From Radiology to… Archeology?

If Indiana Jones and McGyver ever had a love-child, he or she would probably be tempted by a career in Health Information Technology (IT).

Imaging Industry Standards Enable AI Adoption

A typical, mature healthcare organization’s Information Technology (IT) landscape has many attributes in common with an archeological excavation or dig. Often when deploying interoperability solutions, one comes across the occasional skeleton in the network closet. The deeper we dig into the history of a hospital’s infrastructure, the more we can retrace the history of decisions made by the IT department. Through forensic discovery, much can be learned about the technological context and priorities present at the time a solution was deployed, and about the level of competence and innovative solutions offered by IT vendors at that time. All of these historical elements have a direct impact on current projects, one way or the other.

I can’t help but draw a close analogy between the growth of trees, IT infrastructure, and their gradual evolution. I’ve always been fascinated by the concentric circles in the cross-section of a tree because it’s like time travel; growth takes place from the inside out, the inner layers never disappear and become a permanent part of the tree’s infrastructure. New layers build upon their predecessors, and much can be learned from each of the strata. If the tree experienced extreme drought, the layer that year will be ultra-thin. Conversely, if there was substantial rainfall the following year, the next concentric circle in the cross-section will be much thicker.

Feast or Famine: Health IT Budget Constraints Impact Innovation

Similar to concentric circles in the cross-section of a tree, lean IT budget years may have inhibited technological evolution in the hospital; lack of innovation or complacency on the part of Health IT vendors can yield the same result even if budgetary constraints are not a factor. Rapid evolution and innovation in IT can contribute to a period of steep technological adoption in healthcare. Through lean and prosperous years, over the past two to three decades in hospitals, thousands of disparate software solutions have been gradually deployed, interfaced, upgraded, updated, migrated, forklifted, excavated, and replaced.
The IT management tools and standards we enjoy today were not available a decade, or even five years ago, yet many of the solutions and interfaces deployed in a bygone technological context are still quietly serving their purpose, buried deep within the hospital’s data center. Knowledge of some of the older solutions and interfaces is often “tribal” (limited to a few individuals and marginally documented), which can contribute to extensive (and costly) unplanned downtime.

The Hidden Cost of Poor Documentation

During a massive EHR/EMR and data center migration project many years ago, the discovery team taking inventory in the data center was faced with the sad reality that many servers had little to no documentation available to identify their purpose. Through a tedious empirical process, in most cases, they were able to recreate a functional map. In a handful of hopeless cases, they had to resort to disconnecting servers, crossing their fingers, and bracing for the inevitable support tickets and varying degrees of end-user anger (and panic), interlaced with colorful expletives.

This gradual stratification of IT solutions ultimately morphs into a complex and amalgamated ecosystem that requires constant fine-tuning and vigilance in order to maintain a mission-critical continuum of care. The complexity of the challenge grows proportionately, and sometimes exponentially, relative to the size of the organization.

For every new solution adopted, countless IT resources must investigate the solution, validate its utility,verify that it won’t introduce security vulnerabilities or HIPAA violations, document the ROI, negotiate procurement, plan for deployment, and map out where it fits within the ecosystem. They will meticulously interface the newest gizmo with other pieces of software, and (hopefully) document the interfaces so they may be maintained appropriately over time, even in the eventual absence of those who deployed them years before.

The enterprise imaging category is no stranger to these challenges. Although imaging constitutes a mere subset of the overall IT infrastructure, it is a demanding and resource-intensive constituent among IT end-users. This is particularly true in the areas of network traffic, storage requirements and processing power for some of the most advanced imaging applications such as 3D modeling, Tomosynthesis (3D mammography) or functional MRI.

Creating a Sustainable and Interoperable IT Environment In Enterprise Imaging

On a daily basis IT maintains a precarious balance between the necessity to keep established solutions up and running, and the inexorable pile-up of new solutions. New imaging modalities, along with their own software ecosystem, routinely introduce new puzzles and interoperability challenges that are typically solved with the assistance, at high cost, of the modality vendor.
The dilemma for hospitals is whether or not to rely solely upon the IT vendor’s expertise and solutions to solve everyday problems. Some vendors place an unusually high, arbitrary and often prohibitive cost barrier on connecting their solution to other vendors or to solve an interoperability challenge.
Market protectionism, poor interoperability, inconsistent vendor support for industry standards, substandard system design and user experience, cumbersome and labor-intensive systems configuration, fragmented data flows are all elements that contribute heavily to operational, clinical and financial burdening of the caregiver organization.
Hospital IT and imaging staff need to be given a reliable, versatile, and flexible toolset that fosters creativity and inspires inventiveness to support their daily delicate mission.

A hospital’s IT department has a responsibility to make technology choices that generally empower IT to address many of the basic issues themselves, without having to open a ticket with the vendor for every little change request, or challenge encountered. Armed with the right competence and the right toolset, your health IT staff can consistently be superheros for the organization.

In the future, solutions we deploy today will be examined by the next generation of IT archeologists. What sort of legacy will we leave for them to discover? What will they think of our work? How confidently will they retrace our steps? If we all did our work correctly, and clearly documented the intended data flows and topology in the statement of work (SOW), we won’t be leaving a puzzle for someone else to solve in the future!

Dicom Systems has shown that it is possible, and highly desirable, to deploy smart, vendor-neutral, technology that can solve a multitude of interoperability, routing and integration challenges within one platform, without the usual and customary high cost, and without compromising the integrity of the care continuum. To learn more about the Unifier platform contact us to request a demo.

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