By Teresa A. Martin
I spent much of my Out & About time this week in the hallowed halls of medicine. Waiting. In waiting rooms.
This provided ample time to observe the activity and think about the ways the medical business has gone digital.
It all began with a small scooter incident that led to a refresher course in X-Rays. No, I was not the rider! My lovely 9-year was - and her arm was the subject of the X-Rays, a technology that got it name because the person who discovered it didn't know what caused the effect and referred to it as X -- as in unknown! -- rays. In the ensuing social debate the followed, the name stuck.
Being the curious sort, I promptly tracked down the fuller story. It seems that in 1895, Professor Wilhelm Roentgen - a high school dropout with a flair for both the odd and the brilliant - was head of the physics department at the University of Wuerzburg, Germany. November 8 found him working late in his lab investigating the properties of cathode rays. Based on a hypothesis that the rays could penetrate a glass tube, he covered a tube with black cardboard in a dark room and added electrical current. Off went the ray, but ... Oops - he forgot to put a screen in front of the tube. Of course nothing would show. But ...
There was a startling glow on a piece of cardboard several feet away. Not only that, but the glow was in the form of the letter "A" which had been written on the cardboard with liquid barium by a student.
The stunned researched tried it again. Same results. He tried putting different objects between the cardboard and the tube. Like magic, the rays penetrated the objects. For the next month he played with the concept, trying all sorts of combinations. In December he tried a lead pipe and the bones of his fingers, which were holding the pipe, appeared.
It was the middle of the night, but he called his wife (who probably figured it was easier to help out and then go back to sleep rather than listen to him go on and on about this all night long) and had her put her hand on a photographic plate. Several minutes later she saw the results and is said to have proclaimed: "Oh my God...It makes me somehow feel that I'm looking at my own death!" Of course what she saw was the first X-ray image.
It was revolutionary! As word spread, fear, panic, and excitement did too. The researcher became a celebrity. Everyone wanted his or her own X-Ray machine. Bloomingdales in NYC held public demonstrations of the amazing feat. X-Ray portrait studios sprung up. This being the Victorian era with its fondness for the maudlin, newly-weds had images made of their entwined hands and newly-wed women handed out images of their hand with their new ring.
Of course, as you can guess, pretty soon the ugly side appeared - strange burns, odd lesions, and other side effects curtailed the concept that this was a trendy household item. Commercial applications in medicine and other fields emerged. And the invention turned from consumer novelty to workplace tool.
Fast forward some 117 years and the X-ray is commonplace. But our image of how it is managed is still stuck in 1950s doctor-drama TV shows. Films are processed and held upon a light table. A grave looking man views them and pronounces a diagnosis.
Uhm, can you say "outsourcing?" Can you say "remote diagnostics?" Because these are the trends in the medical industry. From Cape Cod to the Calcutta's sunny shores, the business of radiology is changing.
About four years ago, a radiologist at Mass General thought he'd found a solution for the chronic shortage of radiologists - zapping off digital files to India for review and immediate feedback. The term "teleradiology" has been coined to describe this service. A tempest ensued. It still seems to be a bit of sensitive issue, but that hasn't stopped the trend.
Picture archiving and communications systems (PACS) are rapidly becoming as commonplace as the X-ray machine itself. Whether pulled up on a local computer monitor (my young scooter-riding doc-in-training insisted on seeing the pictures of her own arm on the local computer!) or sent to a remote facility for review, the x-ray is just one more image type, and its digital transmission removes the geographic and time zone barrier to its processing.
An April article in Managed Health Care Executive magazine has a case study about an Indianapolis-based PACs provider named NearMed and the role it plays in providing smaller heath care providers with diagnostic service. "The greatest challenge we face is transitioning radiologists who have been reading plain films for a long period of time to become totally digital" is the unsurprising conclusion of one of the experts cited in the discussion.
A January article in the UK's Medical Laboratory World magazine reports that the Department of Health is pushing primary care clinics to shorten patient waiting lists by outsourcing X-ray, MRI, and ultrasound diagnostics and some clinics are expecting to outsource about 40% of such work shortly.
A recent submission to the Journal of International Business Studies by an MIT professor and graduate student looks at offshore outsourcing of these services and concludes that the emerging area of computerized diagnosis - that is, computer analysis of medical imagery - is the real future and that outsourcing is a short term red herring.
Clearly, the various imaging technologies aren't new by any stretch of the imagination. But, the way we manage the images is changing. This all part of a larger trend called "medical informatics" - essentially, the intersection of information technology and the way the business of medicine works. Whether it is teleradiology or electronic medical records, be it a computerized medicine dispensing system or a clinical information system, the real shift isn't so much gee-whiz treatments as underlying data processes. It is less about what we do, than about how we do it.
But those who post-date the era of film aren't blinking a bit. Of course the pictures of her arm would be on the computer, said my daughter. Where else would they be?
Indeed, where else would they be? A very good question, and one to ponder while waiting for that next X-Ray, CT, or other diagnostic result that wings its way in computer bytes from Cape Cod Bay to Bangalore, Boston, or any point in-between.
Become a Member
