Postcards from the imaging informatics road. Despite policy complexities, diagnostic imaging informatics makes progress on multiple fronts.

The current strategic landscape for imaging informatics is one filled with great contrasts and paradoxes. On the one hand, because imaging informatics was not explicitly addressed in Stage 1 of the meaningful use requirements under the American Recovery and Reinvestment Act/Health Information Technology for Economic and Clinical Health Act (ARRA-HITECH) legislation, it instantly lost some of the environment of turbo-charged energy characterized by areas that were directly addressed by the HITECH Act, such as quality data reporting, care management, and of course, core electronic health record (EHR) development. On the other hand, an interesting combination of factors--rapidly advancing technology, the expansion of the image archiving concept across different medical specialties, and the inclusion of diagnostic image-sharing as one element in the development of health information exchange (HIE) arrangements nationwide--is nonetheless pushing imaging informatics forward towards new innovations. The five articles below provide readers with different glimpses of the path ahead for imaging informatics. The first presents a look at the current policy and reimbursement landscape. Each of the four subsequent articles delve into different aspects of innovation, from a process developed at a public hospital to improve and speed up the diagnostic process for trauma patients, to a radiology-specific financial analytics solution in the group practice setting, to an advance in cardiology information systems, to a self-developed federated image viewing platform at one of the nation's largest integrated health systems. Each of those initiatives is very different; yet it is clear that a great deal of innovation is taking place across the US. healthcare system when it comes to imaging informatics. With a landscape filled with uncertainties and potential policy, reimbursement, and industry shifts in the offing, CIOs, CMIOs, and other healthcare IT leaders will need to think very strategically where this critical area fits into their organizations' overall clinical IT strategies going forward.