As the products of radiology—diagnostic imaging data and reports—become more widely distributed across the healthcare enterprise, debate has arisen within the medical community over which group is best able to administer and maintain radiology IT systems: the radiology department or a centralized IT group.

“Today, more compelling reasons support the treatment of PACS as a component of an enterprise strategy that appropriately falls under the chief information officer (CIO) and the IT organization,” wrote George H. Bowers, a principal at the Baltimore-based Health Care Information Consultants, in a point/counterpoint discussion of radiology IT ownership published online before print (April 23) in the Journal of Digital Imaging.

David S. Channin, MD, from the department of radiology at the Feinberg School of Medicine at Northwestern University in Chicago wrote the counterpoint, holding that “radiology is too large, too complex, too valuable, and too dependant on IT to be treated as an ordinary IT customer.”

According to Bowers, the CIO should manage PACS due to the technical complexity of today’s IT environment, which has been steadily migrating from an application-centric approach to an enterprise-wide approach in response to regulatory and economic requirements.

“As PACS technology becomes more pervasive in the organization, it must be centrally managed to avoid duplication of costs and maintain consistency of service,” he noted.

Channin observed that all radiology processes depend on IT.

“The information systems in imaging are not generic systems; they require specialty knowledge and maintenance skills,” he wrote. “Central IT often operates in system silos. Radiology IT staff must be cross-trained in their systems. It is a fulltime job that does not end when the ‘go-live’ date passes. The systems must be constantly monitored for correct use, upgrades, and optimization.”

Bowers conceded that the priorities of the radiology department and centralized IT will probably never be the same.

“But radiology is only one component in delivering care to the patient,” he wrote. “Coordinating the care of a patient among all of the diagnostic and treatment options in the most efficient and cost-effective manner must be the priority of our healthcare delivery system. Processes that affect patient care may flow between and among many departments. IT has been charged with delivering the EMR, which focuses on the patient—not the hospital department. The patient must be the priority, even if this means compromises elsewhere in the delivery system. What is best for the patient may not necessarily be the best or most efficient for individual departments.”

Channin acknowledged the healthcare enterprise is the key user of a PACS. However, his belief is that information professionals located in the radiology department are the most qualified to administer and deliver data to those users.

“I contend that radiology understands the requirements and needs better than a centralized IT organization,” he wrote. “Enterprise healthcare providers are our customers.”

Citing the leadership role radiology has played in the evolution of the Integrating the Healthcare Enterprise (IHE)—an initiative by healthcare professionals and industry to improve the way computer systems in healthcare share information—Channin argued that radiology “can and does serve as a technology exemplar” for other medical specialties.

“The CIO must lead in the support of standards, interoperability, compliance with policies, procedures, and regulations,” he wrote. “He or she should supply intellectual and financial nourishment to let a garden of innovation grow.”