Diagnostic Reading #1: Five Must-Read Articles from the Past Week

CSH-RIS-PACS-Blog-“Diagnostic Reading” is a new weekly series in which we will be sharing five articles we have come across in the past week that are worth reading and sharing. The topics covered will be across the spectrum–from radiology and medical imaging trends, to the most important issues affecting healthcare IT today. We hope you find these articles valuable.

1) Cloud Security and What it Means for Our Health

This article addresses many common questions regarding cloud security in healthcare. The article talks about the basics of the cloud before the discussion shifts to the transformation of healthcare with new technology.

2) Adding DBT to Screening Mammo Boosts Benefits, But Not Cost

Research conducted at the University of Washington has revealed that digital breast tomosynthesis (DBT) is cost effective and beneficial to mammography patients. This article analyzes the economic and medical benefits of DBT.

3) BYOD Security Risks: Strategies to Protect Your Hospital

The BYOD, or bring your own device, trend has started in many hospitals. This allows medical professionals to use their own phone, tablet etc. to access patient portals. This article talks about the potential security risks and how to deal with those risks.

4) Meaningful Use Problems Go Beyond Just Software, Say “Stage 2 Flexibility” Critics

This article touches on some of the current and potential difficulties of Stage 2 Meaningful Use.  As Meaningful Use progresses, healthcare teams will not have as much time to plan.

5) Assuring Quality: a Challenge that Must Be Met Now

In this article, Thomas Pope, MD, discusses the importance of peer-reviewing X-ray results in order to provide more successful diagnostic readings.

Radiology and Macro Healthcare Trends Part II: Cost

Part I of this blog series focused on radiology’s significant role in the capture and sharing of patient data.  This post will focus on costs.   At a time when 23% of U.S. adults either had problems paying medical bills or were unable to pay them, cost is top of mind for patients and practitioners.  Imaging costs now vary widely and, money spent on imaging has correlated to a reduction in hospital stays.

But what can radiologists do to have an impact on cost?  Here are two ways:

  • Imaging AppropriatenessCloud
    • Work with peers and other healthcare professionals to determine which radiology studies will be meaningful.  Better decisions directly correlate with keeping costs down and, with a focus on quality images, will make a difference in the diagnosis process.
  • Nurturing Expertise
    • The quality of images cannot be understated.  While technology plays an important part, the radiologist’s training and expertise contribute greatly to how well an image is captured.  In addition, being able to read an image and communicate that reading makes a radiologist an increasingly valuable asset to the diagnosis process.  By promoting professional development and advanced training, healthcare facilities are supporting cost-control and imaging effectiveness.

The fact is that inappropriate imaging exams and a lack of quality in images drives up healthcare costs. In the U.S., healthcare costs per capita are twice as much as the averaged developed country, and the quality of care is not necessarily better.

To combat these risings costs in healthcare, cloud technologies are being sought out by radiology departments around the globe. Implementing cloud solutions is resulting in reduced costs and improved quality, as turnaround time on reading images decreases, as well as costs associated with managing and storing images on infrastructure as it becomes outsourced.

According to the 2014 HIMSS Analytics Cloud Survey, the number one reason healthcare facilities looked to cloud technologies was because the costs were less than current IT maintenance. Cloud adoption is not only increasing in the U.S. Across Europe, healthcare facilities are looking to the cloud as a solution to boost productivity and decrease costs.

With these trends, it has become clear IT technologies—especially the cloud—are leading the way to improving costs. With medical images often using up the largest volumes of data, radiology is often becoming the leading department in using the cloud effectively.

What do you think? Are there other ways in which radiologists play a role in streamlining healthcare costs?

In part three of this series, we will focus the quality of healthcare and how radiology plays a part.

Carestream CMONorman Yung is the CMO for Carestream. His series about macro trends in healthcare is being published in three parts. Part I was posted in September and Part III will be published in November.



Veterinary Medical Imaging: Give the Customer a Solution, Not a Problem

La versión española de este post se puede leer aquí.

