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July 2003
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Data Management and Information Systems in Radiology
Roberto J. Rodrigues 
Senior Consultant, The Institute for Technical Cooperation in Health Inc. (INTECH), Potomac MDVice-President, Medical Informatics Foundation, Miami FLAdjunct Faculty, Science, Technology, and International Affairs Program of theE. Walsh School of Foreign Service, Georgetown University, Washington DCEx-Regional Advisor, Health Services Information Technology, PAHO/WHO
1. Overview: Information in Health and Healthcare
Information is a key resource and prerequisite for the effective provision and management ofhealthcare. The utilization of an appropriately designed and properly established data collection,processing, and communication systems with the objective of producing and disseminatingmanagement-oriented administrative and clinical information for operational support and decisionmaking has been repeatedly shown to result in greater effectiveness and efficiency [1, 2, 3].Information systems are critical for attaining the goals of improving access to equitable healthcareand the practice of evidence-based quality health interventions; for the achievement of cost-efficientoperation and management of health services and health programs; and for the provision ofindividualized quality healthcare [4, 5] – indeed, the very quality of patient care and success in thevery complex and competitive health sector is directly related to the reliability and timeliness of theinformation available to clinical practitioners and managers [3, 6].Health information systems, to be useful, must allow for a wide variety and scope of clinicaland administrative data. Health information is any and all information related to health – structuredand non-structured data from patient records and files, with all that they may contain: time-basedgraphics; laboratory investigations; biomedical signals, e.g. electrocardiograms; X-ray, MRI, CT,ultrasound scan, and pathology images; bedside recordings of vital signs; and a large volume ofcoded and non-coded data originating from many providers and other professionals. In a broadersense, health information encompasses also other data sources: demographic data; information onsocial, cultural, economic, and environmental determinants of health; profiles on morbidity anddisease specific mortality; findings resulting from clinical practice, biomedical, and epidemiologicalresearch; statistics on the activities of healthcare services, actions of health personnel, and coverageof health programs. At all levels of the health sector, the greatest need is the establishment ofcontinuous information systems that enable the recovery of patient-oriented, problem-oriented, andprocedure-oriented data to assist in the day-to-day operation of services, management of the logisticsof care, and in the assessment of the impact of health services on the health status of individuals andpopulations.The variety of environments, priorities, organization, and operational demands of thehealthcare sector require a variety of information and communication technologies and informationsystem solutions capable of providing support for the challenging and complex interdependentclinical, public health, and managerial decisions and interventions that characterize health practice.Long used by the health sector as organization-facing “back-office applications such as enterpriseresource planning, supply chain management, engineering applications and administration, logistics,and human resource management, health information systems have, accordingly, evolved to supportpatient-related “front-office” functions directly related to diagnosis and therapy [7].
2. Trends in Health Services Information and Communication Technologies
The imperative for information and communication technologies (ICT) in health is concrete, isdriven by the operational requirements of patient care, organizational and resource management, and
 
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by the dictates of health reforms. Most of those health sector requirements are analogous todeterminants found to be relevant in other service areas such as commerce, retailing, finance,transportation, and industry [8, 9, 10, 11, 12]:
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Trend toward consolidation of the highly fragmented, expensive, and inefficient fee-for-service to models based on fixed revenue, e.g. capitation, forcing providers to search forways to reduce costs, gain operational efficiencies, add complementary products, controlinduced demand, and streamline professional supply.
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In many countries, a significant percentage of healthcare expenditures are due tounnecessary costs mostly related to redundant tests and medical errors due to poorcommunication among providers.
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Health organizations and the form of healthcare delivery are undergoing a shift from aninstitution-centered to a citizen-centered model. The prime feature of the model is a newemphasis on continuity of services supporting health promotion and maintenanceencompassing informed citizens caring for their health and an assortment of stakeholdersresponsible for the delivery of a continuum of health services within a region.
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Networks of producers, suppliers, customers, and clients and consolidation and partnering ofstakeholders, physician practice management groups, group purchasing organizations, andintegrated health delivery networks, linking outpatient facilities, diagnostic centers, hospitals,doctors, and patients have stimulated the reform of traditional health practice andmanagement.
