David Brown

Q&A with David Brown, chair of SIIM

April 13, 2015
by Sean Ruck, Contributing Editor
David Brown, CIIP at Kaiser Permanente Information Technology and chair of SIIM will begin his second and final year in the position with this society in July. HealthCare Business News spoke with him to get an update on how his time as chair has worked out and to find out how he got where he is today.

HCBN: How did you get involved with health care?
Basically, when I was in college and having to choose a career path, I looked at different options knowing my skills and decided health care would be a good choice for me. Because if I stayed in that vocation for the full spectrum of my life, I wanted to be able to look back and see that my work benefitted society in some meaningful way, that what I did was, in concept, good for society. So I looked around and landed on nuclear medicine.

HCBN: How did you get involved with SIIM?
When SIIM was establishing a professional certification (CIIP) for PACS, a request was made to the PACS community. Anyone interested in participating in the development of the certification, or joining a SIIM committee, should notify SIIM. Being an advocate of professional certification, I reached out to SIIM and was accepted into the Publications Committee.

HCBN: What are some reasons that a professional should consider becoming a SIIM member?
If a professional is interested in imaging informatics, then there is no better community than SIIM. SIIM brings together a dynamic group of professionals who are engaged in advancing the field of imaging informatics, and educating others on new ways of doing things. SIIM membership provides increased access to educational materials, and networking opportunities.

HCBN: With a year under your belt as SIIM chair, what do you feel has been your greatest accomplishment?
My greatest personal accomplishment this past year has been to learn what it takes to be the board chair of a professional society. While this does not sound like much, I would like to shine a spotlight on this experience to inspire other CIIPs who are emerging as leaders within their organizations, and entering into untested waters. It is through study and doing that one learns, andit is through learning that one is able to achieve more. I encourage CIIPs to step out beyond whatever comfort zone exists in their professional and work life, and become more engaged. SIIM provides such an opportunity, and is available to all who are interested in getting more involved.

Now going back to your original question — this question is best answered by first acknowledging that the work accomplished this past year was due to the contributions of many, and not just one person. I will answer this question as the chief representative of the SIIM Board.

Activities this past year included ongoing work with the SIIM Hackathon, the HIMSSSIIM Working Group, the SIIM Webinar Series, and more. What stands out for me as the most significant achievement of this past year has been an infrastructure change, more of a “nuts and bolts” type of achievement.

SIIM’s new website was launched in January, and is delivered from a platform that provides much more capability compared to the former platform. This new platform is designed to support increased networking amongst our members and the entire imaging informatics community by providing tools that support collaboration. New tools include the ability to create blogs on the SIIM website, and share posted content easily on Twitter, Facebook, and other social media.

The idea is to provide tools to our membership that allow for the sharing of information using a variety of delivery mechanisms, so as to reach the largest audience. The ultimate goal is create an active eCommunity that is available to imaging informatics professionals throughout the year. Everyone who attends the annual meeting knows that one of its strengths is the networking and knowledge sharing that occurs during the meeting. SIIM is striving to provide a similar experience throughout the year.

HCBN: Are there any major projects or initiatives the society is currently working on?
The current collaboration between HIMSS and SIIM is very exciting. The HIMSS/ SIIM Workgroup on enterprise imaging is examining the current and future needs of enterprise imaging informatics. The workgroup is focused on bringing awareness about the importance of imaging within healthcare IT, as well as to identify the best use of imaging and imaging information at the enterprise level. An examination of how best to image-enable the EMR is one example of the work being done by this group.

The SIIM 2014 Hackathon was a success last year, and is part of the SIIM 2015 and 2016 programs. The Hackathon provided an opportunity for participants to code using new standards, specifically HL7 FHIR and DICOMWebRESTful services. SIIM is examining how best to provide this coding opportunity year-round. The idea is that any developer who would like to test code that is using the new standards, particularly DICOMWeb, will have an independent API platform available for testing.

