Better IT needed for radiology's big changes ahead

POSTED IN: Quality and Safety, RIS and PACS, Policy and Legislation

Healthcare IT takes center stage at the Radiological Society of North America’s 98th Scientific Assembly and Annual Meeting this year, with two plenary sessions devoted to meaningful use and health IT.

The sessions are slated back to back on Monday, Nov. 26 in the Arie Crown Theater – Lakeside at McCormick Place. Keith J. Dreyer, DO, and Paul J. Chang, MD, will deliver Eugene P. Pendergrass New Horizons Lectures. Dreyer’s is titled The Future of Imaging Informatics—Meaningful Use and Beyond, Chang’s Meaningful IT Innovation to Support the Radiology Value Proposition.

Healthcare IT News spoke with Chang about his lecture and his vision for the future of radiology. He talked about why radiology will have to re-engineer itself in order to be relevant in a fast-changing healthcare realm.

Q. What do you hope to convey to your colleagues with this lecture?
A. The take-home message is primarily that medicine as a whole – and radiology in particular – is going trough significant change. Certain models that we have taken for granted are drastically changing. Fee-for-service, for example, is probably a model that is going to way newer delivery models, such as accountable care organizations. There are significantly increased pressures – challenges as well as opportunities – for radiology.

We’re kind of stuck between the demand for added value and added efficiency, but also there is a risk of peripheralization and commoditization. It used to be that radiology aligned itself quite effectively from a financial perspective with the hospital because the better we did, the better the hospital did. In a fee-for-service model where you get paid for doing more, radiology did quite well. Now the question is how are we going to demonstrate our value when the rules have changed? How do we re-engineer ourselves to be contributory, and to be relevant and to add value – differentiable value – in a capitated environment? We’re going to have to re-engineer ourselves and understand that the rules have changed.

Q. How do you go about re-engineering radiology?
A. I know of no other way of doing this but leveraging informatics and IT. To me the value proposition in imaging is a function of quality, efficiency and safety, and we have to do all three simultaneously. The only way we can do that is leveraging IT, and this is the second take-home message. We unfortunately have become complacent with respect to IT in imaging. We think that PACS is a solved problem. I would maintain that it’s the immaturity of our IT products, our informatics solutions radiology that actually have contributed to the commoditization of radiology. The immaturity of these IT products actually only allows me to show commodity level performance. We need to expect more from IT. We have to leverage IT and expect more.

Q. How?
A. There are four major things we need to do with respect to IT:

1. Workflow: We need a quantum jump in advancing workflow to support differential value. We no longer just have to deal with report turnaround time; we need to have advanced workflow from an enterprise perspective that demonstrates and provides what I call ‘aligned value.’ The whole concept of accountable care organization is the concept of alignment. We’re going to be capitated. We’re going to be paid x-amount of money for the entire institution, and then we’re going to have to carve that up. We have to decide what is the relative value of radiology, pathology, surgery, medicine and all of this in this capitated environment. There is no question that whatever I do as part of this aligned entity to improve efficiency, quality and safety, not only just to me and radiology, but my aligned partners, both up and downstream is a good thing for radiology. It’s easy to outsource me if I’m just a commodity. It’s very hard to outsource me or replace me if I am viewed as irreplaceable to the institution because what I do with my workflow improves their efficiency too. Whatever I do has to improve the efficiency through all the enterprise.

2. Collaboration: We need to have comprehensive collaboration. In order to demonstrate our value, we have to go beyond just the phone call and the report. For decades, that is all we had – a report and a phone call. My kids have 20 ways to talk to their friends – from Skype to Twitter to Facebook to e-mail to SMS. My kids can intelligently articulate why one messaging mechanism is different from the other. And, yet, we are stuck with the phone call and the report. In the beginning websites were just sites where we got information, much like our reports. Websites aren’t that anymore. Websites are actually interactive portals that provide more than just a static review of content, but rather are adaptive to the needs of the consumer. We need to think in terms not of report, but of collaborative portal.

3. Business intelligence analytics: This is where we’re really behind the curve. In every other business vertical, you cannot improve a process unless you measure the process. You have to have deep business analytics, deep business intelligence. We’re no longer going to get paid or valued by simply interpreting images, which is how we were in the fee-for-service day. We’re now going to be valued and indirectly or directly paid for managing the role of imaging in a capitated environment. In order to do that, we need to provide evidence to demonstrate our value. That means we need quantitative evidence. If we’re going to build a business intelligence analytics infrastructure, we want to be irreplaceable to the whole enterprise. We want to link what we do to outcome. The comparative effectiveness research, all those kinds of things that people are doing, the questions have to do beyond what we do in radiology. It’s no longer analytics to make ourselves more efficient. It’s analytics to demonstrate the value of imaging in controlling costs and improving outcomes in a capitated environment.

4. Connection: We have to connect with the health consumer. Our patients are no longer passive patients. They are discriminating health consumers who have information at the speed of light. Part of the reason we’ve been peripheralized is that many of us don’t have that relationship with patients. We need to embrace IT, using collaborative portals to connect with the health consumer directly so we can demonstrate and educate our differential value.

Q. Are you feeling positive about the likelihood that the changes you envision will occur?
A. A lot of radiologists, especially radiologists with gray hair – my age – are freaking out. They think the world is ending. I’m not freaking out, and I’ll tell you why because actually the abnormal time was before. Now we’re like any other market. You’re going to have winners, and you’re going to have losers. I don’t mean you’re going to have radiologists with signs: "Will read films for food." The traditional expectation of what a radiologist’s life was is going to change – I actually think, potentially for the better. For people who understand and embrace this, they are going to be huge opportunities to win. Before, everyone kind of won. Now you’re going to have winners – big winners, I think – and big losers. So to me it’s an exciting time, certainly for someone like me who’s interested in informatics and IT and value proposition and re-engineering processes. This is an opportunity for people to really differentiate themselves.

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