Davis Sesma, IntechDavid Sesma is the managing director of Intech, company specialized in technical healthcare engineering, both in healthcare radiology and veterinary radiography. Moreover, Sesma has a degree in Physics and is an expert in veterinary clinical software.

Carestream and Intech have developed a system for veterinary radiology exams, with more than 500 veterinarians around Europe using the system. With his experience and knowledge, Sesma is the perfect person to explain the issues we see in veterinary medicine.

How does radiology works in veterinary science? Do you think that in recent years the level of this science has increased through new technological innovations?

Sesma: Currently, the most demanded diagnostic method in veterinary activities is the radiology. This science has become so important to the veterinarian sector that to be approved as a clinic center, they must have surgery and X-ray equipment.
Technological advances in this area in the last 25 years (specifically to veterinary radiology equipment, digital systems adapted to the needs of industry, etc.) have led to growth from 10% to 75% regarding veterinary centers with a registered radiology team. As for digital radiology systems, only 10 years ago, only large referral centers would have the equipment, whereas today over 50% of new businesses are provided with digital radiology systems when first opening.

How does new software affect conventional radiology techniques in the veterinary industry?

Sesma: The development of applications for the collection of radiology images for veterinary activities has significantly helped  to diagnose diseases and the appropriate treatment.  Having specific radiology filters for each animal and anatomical region have contributed to the reduction of repeated exposures, and has also led to reduced radiation dose. On the other side are the measurement tools and veterinary applications that allow for accurate diagnoses as efficiently as possible, while also optimizing cost reduction.

What is the most striking difference between the software for animals versus human beings?

Sesma: A veterinary treatment program is designed by veterinarians and responds to all the demands of the sector. In fact, every six months we incorporate new tools and modify some that have already been made, based on feedback we receive directly from customers

The biggest difference lies in the fact that the veterinary surgeon has a particular expertise. He is part radiologist, part internist, and part cardiologist and psychologist. So what we have always tried, and I think we have achieved, is to implement an intuitive computer program that is easy to use. We have moved away from the complicated PACS platforms for human images, which you have to be an expert to manage.

Our goal has always been very clear: putting the service veterinary diagnostic tools in place, and prevent veterinarians from having to continue to use out-of-date, ineffective software.

Veterinary Imaging from CarestreamCan Intech software also be used with unconventional pets?

Sesma: There are more and more households containing pets other than dogs and cats, resulting in increasingly frequent consultations with birds, rodents, reptiles, ferrets, rabbits, etc. There are already many clinics in Europe (of course in Spain) specializing in “exotic animals.” So in our software, we contemplate different tools and filters for dogs, cats, horses, reptiles, small mammals, rodents, birds, turtles and other reptiles for example.

Incorporating a new technology needs to be accompanied with a training session. Would you say that veterinarians can easily adapt to new technologies?

Sesma: If someone is used to a certain way of doing things, the problem is not for that person, it is for the company–it has failed to adapt to the client. Today, veteran professionals who have never handled a computer, send emails, take pictures, play “Candy Crush” and hold video conferences with their grandchildren. This has been achieved thanks to the new usable software that we find in today’s devices, be it tablet, smartphone, or PC. That’s what developers should do—solutions must answer your questions. Veterinarians who are committed to our company have learned the new technologies, without a doubt.

Is the same security applied to both people and animals, in terms of standard protocol and regulation?

Sesma: There is not a gap in legislation. In fact, the RD 1085/2009 plays under the same heading for veterinary and conventional radiology equipment for humans. So our quality standard and our manufacturing CE markings don’t discriminate in terms of security, whether the use of the equipment is for human or animal patients.

Which would you say are the biggest benefits in the partnership between Intech and Carestream?

Sesma: The win-win relationship. Both companies are in the same line of support and non- interference in each of our tasks. Carestream has given us the green light to carry 100% of the veterinary market and as well as the support of the product, which is considered by many veterinarians to be the best product in its class .

