Three views: What constitutes quality in radiology?

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Judging by the passion of the presenters at the 2014 RSNA meeting in Chicago, measuring quality in radiology is no mere academic pursuit.

A day-ending session on that topic at radiology’s gargantuan annual gathering produced many points of light—and more than a few provocative points to ponder. Here are excerpts from each of the three talks.

Paul E. Berger, MD, chairman, Partners in the Imaging Enterprise, LLC, and former founder/CEO, NightHawk Radiology Services:

The future of radiology is very bright; I don’t think there’s any question about that. What’s in question is the future of radiologists.

Some folks are going to think I’m just a paranoid old guy who feels that the world is coming to an end. We had a great ride and we’re going to ride the horse until it drops. There are major disruptive changes in healthcare on the horizon and unless we understand them and respond, I think personally that our future profession is in jeopardy. That may be scary to some, but I think it’s reality. So although I don’t mean to scare you, I need to scare you.

Despite how much we love what we’re doing and how important it really is, we are no longer the center of the universe. We are no longer the doctors’ doctor. One of our roles [now] is to make certain that we recapture that title, the doctors’ doctor.

Population health turns the economics of healthcare system absolutely on its head. Our current system is basically a sickness system. When somebody gets sick, we benefit. In the world of population health, we’re paid a sum of money and with that money we’ve got to do what’s best for the patient because every resource we use comes out of that pool of money that we get at the beginning of the year. There’s an opportunity for [provider] systems to make a ton of money, because there’s a lot of waste in the system. If we save just 5% of what we’re spending, 5% of [the] $2.67 trillion [in U.S. healthcare spending] is a chunk of change for people to split up.

What is quality? How do you measure it? We need to have standards that are clearly defined, meaningful and measurable. A simple turnaround time is something we’ve been using for a few years now. It’s easy to do; you put in voice recognition and voilà. You’ve improved your turnaround times. But there are so many more things that go into quality. The only true measures of quality are the outcomes that matter to patients. That’s what our focus has to be. With respect to radiology, what does the patient think about quality? The patient would like you to make a rapid and accurate diagnosis. The patient would hope that you did that safely. They would like to know if they had any way of understanding that the radiation dose they got was not too high. Were they treated with compassion and good communications? Were they satisfied with the whole process, and was there a positive outcome?

The future is being defined by a limited number of integrated delivery networks, IDM’s. There is consolidation everywhere. Big-time consolidation. Big, powerful systems are being swooped up by other systems, larger and smaller. Consolidation is massive and the systems will rule the world. They will decide how things are going to go. And it’s going to be up to them to develop this integrated, fully articulated network that really works. And we have the potential to have a major role in that opportunity.

Radiology’s role as I see it in the leadership is to understand how to best align our interests with the success of those IDM’s. If we can demonstrate that we provide quality in a meaningful, measurable way—and the costs to do that are reasonable and appropriate and within the range that they would anticipate—we’re going to be the winners.

Our goal is to again become the doctors’ doctor. If we focus on what our capabilities are, we can do that.

Paul J. Chang, MD, professor and vice chair of radiology informatics, medical director of pathology informatics at the University of Chicago:

Quality—whatever that means—basically is about trying to achieve efficient, measurable improvements in whatever you deem worthy of achieving. Business intelligence analytics, BIA, is the critical, absolutely essential enabling tool. I apologize if this is boring, but it is critical. It’s not enough to do the right thing; you have to prove that you are doing the right thing.

Quality with inefficiency is a nonstarter to my CFO. Efficiency with quality—hey, good days. Got the difference? Don’t throw people at your problems. The widgets,