Chang: How radiology can compete in an Ebay world

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As radiology slips further toward commoditization, providers need to find ways to add value to their services using health IT, which means improving the translation of medical imaging IT innovations from the research lab to the clinical environment, according to Paul J. Chang, MD, medical director, enterprise imaging, at University of Chicago Hospitals.

“The question then is, is radiology a commodity—toilet paper, toothpaste, undifferentiated assets—or a value provider?” Chang asked the audience listening to his presentation during a Society for Imaging Informatics in Medicine webinar on April 25. Commodities, he explained, are only differentiated by price, whereas radiology as an industry has operated on a boutique-like model, with different providers ostensibly offering services of differentiable value.

But the market is changing. Teleradiology service providers are becoming more prominent, and Chang pointed to the growing number of “Ebay for radiology” sites offering imaging services online, all stressing they can bring consumers the lowest prices. Commoditization also leads to consolidation, which can be seen as smaller radiology groups are swallowed up by larger providers.

Chang said that value in medical imaging comes from a combination of quality, efficiency and safety, and that meaningful innovation in health IT must be able to transfer to the clinical practice where it can make real improvements. The early days of PACS were radiology-centric and focused on image management. As PACS moves into its third generation, the bar for justifying the implementation of IT solutions must be set higher.

“We have to have the emphasis on the value proposition,” said Chang. “Everything we do, when it comes to radiology or imaging IT in the enterprise, has to directly result in measurable improvements in either efficiency, quality, safety, outcomes—in other words, value.”

The biggest barrier to real improvements in health IT is the gulf between the culture of clinician users and IT vendors or researchers, according to Chang. Users are looking for immediate, practical solutions to mundane problems and find the technology to be a tool used to support the mission of delivering healthcare, not the mission itself. On the other hand, for vendors and IT researchers, technology is the mission, and long periods of time are spent on development.

Chang pointed to some specific problems that can occur when IT solutions are translated from the research lab to the clinical environment and said IT developers sometimes devise solutions to the wrong problem. For example, when images were first stored digitally, the primary problem was the large storage requirement. Initial solutions focused on dedicated high-speed networks and thick client workstations, which quickly made radiology filmless, but images needed to go out to the whole enterprise and film was still being used for this kind of distribution.

Another problem is that sometimes IT solutions don’t address the big picture, and focus too much on a specific link in the imaging chain. Efficiency in the reading room does little good if there are inefficiencies elsewhere, said Chang. There needs to be greater interoperability between the different stages of imaging, from the ordering through report delivery, and human beings are poor integrators.

“We need a more agile, aggressively collaborative relationship amongst investigators, users, IT and industry partners in order to achieve true value and to avoid marginalization and commoditization,” said Chang.