Dar Al Cliente una Solución a sus Necesidades y no un Problema

The English version of this post can be found here.

Davis Sesma, IntechDavid Sesma es  director general de Intech,  empresa especializada en ingeniera  técnica hospitalaria, tanto  en radiología médica  como en radiografía veterinaria. Sesma es licenciado en ciencias físicas y todo un experto en el mundo del software clínico para animales.

Intech y Carestream han desarrollado conjuntamente un sistema para pruebas radiológicas, más de 500 veterinarios ya utilizan estos sistemas .Por todo esto  Sesma se convierte en  la persona perfecta por su experiencia y conocimiento  para  que nos explique las dudas de la medicina veterinaria

¿Como  funciona la radiología en las ciencias veterinarias? ¿Cree usted que en los últimos años  ha aumentado la categoría de esta ciencia gracias a las nuevas innovaciones tecnológicas?

Sesma: Hoy por hoy, el método diagnóstico más demandado en las actividades veterinarias es, sin duda, la radiología. Esta ciencia ha llegado a tal importancia, que para que los colegios profesionales homologuen como clínica un centro veterinario, estas han de contar con quirófano y equipo de Rayos X.

Los avances tecnológicos en esta materia en los últimos 25 años (equipos de radiodiagnóstico específicos de veterinaria, sistemas digitales adaptados a las necesidades del sector, etc.) han llevado a que  se haya pasado de una proporción del 10% al 75% en cuanto a centros veterinarios con un equipo de radiología registrado. En cuanto a los sistemas de radiodiagnóstico digitales, hace tan solo 10 años, se digitalizaban solo los grandes centros de referencia, mientras que hoy, más del 50% de las nuevas empresas se dotan de un sistema de radiología digital al comienzo de su actividad.

¿Los  nuevos softwares alteran las técnicas radiológicas en las ciencias veterinarias convencionales?

Sesma: El avance de los programas de captación y tratamiento de imágenes radiológicas  para cada actividad veterinaria, están ayudando de forma muy significativa al veterinario en el diagnóstico de patologías y su tratamiento. El tener filtros radiológicos concretos para cada animal y zona anatómica, ha contribuido a la reducción de repeticiones de exposiciones, con la consiguiente reducción de dosis al profesional. Por otro lado están las herramientas de medición y de aplicaciones veterinarias que permiten a diagnósticos precisos en un tiempo mínimo, de la manera más eficiente posible con lo  que se optimiza el tiempo y se reducen los costes.

¿Cuál es la diferencia más llamativa entre los sofwares de animales frente a los de seres humanos?

Sesma: El programa de tratamiento veterinario está diseñado por veterinarios y responde todas las demandas del sector. De hecho, cada 6 meses vamos incorporando nuevas herramientas y  modificamos algunas  que ya  se  han hecho, en función de los comentarios de los propios clientes.

Pero quizás la mayor diferencia, radica en el hecho de que el veterinario clínico no tiene una especialización, es en parte radiólogo, es en parte internista, un poco cardiólogo… y un mucho psicólogo. Así que, lo que siempre hemos tratado, y creo que hemos logrado, es realizar un programa informático muy intuitivo (no hace falta tener grandes conocimientos de ofimática) y extremadamente fácil de usar, lejos de los complicados PACS de humana, donde hace falta ser un experto para su manejo.

Nuestro objetivo ha sido siempre muy claro: Poner al servicio del Veterinario herramientas de diagnóstico, y no el contrario, es decir adaptar al veterinario a las herramientas existentes.

Veterinary Imaging from Carestream¿El software de Intech  también puede ser usado con mascotas no  convencionales?

Sesma: Cada vez hay más hogares con otras mascotas que no son perros o gatos. Cada vez son más frecuentes las consultas con aves, roedores, reptiles, hurones, conejos etc. De hecho ya existen muchas clínicas en Europa (y por supuesto en España) especializadas en “animales exóticos”. Por eso en nuestro software, contemplamos diferentes herramientas y filtros para perros, gatos, caballos, reptiles, pequeños mamíferos, roedores, aves, tortugas y demás reptiles por ejemplo.

