Future of Diagnostic Imaging
Americans receive twice as many MRIs and CT tests — 100 and 265 each year respectively for every 1,000 people — than the average in other countries that are members of the Organization for Economic Cooperation and Development. But extra tests aren’t benefiting patients. Despite spending 18 percent of the U.S. Gross Domestic Product on healthcare, Americans have shorter life spans than citizens of our peer countries.
Individual radiologists may feel like reducing the number of studies their healthcare organization undertakes is beyond their power — how can one practitioner make a difference? There are concrete ways that radiologists and leaders can collaborate to make a difference by working toward value-based care in medical imaging.
For radiologists, much of their hard work goes unseen. For example, take a radiologist who pulls up a dozen images from the vendor neutral archive, carefully compares a number of studies from one patient, goes into the RIS and makes notations about findings, and then documents a number of specific details for the final report. Details noted might include a specific or differential diagnosis, impressions, and other information that will be sent to the referring physician and synched to the patient’s EHR. “When we start with exquisite renderings of anatomy and hypersensitive recognition of physiology, how is it that the product we deliver to the world is often just words on a page?” asked Geraldine McGinty, M.D., in a post on her blog. The lack of visibility of radiologists’ work is one reason that radiologists have been speaking for some time about how to make the value of their work more apparent to the public, and why the ACR launched its Imaging 3.0 initiative last year. As best-selling author John Maxwell said, “A leader is one who knows the way, goes the way, and shows the way.” In the initiative, the ACR called on radiologists to take the lead in enterprise medical imaging and value-based care initiatives. Let’s follow up on the Imaging 3.0 conversation as it is today.
Enterprise Imaging: Is it Possible to Achieve Data Liquidity While Balancing Cost, Access and Quality? Or, What Does this Napkin Drawing Mean to Your Radiology Practice?
Recently, McKesson sponsored a webinar featuring Applied Radiology Editorial Advisory Board member, Dr. Rasu B Shrestha, MD, MBA. The discussion focused on finding the right balance between the increasing pressures of efficiency, quality of patient care and healthcare data management; and how these are the challenges that enterprise medical imaging now faces. With a renewed focus on a holistic, patient-centric approach to care in medical imaging, the true “value” generated by imaging should then rightfully equate to the summation of superior outcomes, patient-centered care, and efficiency at lower costs.
The pressure on hospitals continues to build as CMS payments decrease, special payments like tax breaks and incentive funding expire, and utilization declines. To survive, many large hospitals have merged with smaller ones in an effort to maintain operating profits through asset consolidation. Other hospitals are expanding vertically, purchasing ambulatory care facilities, home care agencies, and free-standing dialysis clinics. Some are doing both.
In the midst of all this change, plus repeated cost-reduction directives, medical imaging executives are seeking guidance. Specifically, they’re asking: What is the role of imaging in a consolidated environment and/or one that involves care across multiple settings?
Diagnostic imaging departments were once driving straight on a fairly smooth road. In the last few years, the Affordable Care Act has caused some significant bumps and now with the shift to value-based care, even more rough road may be ahead. Some imaging executives will choose small adjustments, akin to buying larger tires to accommodate the rough surface. We think a sharp turn toward quality care is by far the better choice.
Game of Thrones® fans are widely anticipating the start of the series’ fourth season. Despite the intrigue, back stabbing, and the fact that the bad guys seem to keep winning, there are five ways that enterprise medical imaging is like this hit series — minus the armor, sword fighting and torment .
Radiologists face commoditization as population health management demands innovation across the care continuum unless they become more involved in patient-centered care. The editors of ImagingBiz focused on four issues that shaped medical imaging last year and demonstrate how radiology departments and radiologists are adapting to new technology, regulation and business risk in ways that allow them to continue to provide high-quality care.
1. Is there a future-proof approach to implementing enterprise imaging?
McKesson customer Methodist Le Bonheur Healthcare (MLH), a Memphis, Tennessee-based health care system of eight hospitals, found both its general PACS and cardiology PACS aging past viability at the same time, raising an interesting question: Was the organization prepared to explore an integrated enterprise medical imaging platform and vendor-neutral archive (VNA)?
Radiologists need to be better gatekeepers and medical imaging consultants. At least that’s what David C. Levin, MD is saying. Dr. Levin is professor emeritus of radiology and founder of the Center for Research on Utilization of Imaging Services (CRUISE) at Thomas Jefferson University Hospital in Philadelphia. He argues that radiologists need to take a more active role in assessing the appropriateness of medical imaging requests, instead of just automatically going ahead and doing the study.
“If there’s a request for an exam that isn’t the right one for the patient’s clinical condition, a radiologist should call the referring doctor and get it changed.”
The use of computerized tomography (CT) has become a concern for doctors and parents of small children because this type of medical imaging exam requires higher doses of radiation. The good news is that new medical imaging software, developed and currently in use only at Cincinnati Children’s Hospital Medical Center, allows doctors to more tightly control radiation doses.
The medical imaging software mathematically determines the lowest possible radiation dose for the patient before a scan is performed, according to David Larson, MD, Radiology Quality and Safety Director at the medical center and principal architect of the technology. Two studies were published recently in the journal Radiology and reported on in ScienceDaily.com, regarding this new technology which showed a 37 percent reduction of radiation exposure from CT scans in children.
Written reports and most of a patient’s medical imaging files will now be available to them at the Cleveland Clinic where they are making electronic medical records (EMRs) far more transparent and accessible online.
MyChart, Cleveland Clinic’s online patient portal, offers patients access to the text portion of their medical imaging report, after-visit summary, medications list, allergies, immunization records, preventive care details and laboratory results. Other medical imaging reports such as MRI, mammogram and ultrasound are being released at the discretion of the ordering physician. The actual medical images are not transmitted through MyChart at this time.