Mandate for imaging informatics: Build radiology’s IT value platform

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 - Kevin W. McEnery, MD
Kevin W. McEnery, MD Diagnostic Radiologist; Director, Innovation in Imaging Informatics, MD Anderson Cancer Center, Houston

Give it up, buy in and figure it out. In short, that was the message from Kevin McEnery, MD, to his fellow informaticists at the recent meeting of the Society for Imaging Informatics in Medicine (SIIM), Inner Harbor, Maryland.

Let go of past practice patterns, embrace ACR’s Imaging 3.0 vision of the future, roll up your sleeves and help create radiology’s IT value platform, urged the director of innovation in imaging informatics, department of radiology, MD Anderson Cancer Center, Houston, Texas.   It is not SIIM’s role to set policy, but it is SIIM’s role to implement and change radiology through IT systems,” he asserted.

To date, everything that informaticists have done is to create “more stuff,” McEnery contended, but the game is changing and so must imaging informatics. “Radiologists are not going to be asking how fast you can get images from the scanner, they are going to be asking, ‘How can I add value to our practice?’” he noted.  “That is our charge, that is what we need to be working on.”

In an unsettling analogy, McEnery compared radiology and its transition to value-based payment models to the Apollo 13 mission—one in which failure is not an option. “I would argue that Apollo 13 has left the Launchpad, and something catastrophic is going to happen,” he said. “This is going to be a very stressful time, but stress is an opportunity to move things along, predict where the puck is going to be and actually thrive in this environment. I think we can thrive, but we have to do this together.”

Moving the puck

Reciting Michael Porter’s by-now-familiar equation for creating value in healthcare, McEnery said that achieving outcomes at the lowest possible cost is the yardstick by which all innovation heretofore will be measured. “It’s a really difficult process to determine the outcomes (in radiology), but I think this is our charter,” he advised. “We have to stop worrying about metrics of volume and revenue focus, and how how thin the CT slices are—that doesn’t matter if it doesn’t change what the ordering doctor is going to do.”

Apollo 13 Reading List

Kevin McEnery, MD, director, Innovation in Imaging Informatics, MD Anderson Cancer Center, Radiology Department, recommends two must-read publications for imaging informaticists as they leave the Launchpad on the way to value-based payment.

  1. Porter M, Lee TH. The Strategy That Will Fix Healthcare. Harvard Business Review. October 2013.
  2. Kruskal JB, Sarwar A. An introduction to basic quality metrics for practicing radiologists. JACR. 2015;12(4):330-332

McEnery did not imply that state-of-the-art technology has no place in value creation. “We better be able to prove that those fancy CT scanners and MR scanners add value,” he said. “I think we can, but we have to move the puck.”

Assessing the lay of the land, he attributed the fast pace of consolidation in the hospital market to the need to develop centers of excellence for care delivery. In order for radiology to participate in that activity, its IT systems and infrastructure must be aligned.

“The strategy involves, at its baseline, informatics,” he said. “We’ve thrived in this environment, we moved radiology from film to filmless; we did that, it’s done. But we have to keep on moving the puck.”

The value IT platform

What will radiology’s new value IT platform look like? Radiology must work with IT vendors to create a new IT platform that is centered on the patient and provides radiologists access to all of the patient data that drives the care process.

The platform must be built on common data definitions, templates and structured reporting. While building this platform, IT professionals must ask themselves the following questions:

  • Are you providing the IT systems that allow radiologists to be consultants?
  • Are they patient centric?
  • Do your IT systems improve the patient experience?
  • Are your IT systems integral to the patient’s care?
  • Are they accountable?

“It’s about the entire process of taking care of the patient,” he said. “It’s the order, the protocols we create, the acquisition that’s done at the scanners, the interpretation which leads to the report, which leads to another order or a better outcome for the patient.”

Above all, the patient must become the central concern. Orders must be appropriate for the patient’s presentation and optimized to inform the clinical decision process. Acquisitions must be optimized to deliver a dose that is adequate for the diagnosis and the age and condition of the patient. Reports