La incorporación de una tecnología necesita ir acompañada de un sistema de enseñanza. ¿Diría usted que los veterinarios se adaptan fácilmente a las nuevas tecnologías que van apareciendo o se han quedado anclados cada uno en su época?

Sesma: Si alguien se queda anclado en su época, el problema no es de esa persona si no de la empresa que proporciona los servicios, que no ha sabido adaptarlos al cliente. Hoy en día, los mayores profesionales que nunca han manejado un ordenador, mandan correos electrónicos, hacen fotos, juegan al “Candy Crush” y mantienen videoconferencias con sus nietos. Esto se ha conseguido gracias a los nuevos software intuitivos que todos conocemos de las tabletas. Es  lo que debemos hacer los desarrolladores de soluciones informáticas.  Los veterinarios que apuestan por nuestra empresa se han adaptado a esta nueva tecnología,  sin lugar a dudas.

¿Se mantiene la misma seguridad en personas como en animales? A nivel protocolario y de normativa vigente.

Sesma: No hay ninguna diferencia legislativa. De hecho el RD 1085/2009 incluye en el mismo epígrafe a los equipos para prácticas veterinarias y a los equipos de radiodiagnóstico convencionales para humanos. Por eso nuestras normas de calidad de fabricación y nuestros marcados CE no diferencian, a nivel de seguridad, si la práctica a la que se destina el equipo es para un paciente humano o animal.

¿Cual diría usted que son las mayores consecuencias y los mayores beneficios del acuerdo llevado  a cabo entre Intech  y Carestream?

Sesma: La confianza mutua. Ambas empresas estamos en la misma línea de ayuda y no interferencia en cada una de nuestros cometidos. Carestream por su parte nos ha dado luz verde para llevar el 100% del mercado veterinario y el soporte en fábrica del producto, para desarrollar, el que está considerado por muchos veterinarios el mejor producto de su categoría.

Digital Breast Tomosynthesis Necessary for Imaging Dense Breast Tissue

Digital Breast Tomosynthesis

The image on the left is a DBT image, and the image on the right is traditional 2D mammography.

Digital breast tomoysnthesis (DBT), or 3-D mammography, has often been referred to as being the key to advancement in breast imaging. With more and more states passing laws requiring that women be notified if they are classified as having dense breast tissue, DBT is proving to be beneficial in accurate detection—a JAMA study showed that using 3-D mammography resulted in a 15% reduction in recall rates and a 41% increase in the detection of potentially lethal cancers.

Dense breast tissue and the accompanying notifications to women who possess it has become a frequent conversation topic over the past couple years. As of now, 20 states have enacted laws that require medical professionals to notify women if their mammograms reveal them to have dense tissue. Organizations such as Are You Dense Advocacy are fighting the good fight trying to get more states on board with these notifications because of the major risk dense breast tissue presents— making it more difficult to detect cancer in a mammogram than normal tissue.

At the International Congress of Radiology (ICR) in September 2014, Dr. Marwa Adel from Misr University for Science and Technology and Cairo Scan in Egypt presented two cases:

  1. The first case, Dr. Adel and company compared breast cancer visibility in digital mammography with that of DBT. Cancer visibility was ranked higher for DBT than for digital mammography in 52% of cases and was equivalent in 49 cases (33.6%). When observing the group with higher breast tissue density, the cancers were rated more visible in 64.6% of the cases.
  2. In the second study, DBT also proved better than digital mammography in image quality of masses. DBT was rated as equivalent or superior to digital mammography in 96% of the total findings.

Dr. Adel and the other authors of the studies concluded that DBT is superior to digital mammography in diagnostic performance. Particularly when it comes to dense breast tissue, it is clear that the use of DBT is vital to providing improved diagnosis to patients.

