As someone who has worked for the last 39 years in both clinical and the IT end of things, I can tell you firsthand it isn’t that simple. (and this is in no way a criticism of you-like most people, you wouldn’t have any way of knowing about these kinds of things)
My clinical background was Nuclear Medicine, and about 30 years ago I transitioned out of direct patient care to Radiology Informatics.
I worked in a very modern, advanced Level 1 Trauma Center 20 miles from Boston. I was involved in every aspect of system design, construction, workflow analysis and design, billing, scheduling, reporting, you name it.
I straddled the transition from a completely analog Radiology environment to a wholly digital paperless Radiology environment.
When I began in 1984-86 after I got out of the Navy (I was a Jet Mechanic) during college studying for my degree, then entering the workforce after graduation, I entered a completely analog environment.
In that analog environment, there were darkrooms that had blind people working in them, developing machines with supplies of chemicals you had to constantly replenish, paper folders full of analog images that were stored in gymnasium sized rooms filled floor to ceiling with patient folders, an entire army of dozens of people who took them off the shelves, sent them to every corner of the hospital for appointments and who filed them back on those shelves when the clinical teams were done with them, light boxes for the Radiologists to hang and view physical films on, paper jackets, five part carbon copy paper requisitions for exams, small hand-held tape recorders for dictating, a large team of bureaucratic personnel who had to distribute these X-rays and requisitions out to Radiologists to read them, and who would have to pick up the tapes WITH the part of the five part requisition to give to a large team of 10-15 dedicated transcriptionists who would transcribe those tapes into mainframe computers that would print them out in batches, which were then sent back out to ALL the Radiologists who had to look at each one and physically verify that what the transcriptionist typed is what they actually said, and all those verified reports were collected and sent to Medical Records to be filed in the patient chart, and another copy sent to the Radiology files to be stored in the paper folder with the films. Another copy was sent to the people who prepared the result to send to the people who would reimburse the hospital for its work.
It was slow. It might take between a week and two weeks to get a result of a chest X-ray into the hands of a clinician for treatment.
And all kinds of things could go wrong. The developing machines could malfunction and eat the film, or break down at a crucial time and not process it correctly. Films could, and did get lost in that massive gymnasium sized room with dozens of people pulling them out and filing them in, sometimes filing them the wrong place by accident. Physicians would keep films for treatment purposes, not returning them when they should and hanging onto them. They would get completely disorganized inside the paper folders, and a lot of cussing and grousing took place when a clinician could not find that one single X-ray taken on a specific date because lazy, overworked, or people simply crazed by stress would just throw them back into the paper folder without organizing them.
Most debilitatingly, only one person could look at any film at any given time.
There might be a patient in the ICU who was having trouble breathing, and the X-ray today needed to be compared to the last several, but...the folder of films could not be found. One physician managing the neurological situation might have all the films and walked away with them to discuss them with some other neurologist, but the pulmonologist needed the chest X-ray right now.
Pagers would go off. Overhead voice pages throughout the whole hospital saying “Dr. Jones, please call extension 1234 STAT. STAT!” in an attempt to locate them. Personnel would frantically be making phone calls trying to find those films.
But sometimes, nobody actually had those films checked out. When they were re-filed in storage, someone made a mistake and filed them where they shouldn’t have been, and from that point on, were considered “lost”. We had a specialized group of film librarians, perhaps two or three who were especially talented with almost a spiritually inspired knack of tracking lost films down and finding them. They knew all the mistakes people made when filing, and could miraculously find those films.
But sometimes, they wouldn’t. And those films might be lost for days, weeks, or months. Then suddenly, a month or a year later, they would suddenly resurface when someone stumbled across them by accident looking for someone else’s film folder. And sometimes, they would never be found.
I was there for the entire transition from analog to digital. I designed the workflows and built the computer systems to integrate with those workflows which meant I had to map them out and know them from top to bottom, troubleshoot them when things didn’t work, develop workarounds when the system could not be changed or adapted to fill in a hole that was discovered that might delay care or cause harm to a patient. Near the end of my career, simply by osmosis and constant exposure, I began to more fully understand server setup, intersystems messaging, and database configuration. I learned SQL that allowed me to pull data to analyze issues and provide data to managers.
It took us many years to go to a front-to-back wholly digital, truly paperless system, and it was often very painful, as we could only do it as fast as the current technology in servers, workstations, networking and software would allow us to. And we were always waiting for technology to allow us to do what we needed to do.
Always.
Now, the clinicians order the imaging study, it is sent electronically to all of our systems in an authorized/signed status, the techologists taking the images have it show up on an electronic wordlist on their imaging device, they take the images, we track the flow so that we know where a patient is at any point in the process, with milestones (arrive in Radiology, begin the exam, end the exam, and when the final result is produced.
