A Clearer View: Extending and Demonstrating Radiology’s Value
Paul Chang MDThe advent of advanced IT for health care has benefited the enterprise unevenly, according to Paul Chang, MD, medical director of enterprise imaging at the University of Chicago. While radiology has successfully leveraged cutting-edge IT to improve efficiency, other links in the care chain have lagged behind. “Around the world, many radiology departments are paperless in the reading room,” he says, “and that’s great, but that’s not where the bottleneck is anymore. Reimbursements are dropping and expectations are rising. We need to demonstrate even greater value, which is the sum of quality, efficiency, and safety.” For Alan Pitt, MD, a neuroradiologist with Southwest Neuro Imaging (Phoenix, Arizona), timeliness of reporting to other departments is a critical component of this greater value. “If I give you a correct report, but it’s three days after the patient died, I didn’t do my job,” he notes. “I want to be able to give a correct report, in time, to the correct care providers, but my interpretation largely relies on clinical context—what’s true for an 80–year-old patient might be ridiculous for a 14–year-old patient.” Pitt echoes Chang’s perspective on the necessity of extending radiology’s value. “To improve the value of imaging services both internally and externally, radiologists need to get out of the dark and in front of referrers, or risk becoming a commodity,” says Pitt. “The problem is weighing that against the work that needs to be done.” Integrating Radiology For these reasons, Chang and Pitt have focused their efforts on enhancing workflow, enabling them to spend more time collaborating with other members of the care team. Chang notes that in attempting to improve efficiency, radiologists often fail to look at the care cycle as a whole. In a recent closed-loop imaging initiative at the University of Chicago, Chang and his team decided to begin by measuring turnaround time differently: they included other clinicians. “The clock doesn’t start or end at radiology,” he says. “It starts with the physician determining imaging is needed for the management of the patient and only ends when the patient gets a collaborative message from the radiologist.” Pitt concurs; “As a neuroradiologist, I spend a lot of time doing collaborative care,” he says. “My question is, ‘How do I get critical results to the right provider at the right time.’” In pursuit of this goal, Pitt and his colleagues have begun leveraging a tool that allows providers to create and join Web-based communities and communicate with fellow community members electronically. “I want to be able to be anywhere and be able to talk to that doctor and share information—not just call them, but actually show them,” he says. “Currently, most radiologists stop the minute they hang up the phone and complete the report.” Leveraging innovative IT solutions will enable radiologists to collaborate better with their clinical colleagues—and in doing so, to demonstrate the value of their services, Pitt says. “The information I share could be anything—there’s a lot of potential,” he says. For instance, Pitt says, he could share other IT tools; he cites as an example Microsoft Amalga for PACS from Microsoft Corp (Redmond, Washington), which integrates clinical information from throughout the enterprise to provide an enriched view of patients’ needs. “We’re in a new era of collaboration,” he observes. “The ability to bring a tool like Amalga for PACS to a group of people would allow the group’s members to make a better decision than an individual would. You could bring in multiple clinicians to look at a patient’s enriched clinical dashboard and figure out what to do.” Microsoft Amalga for PACS integrates data from across the enterprise to give radiologists a clearer view of patients' complex clinical histories, enabling both better service to their fellow clinicians and improved outcomes. “The context I place a patient in influences my diagnosis, based on other clinical parameters, and tools like Microsoft Amalga for PACS would provide me with a much richer dashboard to work from,” he says. Assessing and Demonstrating Value Chang and colleagues have focused on improving imaging workflow in an oft-overlooked area—that of the technologist. Chang explains, “We found that even though we were efficient in the reading room, we were inefficient in the scanning area. A lot of IT for imaging is very reading-room centric, but the technologists need these tools, too. Our hypothesis was to apply high-level IT integration outside the reading room—including the modalities.” By writing software that does just that, the University of Chicago team has seen strong improvements in both efficiency and quality. “The result was a 67% improvement in efficiency—we went from tying up the technologist for an average of 30 minutes to an average of 10,” Chang says. By demonstrating its ability to achieve increased efficiency and cost savings, the radiology department positions itself well for an uncertain future. “Right now, we’re facing a 35% reduction in the technical fee, but I’m okay with that because I’m 70% more efficient,” he notes. "If we want to make a positive impact on value, we have to look at the whole cycle, not just what goes on in radiology or the reading room." Connecting better with patients is going to be critical in ensuring radiology’s future as a specialty, according to Pitt. He envisions a future in which online communities like those used to connect clinicians can also be used to deepen patient relationships, ultimately allowing radiologists to assess and demonstrate their value. Pitt echoes Chang’s thoughts on the significance of radiologists accessing and demonstrating their value based on outcomes. “We as radiologists evaluate our value according to quality, but not outcome—we look at how good of an image we produce rather than what the interpretation meant for the patient,” he says. By bringing together data from throughout the enterprise, he observes, “We can aggregate information for a group of patients over time, following people who get certain studies to begin to show their value. Otherwise you have no leg to stand on when your reimbursement is cut in half.” Health IT for imaging will not have reached its full potential until it enables radiologists to maintain productivity while leveraging their expertise to improve treatment planning and care delivery, Pitt concludes—and with the help of emerging IT tools that synthesize information from the entire enterprise, such as Amalga, the seemingly impossible is finally becoming a reality. “The radiologist should be a part of the care team, but the problem has been that being part of the team is very inefficient,” he says. “We need a sustainable business model. From what I’ve seen, products like these are the future.” Cat Vasko is editor of ImagingBiz.com and associate editor of Radiology Business Journal.