There are important questions regarding financial, technical, product, and workflow issues related to DBT that should be answered before a facility installs a system. As women’s healthcare continues to evolve, more and more facilities are able to implement DBT machines and be in a position to provide the highest quality of care to their patients.

At RSNA 2014, Carestream will showcase enhancements to its DBT module including a DBT image map that indicates the location and orientation of the currently displayed slice in the breast, a slabbing tool that allows  adjust of the slab thickness , improved workflow settings and the display of DICOM-compliant 2D synthetic views, which are calculated from the 3D dataset.  For more information, you can visit us in South Hall at booth #4735.

UPDATE, NOVEMBER 10, 2014: According to an article published last week by Health Imaging, “the Centers for Medicare & Medicaid Services (CMS) established two new add-on codes that will go into effect Jan. 1, 2015, and extend additional payment when DBT is performed along with 2D digital mammography.”  You can click the link to get more details about the designated codes and payment amounts for DBT. CMS said it will also “revisit payment for DBT and 2D mammography for 2016 as part of a review under its misvalued codes initiative.”

Ron Muscosky, Worldwide Product Line Manager, HCIS, Carestream Ron Muscosky, Worldwide Product Line Manager, Healthcare Information Solutions, Carestream 



Challenges of Stage 2 Meaningful Use Require More Allies

ONC, Meaningful Use, Stage 2

Click the picture to go to the HealthIT.gov website to learn more about Stage 2 meaningful use certification.

Stage 2 of Meaningful Use is a vital component to the initiative since it, as the U.S. government defines, “intends to increase health information exchange between providers and promote patient engagement by giving patients secure online access to their health information.”

As reported by Hospitals & Health Networks, only 140 hospitals have achieved Stage 2 of meaningful use. Throughout 2014, hospitals have been claiming that requirements such as this are more difficult to implement than originally thought. Assistance is needed in the form of decreased time for reporting periods or providers fear that they will face the severe penalties.

From the vendor side, to properly help providers, it is clear that we must be able to provide the answers to two key questions:

  • Can the technology be optimized with the existing solutions in place?
  • One of requirements for Stage 2 states that more than 5% of unique patients during the reporting period must use the hospital’s portal to view, download or transmit their health info to a third party. Since patients will be using the technology, is it intuitive and secure?

For both of the questions, I feel confident that Carestream would be able to answer, “Yes.” Our Vue RIS platform recently achieved Stage 2 certification, making it one of the first RIS platforms to achieve both Stage 1 and Stage 2 certifications. This means that those facilities using the system can exchange patient medical records and clinical documents with other certified EHR providers.

Beyond just being having an integrated solution, working with your clinical departments can enable capturing specific clinical data required: i.e. smoking cessation, BMI etc. In the case of the University of Virginia, the organization shared that radiology helped meaningful use attestation because it was able to capture the data that would not otherwise be captured.

With the Stage 2 certification, Vue RIS includes the following capabilities: family health history, the transfer and sharing of health information, and online patient access to information and communication. Additionally, the RIS platform can also be coupled with the MyVue patient portal to allow for patients to view their exam results, view and reschedule appointments, and also share the exam results with their primary care physicians.

Stage 2 of meaningful use has been deemed so vital to the future of healthcare because it is the first stage that involves the patients becoming ingrained in the process. As the patients become more in tune with their own health, we must make sure that we not only provide them with the tools to take action, but also the guidance and education on how best to use them, as well as the benefits these tools provide.

What have been your biggest challenges when working to achieve Stage 2 meaningful use? What have you been doing to combat these challenges, and what successes have resulted?

Cristine Kao, Healthcare IT, CarestreamCristine Kao is the global marketing manager, Healthcare IT, for Carestream.




