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.

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