Ah, Grasshopper

By David Weiss, MD, Carilon Clinic and Virginia Tech Carilion School of Medicine
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Dr. Weiss is Physician Coordinator, Imaging Informatics at Carilion Clinic and Associate Professor of Radiology at the Virginia Tech Carilion School of Medicine. He is a member of the Applied Radiology Editorial Advisory Board.

Ah, Grasshopper. Such wonderful radiology training, but so much to learn. How did you invoke the wrath of the IIP (imaging informatics professional) staff so quickly?

IIPs are diagnosticians just as we are, Grasshopper. Picture archive and communication system (PACS) problems can be complex and multifactorial. Sometimes the first hypothesis is not correct. They may need to consult with specialists, such as network and server experts,just as we do. Try to be a good historian when you report a problem. Be specific and give examples. Be tolerant of the time it can take to diagnose and correct some issues. On the other side, IIPs need to be sensitive to our workload. Training sessions and upgrades should be scheduled on off-peak hours with physician input and ample prior notification.

Don’t make unrealistic demands. IIPs are limited by the hardware and software we ourselves have chosen. They cannot make the mouse hover one inch over the desktop no matter how much you want it to. Remember also, Grasshopper, that your request to change a system setting may adversely affect the rest of the swarm and might not be advisable.

IIPs are technically oriented by nature, Grasshopper, so don’t be insulted when they call you Encoptolophus sordidus. Learn their patois. Use department resources. We have a radiology information technology (IT) committee that serves to establish comity and solidify working relationships between physicians and technical staff. They can help translate your clinical workflow problem into a functional request. In addition, the committee helps to prioritize projects and establish a roadmap and timeline for upgrades. We are also fortunate to have a department chair who understands IT issues and uses IIP advice effectively. This is not always the case. I have seen enormous workflow problems elsewhere, precipitated by clueless department leadership.

I am as frustrated as you are to hear repeatedly that“everything is on hold until the EMR project is completed.” As PACS has moved from a radiology-centric system to a mission-critical enterprise-wide tool, decision-making has, in some cases, shifted from departmental to a more centralized structure. Radiologists must be vigilant not to lose control of our own workspace. We spend far more time at the workstation than any other specialty. We need adequate resources and domain-specific support to ensure that PACS software remains configured to our particular workflow requirements.

The IT landscape is constantly changing, Grasshopper, with frequent upgrades and new software purchases. If this were not the case, we would, like the ancients, still be reading from film or glass plates. The best radiologists are those who are always learning, not just from IIPs,but also from fellow users and individual experience. Vendor user groups are an excellent way to keep current, as are online websites. The Society for Imaging Informatics in Medicine (SIIM) is another very helpful resource where physicians and their technical counterparts interact to share knowledge and discuss mutual issues.

Follow these simple words of advice, Grasshopper, and you will achieve total consciousness. So you’ve got that going for you, which is nice.

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Ah, Grasshopper.  Appl Radiol. 

May 26, 2011

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