NHS Ayrshire and Arran Works to Improve Radiation Dose with Radimetrics

Controlling and improving radiation dose is a top concern for imaging centers.  NHS Ayrshire and Arran serves 400,000 people at 10 hospitals across East, North, and South Ayrshire in Scotland. In 2012, the organization worked to integrate Bayer HealthCare’s Radimetrics with its Carestream Vue PACS. The integration was completed in weeks, and the facility immediately found how well the two work together.

With Radimetrics, NHS Ayrshire and Arran are able to track radiation dose and room utilization as a way to collect data and act swiftly if issues are to arise. The big questions that the facility can now answer include, “Are we minimizing radiation dose for our patients?” and “Are we making the best use of our resources?”

As the video above explains, the organization was able to bring protocols together, standardize them, and oversee the management of dose. With this newfound efficiency, NHS Ayrshire and Arran can now easily spot discrepancies in the data, and seamlessly update patient information.

As the volume of exams increase, and imaging exams become more complex, the organization needs to justify its decisions. As an example, it can view dashboards to determine room utilization, which allows for specific acquisition on how a room is being used. Radimetrics gives them the information at their fingertips.

Radiology’s Response to Healthcare Consolidation – Step One: The Global Worklist

Enterprise Image Access

Click the image to learn more about Vue Connect and download a presentation about enterprise image access.

If you’re like me, your day starts with a scan of healthcare headlines that are packed with merger, acquisition and partnership news.  This month Becker’s Hospital Review reported that – in my backyard – Jameson Health will join UPMC. Elsewhere, Advocate and NorthShore are merging to create a new 16-hospital system.  In the Seattle, eight hospitals, 163 clinics, 24 ancillary provider locations and 2,875 primary and specialty physicians from CHI Franciscan Health, Virginia Mason and others have formed a new health network — Puget Sound High-Value Network.

This climate of change in the healthcare system shows no sign of slowing. Booz & Company predicts that 1,000 of the nation’s roughly 5,000 hospitals could seek out mergers in the next five to seven years.

These new care systems and models bring with them large interoperability challenges.  Take this survey of 62 accountable care organizations that found 100 percent of respondents have difficulty achieving interoperability with disparate partners.

I see this often in radiology departments faced with change. Here are five immediate interoperability questions that departments will face:

  • How will we index images from multiple sites and vendors?
  • Can we synchronize patient data in real time from multiple sites?
  • How will we manage metadata discrepancies and accommodate IHE profiles?
  • Is there a way to provide a common interface and tools for reading and reporting without migrating?
  • What’s the best way to allow the referring community to view all patient data regardless of originating site?

Many I talk to worry that the radiology department will not get the funding needed to make a PACS replacement or archiving consolidation project a priority. A complex, forklift migration is time intensive and could be delayed for other system needs.

To respond to change out of the gate and bring immediate value, I counsel my clients to look for solutions that allow them to leverage their existing investments first.

I recommend that step one should be to federate multiple repositories into an intelligent worklist.

By cross indexing multiple databases without replacing existing infrastructure you can enable enterprise wide reading, but keep local autonomy.

This global worklist acts as the “brain” of the new enterprise helping to bring teams together with a common interface and set of tools that allows all people, at all locations to work as if they were just down the hall from each other.

Addressing the worklist first with an intelligent workflow layer like Vue Connect and allowing local sites to keep some local autonomy at the start of a merger, acquisition or affiliation could help drive collaboration and partnership for future changes.  The global worklist can also help ease future transitions such as maintaining the enterprise’s workflow during a VNA deployment and connecting additional PACS systems as the network grows.

Are you planning for change and more interoperability demands now? What alternatives to “ripping and replacing” your PACS are you evaluating?

Interested in learning more about the first step in “Enterprise Image Access in a Climate of Change?” You can download a SlideShare presentation or contact us to learn more about Vue Connect here.

Daniel Hixenbaugh, HCIS, CarestreamDaniel Hixenbaugh is an account executive in the Mid-Atlantic for Carestream.



