Gaming. Hardly the technology that would normally be associated with radiology and imaging informatics, the design thinking and immersive experiences provided by games have the potential to change workflows within the radiology profession. From changing how developers think about systems to engaging with radiologists in their busy lives, gaming has the potential to enhance imaging informatics and improve results.
At the Radiological Society of North America (RSNA) 105th Scientific Assembly and Annual Meeting that took place towards the end of 2019, the use of gaming in imaging informatics and radiology was discussed by Elad Walach, the CEO of Aidoc; Dr. Irena Tocino, vice-chair of imaging informatics at New Haven Health, CT; and Dr. Paul Chang, professor and vice-chair of the Department of Radiology at the University of Chicago. Their discussion focused on the core elements of artificial intelligence (AI) in radiology as well as on how gaming can be used to enhance workflow and improve results.
Workflow integration can mean two very different things – how it works within PACS and how it works within the workplace. What’s interesting is clinical workflow integration and how this has been influenced by gaming. At the end of the day, the workflow has to be used constantly by radiologists and one very important question worth asking is how gaming can be used in real-world scenarios to enhance the implementation of AI.
“When we designed the Philips PACS center, we ensured that it was contextually aware, that it didn’t have a lot of widgets and buttons,” says Chang. “We learned this from gaming. The reality is that when you use the EMR, it’s something you have to do, it’s your job. Gaming is a choice and the experience has to be seamless, engaging. In order to enhance the user experience for the radiologist, then, you need to design a platform that’s usable. When we were developing the center, we closed the lab and I forced all of my developers to play video games.”
The team purchased the games, played them for 15 minutes, understood the informatics principles and then would use this understanding to reshape design within radiology workflows. The reason? For Chang, it’s because the best usability and interfaces are built into video games because they have to be usable and interesting. Their success lies in their ability to engage the user – purchasing and investing time into a game is a choice. If the interface is poorly designed, nobody will play the game.
“These principles embedded within video games are important, they are an orchestration of technology and capability that gets results,” says Chang. “Their presentation state is designed to harmoniously orchestrate and push a particular world view or workflow model. Now, as a radiologist, this is something that I would want to experience in my own workflows. When a startup starts talking about capability, I get worried. Solutions should be about more than just capability.”
The truth is that any potentially transformative technology is going to grow and evolve as it matures. Capability is great, but this is not what’s going to differentiate a system from another. What will make a solution stand out is its ability to deliver a workflow orchestration that’s harmonious and fits in with the way professional radiologists work. It has to be agile; it has to solve problems while engaging users, not alienating them with additional learning curves and complexities.
“No one size fits all, people are idiosyncratic with different workflows and approaches,” says Chang. “Companies need to understand that technology isn’t the only part of the process, it shouldn’t be what sits front and center. It has to orchestrate workflow just like a video game. Video games don’t separate the capability from the experience. You don’t sit and play a game and think, ‘Oh, wow, this is harmoniously integrated’.”
The algorithms will change, the technology will adapt and evolve, the capability will shift in alignment with market, demand, and need. These factors will constantly be in flux throughout any solution lifecycle but without the gamification of the user experience, the solution will create friction. There have to be user-friendly, engaging and immersive design features that allow for improved and individualistic usage of system and workflow integration.
“You take a radiologist, a data scientist and an entrepreneur and you put them in the room and they’re all smart, they’re all creating something new and intelligent,” says Chang. “But are they creating something that listens to the user?”
Dr Tocino adds: “I don’t care how sensitive it is, what I want is the company to think in three dimensions. Deploy the algorithms, do the technology, but work with us so that the algorithms are deployed with common sense and are evidence-based. Take the different elements into consideration and make the experience seamless so that I don’t even know it’s there.”
For Tocino, it’s essential that any new implementation or innovation within the imaging informatics space be developed with design thinking and relevance in mind. It has to be more than just another toy, another idea, but something that can do what it says on the tin in a way that transforms usage and workflow. It’s about reducing the friction felt by practitioners, removing the widgets and the buttons and replacing them with simple and accessible tools.
Gaming is a choice. It’s also powered by that choice in terms of innovation and engagement. Games are played by radiologists, by specialists, by IT guys and by sales clerks. It’s not a niche group anymore because it’s immersive and captivating. So, make it a choice for the radiologist. Let the systems that leverage the new technologies tug on the design thinking of games to create solutions that make workflows interesting and individualistic.
“Make it do what it’s meant to do, make it interesting, but don’t make it an annoyance,” says Tocino.
For Chang, it’s the user experience. “What are you playing? What did you choose? That’s the freedom of gaming. With your EMR that’s your job. Now we need to make the latter the same as the former because it will tug out the unwieldy elements to create experiences that get results,” he concludes.
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