Bringing New Paradigms in Radiology Practices

By Shannon Werb, CIO, Virtual Radiologic

Shannon Werb, CIO, Virtual Radiologic

Challenges for the Current Industry

Radiology is typically thought of as one of the more innovative and technology enabled specialties. However, on the whole, we have been slow to think how to move beyond technology as a way to drive new levels of efficiency, quality and value. When radiology considers how to evolve in healthcare’s uncertain environment, many ask, “What technology will ‘fix’ our practice (or service line)?” But it is the wrong question because technology alone is not the answer. Technology has been radiology’s crutch for way too long.

"Technology alone will not help radiology practices be more efficient, nor will it help a group deliver complete radiology services within a hospital or across a health system"

Technology must inform a solution that is defined by the right questions, such as “What outcomes are we preparing for?” and “What problems are we trying to solve?” and “What do we want to look like when we are successful?” These questions must start with “What data is required to provide the insight we need?”

We spend a lot of time helping clients understand the need to develop an operating plan–or figuring out the “Why” before moving to the “How.” For example, installing a new enterprise solution may address a set of immediate symptoms; it does not necessarily cure long-term needs, nor address quality outcomes. In fact, it can create a new set of challenges for the organization if not done as part of an operating plan. Technology alone will not help radiology practices be more efficient, nor will it help a group deliver complete radiology services within a hospital or across a health system.

vRad’s technology solutions empower our physicians and our practice because they are developed in partnership between IT and medical leadership. The operational and clinical teams work collaboratively to understand the “Whats” and “Whys”— resulting in tangible benefits for our clients and patients. At the top of my wish list would be for other technology providers to include input from frontline clinicians to solve real-life challenges vs. expensive hardware and software combinations looking for a problem to solve. Such collaborations start by asking the right questions together.

Beyond a new approach to solution development through operational and clinical collaboration, my wish list would include a focused effort to protect radiology from the increasing occurrence and scale of cyber security incidents. No longer are we seeing simple hackers or basic hack attacks. Today’s incidents are well orchestrated, well financed and often foreign based— and target ill-prepared end users within healthcare organizations. This isn’t just a technology challenge; it will require cultural changes within the organization.

Medical records now carry an estimated value of 20x more than credit card numbers. The challenge will only get bigger—and technology providers can’t wish it away. It’s no longer a question of “if ” a cyberattack will happen, but rather “when”—and how severe it will be. Technology partners must help lead the charge on how to reduce risk and impact to healthcare providers and patients.

360 Degree View of Customers

Healthcare organizations must integrate data across the enterprise—but it must be the right data. By that I mean normalized data. Many perceive radiology lacking value beyond its function as a diagnostic tool because they do not understand the potential value of the clinical insight that can be gained from patient and imaging records.

Healthcare organizations continually struggle to hold back the flood of complex clinical data. Measuring radiology quality in any practical manner within this information overload—that is finding, gathering and using the best data to change or improve radiology processes—is extremely challenging. vRad learned this first hand as a result of our broad national scale integrating a myriad of different vendor products. We could not use this large pool of nonnormalized data to develop meaningful benchmarks and metrics to measure what was happening within our practice.

We had to normalize that data so that we had one accepted “gold standard” with which to analyze and compare data from multiple hospitals and other healthcare facilities. All facilities must speak the same “dialect” of radiology in order to aggregate and define metrics and benchmarks.

Data normalization is one of the largest challenges facing radiology today. One hospital’s “ultrasound gall bladder,” is another hospital’s “ultrasound right upper quadrant” or “ultrasound liver.” Normalization is at the core of making radiology analytics a reality and insight possible. It was vital for vRad to develop the granularity and flexibility required for index creation and metrics comparisons.

After developing tools with which to normalize data across thousands of client facilities, were we able to create analytics solutions to manage our own clinical, financial and operational practices. These tools are also being leveraged by our partners— radiology groups and hospital imaging departments. They allow data from client facilities to “speak the same language” so that metrics can be established and objective comparisons made (i.e., benchmarking).

Getting data right is extremely important, especially as our healthcare system moves from fee-for-service to a pay-for-performance/value-based reimbursement model. That means imaging departments and private or hospital-based radiology groups will need to measure performance like never before.

Creating Competitive Edge

There are three types of technology that can give radiology a competitive edge:

1. As noted earlier, technology that allows radiology to aggregate, normalize, and understand data that can provide actionable insight into a healthcare population or operations (clinical, financial and business).

2. Technology that enables the aggregation of a complete patient/ clinical record at the point of care. This is more difficult than many realize. Healthcare systems function with numerous silos of information, and even with electronic health records, there is not a single source of truth for a patient. Truly innovative technology would provide clinicians with a set of aggregated clinical and longitudinal information (from the silos) about a patient at the point of care. This would be available to a radiologist as the exam is being interpreted and would include past studies, physicians’ notes, pathology reports—any data that helps a radiologist make the best diagnosis possible.

3. Workflow technology that provides true efficiency to the specialist. In radiology, this includes capabilities such as automatically pre-fetching prior exams, making prior reports available (in multiple formats), automating the placement of objective information to the report, automating and structuring report output, and eliminating administrative burdens—such as the process of calling in significant or critical findings—all saving the radiologist time and effort, which allows them to focus on being a doctor and providing better patient care.