R
adiology ended the 20th century with PACS (picture archive and the possible negative consequences of sharing data often outweighs the perceived
communication system) taking centre stage in the workings of almost every benefits of doing so. As a result, hospital information technology (IT) departments Bidding has
busy radiology department. True, United Kingdom (UK) imaging departments can find themselves more focussed on maintaining patient confidentiality than
had been somewhat slow to move with the digital times but, by the beginning they are on allowing those outside the organisation to access the data that they alarmed many
of the 21st century, all National Health Service (NHS) radiology departments need. Evidence for this can be seen, for example, in tertiary referrals for cancer
had been (or were in the process of being) equipped with a film-free system care, where weekly multi-disciplinary team meetings are often unable to progress who see it
for creating, storing and reviewing medical images. PACS investments by private patients along their urgent care pathways as a result of data that has not yet been
companies have since seen an increase following the NHS lead. sent from one organisation to another. as the end of
Looking back only 15 years to the early days of the introduction of digital imaging The reason for this is simple: individuals are currently more likely to get fired for radiology as it is
in radiology, it is easy to forget the feverous debates that raged then between compromising patient confidentiality than they are for holding up a treatment
those that welcomed the use of the new computer screens and those that said programme. Healthcare organisations are not like banks; money lost if account known today
they would never be good enough to replace traditional light box viewing. security is compromised can be given back but a patient’s confidentiality cannot
be returned in the same way. So, the need for an organisation to avoid the risk of
How times have changed. As films have given way to fluorescent screens, so prosecution leads to a consequential investment in systems and procedures that
paper worklists have been replaced by computer programmes that plot the daily support this goal. And because, thus far, it is much less likely that a patient will
workflow of the radiographer and radiologist alike. And, in what feels like a final sue because their data did not arrive on time, the need to put in place systems
act of digital domination, even the radiology secretaries are now being replaced by for security management has tended to get more management attention than the
voice recognition engines which tirelessly and (mostly) faultlessly transcribe words need to build systems to facilitate data exchange.
into digital reports.
Progress towards virtual data sharing is nonetheless being made. Teleradiology,
though still regarded with concern, especially when this involves overseas
Digitisation gives way to virtualisation organisations, has become the leading edge in a wave of virtualisation initiatives
With medicine finally beginning to move with the digital times, industrial that is now beginning to change the world of radiology.
corporations had already entered the 21st century digital age with gusto. Having
seen their individual organisations benefit from the digital world, companies The DICOM standard
2
, supplemented by its more recent cousin IHE
3
, has enabled
had started to link them together using copper and fibre optics to build super- those organisations that wish to create virtual radiology links to do so irrespective
organisations, allowing digital information to flow easily across the borders of this of PACS system vendor. Some radiology departments have simply viewed this as
new ‘virtual workplace’. a way to access services during periods when their in-house team are not able to
meet demand. Others have been looking at virtualisation as a means of putting all
From car manufacturing to banking, information flows, made safe by industrial or part of their work out to regular sub-contract, with the expectation that this will
strength encryption, had broken down the borders between collaborating help them to better manage the costs of delivery of radiology services.
companies, allowing even small businesses to achieve efficiencies and profitability
hitherto only possible in major multinational corporations. New forms of business This newly emerging potential for virtualisation to introduce price competition
also emerged alongside their more traditional cousins; Google and Yahoo to name between local and distant radiologists is viewed with alarm by many leading
but two, with Google laying plans to extend the reaches of its technology into figures in the field, who point out that this will be detrimental to both professional
every aspect of people’s lives. In 2007 this saw the introduction of Google’s virtual development and to patient care. At the very least, they say, UK reporting should
patient record Google Health
1
, proof, if needed, that virtualisation in medicine is be restricted to UK radiologists, ensuring both quality and continued professional
fast becoming a reality. development within national boundaries.
Progress towards virtual data sharing within the healthcare economy is, however, And yet the forces of virtualisation may be unstoppable. The relatively small
much slower than it has been in the corporate world. Despite the fact that amount of remote reporting that currently takes place is already leading to the
‘networking’ is at the heart of the medical community, it seems that the fear of emergence of a ‘market rate’ for a given reporting episode. This separation of the
2009
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IMAGING & ONCOLOGY
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