Friday, October 1, 2010

Conforming DICOM Conformance Statements

I still come across very poorly written DICOM conformance statements. For example: Conformance statements from the major modality vendors are generally over 100 pages and can be up to 400 pages in length. On the other hand, there are some mid-level and smaller modality vendors that submit only 10 page documents. Although quantity does not always mean quality, it's a good bet that there is a lot left to the imagination of the user when they only have a 10-page DICOM conformance statement from which to work. 

I believe the DICOM standard should specify, in detail, what elements belong in a conformance statement. Further, the standard should include boilerplate samples of what this might look like. In this way, there would be very little wiggle room for vendors to submit less-than-adequate conformance statements with their products. They would either be compliant with the DICOM standard conformance statement or they would not. 

Having a complete conformance specification is your right as a consumer. For example, would you buy a car without knowing what type of engine was powering it? It might come in handy to know if it is oil cooled or water cooled, how many cylinders it has, what type of fuel it requires and so on. You probably wouldn't rely on the smiling salesman saying, "Trust me." So, doesn't it make sense to insist on the same level of information when buying a patient-critical medical device? 

Another area the DICOM standard committee should take up is the publishing format of conformance statements. By requiring that all DICOM conformance statements be encoded in the XML format, it would allow for the easy comparison of comparability elements among various documents. For example, one could easily check among various CT offerings that they implement the enhanced CT multiframe SOP Class with a receiving PACS archive and workstation. 

I know that some vendors have begun to encode their documents in XML, but a uniform standard would be helpful. In any case, the absence of a publishing standard still does not justify the wide variety and lack of detail in some vendors' DICOM conformance statements. I hope they read this column and take action. 

Is 'Meaningful Use' Making Imaging Meaningless?

The U.S. government is set to dole out billions of dollars to promote healthcare IT solutions that meet its Meaningful Use (MU) criteria. The Phase 1 requirements were published this past July and the Phase 2 requirements are expected to be available for public comment near the end of the year. 

Most professionals working in medical imaging informatics, especially the radiology and cardiology area, were very surprised to notice the absence of PACS in the MU requirements. Also conspicuous by their absence was the mention of DICOM and HL7 as well as any of their corresponding IHE profile definitions. Interestingly, radiology is only mentioned in the context of orders; there is a mention about results (not the imaging, but merely the reports) in Phase 2. 

This is very puzzling to me and many of my fellow imaging informatics professionals. The implementation of digital image communication, archiving, and display over the past 30 years has been a major, but seemingly, silent revolution. Our efforts have provided health professionals in remote areas of the world with instant access to experts, during practically any time of the day or night. When it comes to an electronic health record, it's obvious that having images available to any physician at any location will eliminate duplicate procedures—increasing patient safety AND significantly decreasing the cost of providing care—and allow the physician to make a fully informed decision about the patient's course of treatment. 

The Medical Imaging and Technology Alliance (MITA), the medical imaging market's lobbying organization in Washington, D.C., has written letters to the Office of the National Coordinator for Health Information Technology (ONCHIT) about these issues—apparently to no avail (yet). 

So, why the silent treatment from the federal government? Not including the more than three decades of work in medical imaging informatics into the MU criteria is foolish and wasteful—both to patient safety and to our healthcare economy. On a pragmatic level, by not including PACS in the MU criteria, federal stimulus funds will be unavailable to implement these systems and related technologies. This means that the small clinics that are still using film and processor technology will still be left on the digital imaging roadside. 

One would be surprised how many of these facilities there still are. I recently visited one of these clinics, which only performed about 10 or so exams each day. They rely on an old processor and then have to digitize the films so they can be read in a hospital about 45 miles away. Imagine how much more efficient and economical a digital system would be—if they only had the initial capital needed to acquire one. 

I hope that our professional organizations (such as RSNA, HIMSS, SIIM, ACR, ACC, and others) make a concerted and sustained effort to ensure that medical informatics takes its rightful place in the MU requirements, as Phase 2 are about to be defined. I also urge any and all of my fellow professionals to urge these organizations to lobby for our rightful place at the healthcare informatics table.