Scott Seidelmann is the founder and CEO of Candescent Health, a health IT startup based out of Boston. He was previously the founder, CEO, and president of Radisphere, and he co-founded RIS Logic, a radiology software company acquired by Merge Healthcare in 2003.

Seidelmann grew up with a deep appreciation of radiology because his father, Frank Seidelmann, DO, was, and still is, a radiologist.

Seidelmann spoke with RadiologyBusiness.com via telephone, providing insight into the current state of radiology and addressing some of the industry’s current challenges.

RadiologyBusiness.com: What are some ways you have seen radiology change over the years as a result of the current shift from volume to value?

Scott Seidelmann: The shift from volume to value—we thought about it a lot at Radisphere, we think about it a lot today at Candescent Health, and our customers are starting to think about it, but I think the short version is that it hasn’t had any impact on radiology yet.

When you talk with at-risk providers today, they’re appropriately focused on the impact of their primary-care models at managing value, behavioral health, and some of the high-impact areas. I think they’ll get to radiology, but I don’t really think we’ve seen any impact in radiology yet from this shift.

Now, I think the risk for radiology is that, as I spent time speaking with at-risk providers, there really is no awareness, engagement, or interest in engaging radiology in terms of the healthcare value equation. I think the scariest words for a radiologist from a value basis are, “contract under the cap,” which means when healthcare systems are capitated, unlike their primary care physicians and other physicians they believe can exert significant impact on the cost and quality of their care, they are thinking of radiologists as a fee-for-service service line. I think that’s incredibly dangerous for radiology and incredibly misguided, but I do think that’s the biggest risk.

I’ve spoken with radiologists who expressed concern about demonstrating their value as radiologists. Is there a reason to be worried?

It’s a huge problem. There hasn’t been enough research on it. There certainly hasn’t been enough operational experimentation. We say this all the time: Look, $70-100 billion is spent in this country a year on direct radiology spending. The point isn’t whether or not it’s $100 billion or $80 billion or $70 billion. The point is, what’s the impact of the $100 billion on the other $2 trillion?

If we can’t demonstrate the return on investment, if we can’t justify what the return of investment is on imaging, then when the clinician is at risk, they will use less and less of it. And that’s unfortunate.

What does it take to be successful as an entrepreneur in healthcare?

The reason healthcare is so exciting is that the problems are big, there are lots of problems, and they are massively impactful. The exciting thing for an entrepreneur in healthcare is that you can solve some really big problems and have a big impact, not only on people’s lives, but on the cost of care delivery, which is important to society, etc.

The corresponding challenge of that is that healthcare is unbelievably hard to change. There are layers and layers—whether it is regulatory, reimbursement, cultural, political, institutional, sheer inertia of an industry that has functioned this way for 100 years—it is very, very hard to change.

So to be an entrepreneur in this space that—forget being successful, that maintains their sanity—I think you have to be incredibly resilient, you have to be willing to change and be flexible, you have to be intellectually nimble. I think that’s the challenge of healthcare.

Are there any big issues facing radiologists today that you don't think are getting enough attention?

It touches back to the first point we were talking about: this crossroads radiology is at. I think what we’ve forgotten is that the radiologist is a position that is massively overwhelmed from all the various systems, the body of knowledge, the nonstop amount of work coming, and, frankly, the risks.

At the end of the day, these are people that got into the field because they wanted to diagnose problems and they wanted to do it in the front end of the care continuum. That’s what they wanted to practice. You speak to radiologists today, and they’re not doing that all day long. They’re spending a huge percentage of time doing things they shouldn’t be doing.

These are individuals who drive an enormous amount of value, and we need to use them appropriately.

When you mention “things they shouldn’t be doing,” do you mean red tape and changing regulations?

Yeah, exactly. You sit down in the most sophisticated radiology departments in the United States, and the average radiologist is chasing information in RIS, reading things off the PACS, trying to chase information in the voice recognition system, trying to root around in the EMR, and they have post-it notes of people they were supposed to call or call back ... we’re not talking about an elegant environment befitting of an incredibly and profoundly trained knowledge worker. That’s unfortunate. That’s wasted opportunity, that’s burnout, that’s fatigue.

Note: this text was edited for clarity and space.