Commodifiable Me: A First-person Account of the Virtues of Imaging Informatics

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The Argonauts (and Odysseus, after them) had to sail past rocky islands housing the enchanting Sirens. Their wonderful songs made sailors hurl themselves overboard and swim toward them, even as they died upon the jagged rocks. After my fifth birthday, however, I accepted that plugging my ears never makes bad news go away for long. Can I stop myself from being successfully and wholly commodified? Commodification has pierced our daily workflow: Requests for imaging studies are automated through computerized provider order entry, yet scrutinized at different levels for appropriateness. Protocols are standardized for problem sets, but customized for specific patients. Postprocessing offers an array of presentation displays, yet not all displays are used by all radiologists completing final reports. With standardized reporting, streamlined workflow, and cloud technology, we risk losing value differentials between our work products. Equivalent work products necessarily imply equivalent work producers—and the lowest bidder wins. The injection of informatics into diagnostic imaging implies our willingness to accept a matrix of threats that might ultimately make us expendable. With ubiquitous connectivity, we see empowered consumers taking ownership of their health care, changing the market into one that is both patient centered and patient driven. The Plain Truth Many imaging clinics and health-care enterprises have successfully integrated data-intensive and technology-driven informatics into their workflow in the past decade. Examples include PACS, the electronic medical record (EMR), the RIS, hospital information systems, and telemedicine (including teleradiology) systems. The ubiquity of teleradiology has accelerated the commodification of the radiological consultant—while improving health-care access and expediting patient care. Initially touted as a time-shifting solution for consultant radiologists, teleradiology metamorphosed into a burgeoning market boasting connectivity between specialist providers and specialist consultant radiologists. Increased competition (with reduced reimbursement and the rise of radiology benefit managers) sparked price wars that led to the rise of predatory teleradiology companies. As consultant radiologists, we need to take concrete steps to correct the total commodification of our role as consultants. This is not an insuperable goal: We need to innovate and to favor process over results, at least initially. Innovative changes might or might not affect existing market conditions. Many disruptive innovations in informatics are a combination of evolutionary (made in response to customer needs) and radical (unexpected and extreme). An evolutionary change, for example, would be diagnostic decision support for image interpretation. This requires active engagement of the interpreting consultant radiologist in the EMR. At our facilities, we have embarked on offering further guidance (for studies requested by nonspecialist providers) by recommending surveillance studies at the evidence-based intervals recommended by central bodies. An example of a radical change would be the codification and distribution of appropriateness criteria for studies, especially high-ticket exams. This necessarily mandates interspecialty collaboration. We have successfully implemented diagnostic pathways for stroke and for right upper-quadrant disease (with corresponding correction of the use of multiple studies). Work also is ongoing to reduce the use of studies that employ ionizing radiation in children. This project uses collaboration with providers to choose alternative (or no) tests, along with collaboration with vendors to apply dose-reducing strategies. Here to Serve The RSNA has initiated a comprehensive response to the challenge of patient-centered practice by launching the Radiology Cares campaign.¹ Its mission is to facilitate our meaningful engagement in the patient experience. Disruptive informatics: Use Web-based technology to permit patients online access to schedule, cancel, reschedule, and check in for imaging encounters. Enable patients to receive (on their authenticated smartphones) impressions of final reports—within 24 hours of the appointment—for any study. Continuous enhancement of online offerings keeps the customer base excited. Tip: Several patients with chronic illness, or otherwise in need of recurring appointments for similar imaging encounters, will be early adopters. They will be particularly