We have doctors today that when the result isn’t ready in under an hour from the time they enter the order, they get impatient and begin investigating to find out what the delay is. That process used to take weeks. Now, it can take minutes. And everyone can look at the images at the same time. Nurses checking the position of the line in a patient’s airway can see it while it is being read by the Radiologist, who might have another radiologist pull it up on their workstation to discuss it.
And we are using AI to help out. When the technologist looks at the digital image to ensure the quality is up to standards on a CT brain scan for suspected stroke, a copy of the images is automatically sent to an AI system which analyzes them for anything that might remotely resemble a stroke. If it finds something, it can flag the study with a key image of the brain where it sees the abnormality, and trigger a priority flag that the radiologist reading exams sees as they peruse their wordlist while, at the same time, moving the exam to the top of all exams awaiting interpretation, flagging it even more dramatically by making the entire line in the wordlist at the top turn red. Any Radiologist will see that, can stop and save whatever they are currently working on, and switch over to interpret that flagged stoke exam.
When they open it, the AI Key Image opens in a heat-mapped image that makes the abnormality obvious, and the Radiologist and go immediately to that exact spot and begin their human, in depth interpretation.
When someone is having a stroke, every second counts, and can make the difference between a full recovery and the paralysis of half of the patient’s body, or even the death of the patient. Seconds.
These are things that cannot be replicated on paper in a manual system. They simply cannot. It is impossible.
But I can tell you that we worked damn hard to develop the best downtime processes we could, but to be honest, all downtime processes, all of them, without fail, are imperfect and difficult. And when you have one of those ransomware attacks that not only takes down the ordering system, dictation system, radiology workflow system but also takes down the entire network, you CANNOT build in a level of redundancy where you can flip a switch and regain functionality.
In the real world, it simply doesn’t work that way. The best you can hope for is to have a primitive way to obtain the images, view the images, and get information to an ED physician who is treating a seriously injured patient that could potentially die. For the time being, you have to hope the system outage happens at night when there are far fewer patients rather than the middle of a busy day, where there may be thousands.
It is things like these downtimes that do make me relieved I am retired. It was extraordinarily stressful, knowing that the life of the patient, someone’s child, husband, wife, father or mother, could be hanging in the balance because the ED physician is unable to get the radiologist interpretation for whatever reason.
I was extremely lucky. I had worked both clinically and in IT, so I had the requisite blend of knowledge to do what was needed. I had a great, productive, rewarding career, and for the last 20 years of it, I worked 60 hour work weeks on salary, not hourly. I was being paid for 40 hours. I was on call 24x7. But I was blessed to work the the most amazing Radiology Informatics team. I was the oldest one. At the end, they worked hard to take things off my plate, when for so many years, everything was ON my plate, all of it.
These people I worked with, endeavored to lighten my load, and I will never, ever be able to thank them for that. THEY are what I will miss in my work.
At the end of my career, I no longer had direct patient contact. But as I walked through the clinic, I would see patients who were obviously lost and confused. It was my favorite part of the job, at the end. I could go up to them in the hallway and ask them if they needed help. Their faces would light up with genuine gratitude, and I would talk to them. If they were wearing a military hat, I would thank them and ask them about their service and what they had done, and when they were in.
But the look of unalloyed gratitude and appreciation on their faces, for something that was so easy and effortless to me, was in my mind, what I thought a dose of crack must be like for an addict. And for me, it cost me...nothing to walk a little old lady to the elevator, or some fellow to a destination in the hospital, chatting all the way.
That is what I will miss most of all from my profession. But we all move on. And now I do.
I'm in my 22nd year of retirement. Never thought I'd live this long. I was at a funeral service yesterday and ran into one of the officers I'd worked with. He had just retired as a Sergeant like me, after working 35 years. God bless him. I was old enough in 2003 to retire at 56 with 25 years when I went out. The system was bad when I left, and it's gone terribly down hill even more since then. They can't find anyone to take the Civil Service Test for the position anymore. They start Correctional Officers now, at basically the amount I retired at, as a Sergeant.
"I was there for the entire transition from analog to digital."
Some people have a problem with change. I was a long-time patient of a rheumatologist. During one of my visits I discovered that although every doctor was required to use a laptop to record visits, he didn't seem that familiar with the behavior of computers. He walked into the room, looked at the black screen on the laptop, and said "Well, that doesn't look good." I asked him what he was talking about, and he pointed to the laptop on the desk. I told him that it was just asleep, and all he had to do was touch one of the keys, and it would wake back up. I pressed down on a key, and he was delighted when the screen returned to normal. He actually thanked me for fixing his computer. Yikes! I asked him if he had a computer at home, and he said yes, so I wondered why he'd never come across his computer going to sleep on him there. It wasn't long after that, he discovered that the healthcare network he was working for, was going to be installing a new computer system, and that he'd have to take classes to learn how to use it. He was so scared of the whole thing that he retired. Never did get around to finding another rheumatologist. One less co-pay to come up with.