM. Previously, we were SCAR (the Society for Computer Applications in Radiology), and before that, we were two organizations -- SCAR and RISC (the Radiology Information System Consortium) with close ties to the Computer-Assisted Radiology meeting. None of those transitions was easy or obvious at the time. The annual meeting of our society has also changed its look through the years. Those changes always involved the risk of changing a working formula, but it was felt necessary in order to serve our membership the best, and they nearly always proved to be great changes.

I think we are again at one of those transition points. While I think it is too strong to say we are doing a ‘hard reboot,’ I think that we have already begun to implement some important changes, and will continue to adapt to the changing environment. A few years back, SCAR University was implemented because the sharp upswing in the adoption of PACS drove a strong demand for education of IT and RT people to operate their (new) PACS. The market has now changed, and both the market and those operating the PACS are more mature, requiring a new educational model. I think that the annual meeting this past year showed a strong commitment to an educational style that is better tailored to experienced adults -- one that promotes interaction rather than just didactic lectures. In fact, it is possible we were too successful -- attendance at those sessions was very high, meaning that fewer meeting attendees were interacting with vendors. That is not healthy, as ours is a society that relies on users working with vendors to advance the field. Some of the most important discussions I have had in learning imaging informatics happened during informal conversations with people who happened to be vendors.

The SIIM board of directors recognizes that we must preserve our core values, including productive engagement of radiologists, scientists, physicists, IT professionals, technologists, businesses, and government. Because the society does believe that members interacting with vendors is valuable to all, you will see an evolution of the program that continues the trend of more interactive content, but with more involvement of vendors. This interaction can help users understand how best to use the products available to us, as well as provide a conduit to educate vendors about the practical challenges we all face.

We also recognize that we need to be able to deliver more content via the web. The development of electronic media is important for distributing our content over space and time. While face-to-face interaction at an annual meeting is perhaps the best way to learn, many institutions are not able to support people to interact at that level. More recently, more content that was designed for the web has been developed. We will continue that, and increase the focus on developing interaction between members. Specific examples of this might include blogs or ‘tweets’ that are based on users with the same RIS/PACS/EMR installation. We all recognize that despite efforts of IHE, each vendor (and even versions of products) has unique characteristics that are best understood by other users of that particular product. And because the RIS and PACS and EMR may be from different vendors, it can be difficult for a vendor to fully encompass the situation. SIIM has the potential to be an effective forum for supporting such interactions. This is just one possible example of what might be done. I encourage you to consider what might be helpful to you, and how SIIM might play a role. Of course, there is much work to be done in making such forums effective, and so we ask members who live with these problems to help SIIM develop tools for all members.

SIIM will continue to look for opportunities to better serve its members. But the best way to make sure that happens is for members to tell us more of what they need. In the past, SIIM heard that IT professionals needed some form of professional certification to help them in developing and improving their professional standing. SIIM responded by putting significant resources into helping to develop a professional certification program for imaging informatics professionals. We think that there is still more to be done to help that constituency do their job, largely by improving the communications and collegiality within this group.

Another important constituency is the medical physicists who are expected to support the PACS and RIS within the radiology department. For many, the strategic informatics initiatives fall to them to implement with little input in the planning stages. The training and competencies for this group can also be a professional challenge, depending on the nature of their medical physics group. Their role may appear very different from a traditional medical physicist, so job expectations can be highly variable, and job responsibilities can be unrealistic.

Another focus of activity that needs invigoration is the TRIP™ (Transforming the Radiologic Interpretation Process) initiative. Early efforts successfully contributed to a focus on the hardware systems to better manage the large datasets commonly produced today. However, tools that effectively extract the key diagnostic content and present it efficiently are still lacking. Over the next year, I intend to have TRIP™ more effectively engage the physicians and vendors that must deal with the large and complex datasets that modern imaging devices can create. I think that prioritizing today’s pain points, so that vendors can hear a relatively united voice, will help them effectively focus development efforts. The list could also serve as a useful resource to granting agencies for those problems where an immediate solution is not obvious. To that end, I encourage all SIIM members to contact me (bje@mayo.edu) with their favorite ‘pain point’ and I will be sure to communicate that to the other members of the TRIP™ committee. It is also possible that we will survey SIIM members to help prioritize problems that affect their domain (e.g., separate pain point lists for radiologists, IIPs, RTs, administrators, physicists, etc).

To help members directly impact problems, SIIM has begun funding grants in the field of imaging informatics. The quality of the applications has increased dramatically over the life of the program, which is a very good omen for the future of this field. However, these grants are relatively small, and are designed for junior career people.

It is essential that funding agencies begin to fund senior scientists in imaging informatics projects. There certainly has been funding of wonderful imaging algorithms, but there is a lack of grants awarded to projects that evaluate the value of these algorithms to clinical practice, or of tools that help to develop models for how to measure the effect of tools in clinical practice. Scientists in this field face the challenge of not fitting into the mold of either an imaging device scientist, or of an informaticist. The focus on comparative effectiveness research in the stimulus package is a natural focus for imaging informatics because imaging is a high cost/high impact technology that needs to be linked with outcomes. Performing an advocacy role with grant funding agencies must be another important focus of the SIIM community.

I hope that this serves as a note of encouragement in what can be discouraging times. We are all facing challenges, but your skills and leadership will find the silver lining in these clouds. In some cases you may feel like you need to “Hit the Reset Button,” and in some cases that is necessary and even good. More likely, you will need to recalibrate, re-organize, or re-focus your efforts to only the most critical challenges your organization faces. SIIM is a community of people who are like you, and I want you to feel that SIIM is reaching out to you, with people who have been in your situation. I encourage you to use the network to explore and identify the most effective solutions to the problems you face. I encourage you to start planning now to attend the annual meeting, because establishing relationships in person is always the most effective method. But if that is not an option, start establishing new connections through the SIIM website.

Dr. Erickson is a Professor in the Department of Radiology at the Mayo Clinic, Rochester.