Paul Chang is excited about the opportunity to present the Dwyer Lecture at the upcoming SIIM 2010 Annual Meeting because it gives him a chance to look into the future of imaging IT. Chang’s topic, “The Role of Imaging Informatics in the Next Generation of EMR/EHR,” begins with the premise that existing EMR/EHR models are probably inadequate to address current and near future requirements. The lessons learned and approaches validated in imaging informatics can contribute greatly in the design of more optimal EMR/EHR approaches. The 2nd Annual Dwyer Lecture focuses on the opportunities for imaging informatics in this new reality.

“Sam [Dwyer] was very forward-thinking,” Chang notes. The lecture will start with a historical perspective, and then move to the present and the future. “I’d like to use PACS/EMR as an analogy for other things,” he says.

According to Chang, historically, there are a lot of different analogies for the current transition:

• PACS vs. EMR (radiology vs. the enterprise)
• Workflow vs. storage of data
• Multimedia vs. text-based results
• Optimized workflow vs. control and sustainability

One thing is certain, though: “We are going through a transition that will be really exciting in the future,” says Chang

Historically, Chang notes that before PACS, IT needs and infrastructure were basic. “We just used a text-based terminal. PACS drove the need to enhance the network infrastructure – we needed something that was graphic-based. Along with the web, this had a huge role in the requirements for infrastructure,” says Chang.

In the current environment, he credits imaging informaticists and PACS IT with pushing the idea of workflow over basic storage and delivery of images. “With everything we talk about at SIIM – TRIP, for example – the major issue is workflow. Workflow is what is currently lacking now in the EMR. We in imaging informatics understand the need for interoperability; we were the pioneers in that.”

In the future, Chang predicts, the EMR will change to be more like “what we do in PACS.” It’s becoming increasingly unpopular to store data and images locally – storage is a commodity and will shift to the “cloud.” “If you take a look at PACS vendors, they’re selling the richness of the workflow, not the storage capability,” he says.

“The battles are fought in the trenches – ICU, reading room, ER, etc. – where the patients and the doctors are,” says Chang. “The content is not all that is important. The content provides the relevant context to do the appropriate workflow. There will be an emphasis away from storage and results review – traditional EMR functions – and we’ll put storage in the clouds and focus on content combined with developing a useful workflow with intelligent workflow tools.

“The future of the EMR will be modeled more like PACS – utilizing intelligent agents that optimize workflow. The value add is in the workflow – that’s a space that we in imaging informatics have always lived in. We can serve as the living model for what they need to do with the EMR in the future,” he says.

Chang uses as an example the personal health record (PHR), which will increase in prominence. The current EMR is for the provider, but the PHR is for the patient, he notes. In the future, there will be more need for the information contained in the EMR to be conveyed to the patient in the PHR. How will they integrate when the EMR information needs to go to the patient? “Our history in the PACS/imaging informatics IT world can serve as a model. We have been in parallel with the EMR folks. The EMR will need to change to accommodate increased needs,” says Chang.

Founded in memory of Sam Dwyer, a pioneer in PACS and one of the early members of RISC/SCAR/SIIM, each year the Dwyer Lectureship features a SIIM Fellow as the presenter of a particularly relevant and insightful topic. Paul J. Chang, MD, FSIIM, Vice Chairman of Radiology Informatics and Medical Director of Pathology Informatics at the University of Chicago, Pritzker School of Medicine, will present the 2010 Dwyer Lecture at the SIIM 2010 Annual Meeting.