Infographic: Orthopaedic Medicine Vital to Addressing Musculoskeletal Disorders

Yesterday, we announced a partnership with UBMD Orthopaedics & Sports Medicine to collaborate on the development of a new three-dimensional medical imaging system for capturing orthopaedic images of patient extremities.

The orthopaedic medicine market is one that is poised for intense growth over the next 10 years, with inpatient orthopaedic volume expected to grow 15%, and 28% for outpatient orthopaedics, according to the Advisory Board. The organization also highlighted that between 2002-2011, knee replacements, hip replacements, and spinal fusions grew by 88%, 34%, and 67%, respectively. With these growth numbers, we can expect orthopaedic medicine to be an immensely important need in the years to come.

The infographic below illustrates some of the major musculoskeletal disorder trends in the U.S. You can see in the statistics that orthopaedic medicine is a necessity to provide high-quality patient care. For example, with 10.4 million knee injuries happening annually, and U.S. employees missing 440 million days of work due to bone and joint injuries, improvements in diagnosis and treatment cannot come soon enough.


The Role of a Fully Integrated RIS-PACS: Dream or Reality?

RIS_PACS Integration

The evolution of PACS makes it so radiologists are looking for more dynamic systems.

The EHR is playing an increasing role in the management of patients. In the U.S., according to a recent NHCS Data Brief, 78% of office-based physicians use some kind of EHR. Far from being just a collection of patient medical information in different storage systems, we need the ability to integrate all the information and to have it readily available, thus avoiding redundant tests and appointments. We also need to be able to manage sensitive data as well as to transmit it to health care decision-maker. It must be a dynamic system, constantly achieving more ambitious goals. However this vision is far from being shared by all the players, considering that even some national authorities view it simply as a data repository (or, to put it in bureaucratic jargon, “a set of digital data and documents relating to health and social health generated by present and past clinical events, relating to the patient”).

These goals can be fairly easily met either within homogeneous populations, or within a health system, which is allowed to set the rules of the game and to enforce them. However, this is an extremely complex task in all those environments where different systems are allowed to coexist and no rules are set/enforced to reach the ultimate goal of “one patient-one record.”

The end-solution to this goal lies probably, at least for the near future, in the vendor neutral archive (VNA). However even in its definition, VNA is a compromise solution: a medical imaging technology in which images and documents (potentially any file of clinical relevance) are stored in a standard format with a standard interface, making them accessible in a vendor-neutral manner by other systems. It can be considered an evolution of the original RIS-PACS concept, where no longer are radiology and nuclear medicine the sole players, but on the contrary, all the medical and surgical specialties are involved, as long as they are capable of providing images or documents to be managed within the same archive.

This makes the contribution of a fully integrated RIS-PACS of paramount importance. We should no longer rely solely on the principles of improved productivity, more efficient staffing, optimization of the financial management of the department we are running, and the backbone of the RIS as we have been used to consider it. Instead we should try to put under the same enterprise-wide umbrella all the images and documents which could fit in the system, with positive outcome in the patients’ management. I believe that the key word to this approach to the digital world in health management should be “share”—overcoming the still too common fear to make data accessible not only to the patients but also to “competitors” in the health business. Far from being just a tiny dot within the digital world, the fully integrated RIS-PACS should be a cornerstone not only to the VNA, but also to the EHR.

In fact, as long as we shall not be able to integrate within one single framework all data concerning all patients, whatever the source (private, public, national, trans-national as it happens in the European Union), the talk about a real EHR will sound just as a simple exercise in debate. Unfortunately, these same doubts are shared by other thinkers, such as Gary Drevitch in his short editorial, “Will we ever have universal electronic health records?” published last year in Forbes.com.

Dr. Ivo Bergamo- Andreis is Chairman, Department of Radiology/Diagnostic Imaging at Legnano City Hospital, Legnano, ItalyDr. Ivo Bergamo- Andreis is Chairman, Department of Radiology/Diagnostic Imaging at Legnano City Hospital, Legnano, Italy, and is a member of Carestream’s Medical Advisory Board