The SIIM Webinar Series is also very exciting. There have been three webinars to-date. Speakers for the webinars were doctors Paul Chang, Eliot Siegel, and George Shih. Webinars include a Tweet chat so that participants can contribute during the webinar, or ask questions. The webinars have been well attended and received good reviews from the attendees. Look for more webinars throughout 2015.There is a strong lineup of speakers scheduled.

HCBN: What do you believe are the biggest challenges facing the imaging informatics sector in the coming years?
Interoperability is a big one. There is an urgent need to provide an infrastructure that supports the exchange or sharing of images between providers across a region and across the nation. Without an adequate infrastructure, the sharing of images between providers will be a series of one-off solutions that will only continue to challenge health imaging IT going forward.

Consider secure image exchange as one example. The number of vendors who are providing secure image exchange solutions is increasing, particularly now that PACS vendors are offering this functionality. What I am seeing in today’s cloud-based image sharing market reminds me of CD-based image exchange. A hospital or provider will select their preferred solution for image exchange, and then want to share or exchange images using this solution with others. This is not a problem if the hospital is partnered with other providers who use the same vendor solution, but quickly becomes one if the other provider has elected another solution.

Now, the providers are faced with which vendor solution to use, particularly if there is the desire to share images in both directions. Now expand this scenario to include multiple healthcare providers wanting to exchange images with each other, and each of these providers has selected a different image exchange or PACS vendor for sharing images. The picture becomes ugly quickly. The picture becomes even uglier when one considers the fact that each image exchange solution has its own software with its own special workflow and user interface. Is it reasonable to expect a facility to train its personnel to support different workflows and user interfaces on a provider-by-provider basis?

This is why I stated that the current cloud-based market reminds me of CD exchange. Each vendor solution is different from the other, and a provider who receives CDs is tasked with figuring out what to do with the different ways in which the imaging data is presented. What is needed is a standard approach to sharing images across providers and across vendors. There are standards such as XDS-I, but there is not sufficient infrastructure supporting this standard across our nation. HIEs have adopted XDS for the exchange of results, but have been slow to adopt XDS-I for the exchange of images. There are also emerging standards such as DICOMWebRESTful services that can be leveraged with increased adoption of these new standards.

There is also the option of developing a standard, open API that could be leveraged for image exchange between vendors. This option would require a critical mass of image exchange vendors opting to develop and support an open API for its success. Whatever the approach, a proposed solution would need to be made available on a wide scale, preferably at a national and international level.

HCBN: How do you think the sector will evolve or need to evolve?
It is clear that there is a strong need to develop a standards-based infrastructure to support the imaging data exchange between healthcare providers. In order to avoid repeat CT or MRI scans when a patient is seen by different providers, there needs to be an efficient manner to share the images between these providers. If I am a neurosurgeon and preparing to perform a surgery on a patient who had a recent CT exam outside of my facility, I would want access to the images.

The imaging report is not enough. What is also clear is that the sector is moving toward cloud-based solutions. While a facility may maintain a strong local footprint within their organization’s firewalls, we are increasingly seeing new functionality being presented that is leveraging cloud services. This is the direction that our society is going as a whole. Healthcare IT is not immune. But just as we are not immune to the direction that consumer IT is headed, we are not immune to the vulnerabilities that are presented. Malware, lost devices, or mismanaged cloud environments need to be on everyone’s mind.

The recent Anthem exposure is still on everyone’s mind, but will be forgotten over time. That is, until the next major breach occurs. Personal health information needs to be protected, and our sector must act responsibly when it comes to PHI. As vendors embrace cloud solutions, they must be very serious about how they implement their solutions, and be ready to provide evidence that they are following best practices with regards to PHI management and HIPAA compliance.

Finally, the sector must evolve to support high quality care at affordable cost. This will only be achieved in our sector if we look at our current standard of practice, and look for ways to reduce costs without compromising the quality of care. As our population ages, and more of our population needs healthcare, there needs to be a way of containing costs in order to keep our country’s economy strong for future generations. This will be accomplished by using new technologies balanced withhold-fashioned common sense.