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Leasing, membership, service agreement, and strategic alliance models replace traditionalbusiness organizations based on ownership of physical assets and long-term structures.
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Lifetime value of customer retention replaces “one time sell”. Customization capable ofachieving a “one of a kind” product or service and the possibility of instantly changing theproducts, prices, promotions, and other content to better meet user needs through economiesof speed, demand forecasting, and customer service and satisfaction are becoming moreimportant than economies of scale and impersonal service provision.
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Growth of a global marketplace and the ubiquity of interactive communications. Globaldemand for telehealth services is estimated to be of US$ 1,25 trillion, of which about two-thirds is for direct services and the rest for second opinion, consumer information, continuingeducation, management and other services.
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Leveling effect of information and communication technologies which, by reducing entrybarriers, allows small firms and poor countries and populations to have access to markets,information, and other resources, thus balancing the vertical integration competitiveadvantage of large corporations
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Availability of front office customer-facing applications such as Customer RelationshipManagement (CRM), Customer Interaction Software (CIS) as well as Customer AssetManagement (CAM) with the goal of: identifying, attracting and retaining customers togenerate profitable revenue growth; supporting the overall process of marketing and serviceprovision; and the exploitation of provider and client information, data, and analyze patternsof activity among multiple organizational units for competitive differentiation.
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New back office applications including a wide variety of "company-facing" applications:financial management, accounting, inventory control, logistics, distribution, manufacturing,human resources, supply chain management, network systems, office tools (like wordprocessors), and database systems. Even in this well-consolidated area there are emergingtrends in response to increased competition among technological solution suppliers:
 
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partnering for technology and content; application outsourcing through an Application ServiceProvider (ASPs) model to host products off of client premises; web-enabled solutions thatoffer an easy and inexpensive way for clients to integrate their applications into existingcomputer facilities; development of affordable complete and highly integrated applicationsuites; and the targeting of small and mid-sized companies by delivering packaged hardware,software, and services to meet the business requirements of small and mid-sizedorganizations which helps smaller companies keep their costs down by eliminating the needto do business with different vendors for hardware, software and services.
3. Hospital Information Systems (HIS)
The objective of a hospital information system (HIS) is to use computers and communicationsequipment to collect, store, process, retrieve, and communicate patient care and administrativeinformation for all hospital-related activities and satisfy the functional requirements of all authorizedusers. Modern HIS products have the capability of managing integrated multi-facility medicalcommunication and the storage and retrieval of all patient data during the current and previouscontacts with the healthcare system [13]. Clinical information systems are evolving in the direction ofa “lifetime” electronic health record capable of storing all significant personal health data. To attainthose goals, a number of functional objectives must be achieved:
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Establishment of a database capable of providing and integrated and continuous computer-stored medical record for all relevant patient data and make it directly accessible to allauthorized health professionals at all times (“24 hours a day, 7 days a week”).
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Communication of patient clinical and administrative data to and from all hospitals servicesand between different hospitals.
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Support of all health provider functions, including order entry, results reporting, consultations,and procedures.
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Provide clinical and administrative evidence-based decision support.
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Have functions capable of supporting logistic and business functions such as eligibility,registration, scheduling, accounting and billing, personnel, materials management, andfinancial administration.
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Assist with quality assurance, accreditation, and regulatory requirements.
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Support research, education, and training requirements.
4. Radiology Information System (RIS)
The rationale for the establishment of a RIS depends greatly on the size and type of practice,degree of specialization required, and economic determinants. For the clinician user, a RIS meanstimely accessibility to reports and the concurrent access to various types of imaging studies, manydone in different diagnostic units. The addition of telecommunication links reduces the lag timeassociated with sending studies by mail or courier from small clinics to an off-site radiologist forinterpretation and, conversely, reports, films, and other studies once interpreted can be madeimmediately available to remote users.For the radiologist, a RIS eliminate redundant entry of patient data, allows the reception ofrequests electronically, automates image display and storage, facilitates the recovery of previousexams for comparison, assists the implementation of standardized reports and digital signature, andallows the integration of voice processing through digital dictation [14, 15]. A RIS that incorporates a
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