RSNA: Beyond Meaningful Use

CHICAGO— Keith J. Dreyer, DO, PhD, vice chairman of radiology at Massachusetts General Hospital in Boston, reflected on the question of whether Meaningful Use (MU) has moved into the radiology mainstream or not. The answer is a resounding yes. During the Eugene P. Pendergrass New Horizons Lecture Nov. 26 at the Radiological Society of North America (RSNA) meeting, Dreyer shared a few figures to demonstrate the point and considered imaging informatics in an MU model.

When Dreyer and colleagues conducted a survey of radiologists’ plans to participate in MU at RSNA 2011, 32 percent answered affirmatively. The figure doubled to 65 percent at RSNA 2012. Two years ago, no radiology software was certified EHR technology. As of RSNA 2012, 23 RIS packages are certified EHRs.

During the lecture, Dreyer also said how imaging informatics systems will adapt to the reality of MU.

Healthcare incentives, which impact software design, he said are changing. The fee-for-service payment model has determined the business model. Because fee-for-service compensates based on volume, informatics tools have developed to facilitate increased volume. Existing tools have a neutral effect on metrics that matter in the MU world: value, quality, safety, access and outcomes.

Dreyer offered the example of a radiologist interpreting a difficult case. How the radiologist handles the case depends to a degree on software, which, in turn, is determined by the incentives. In a fee-for-service environment, software likely guides the physician into additional diagnostic imaging. Conversely, in an environment that demands quality, safety and access, software should encourage a review of the clinical record and dialogue with the referring physician and/or patient.

Current technology has developed to provide secure image access for radiologists no matter where they are located, Dreyer said. But it has not provided similar access for regional colleagues or patients. The unintended consequence, he observed, is commoditization.

As the Centers for Medicare & Medicaid Services (CMS) explores alternatives to fee-for-service such as bundled payments and accountable care organizations, radiologists need to be aware of the common thread linking these models.

“They shift risks from payers to providers, and this risk extends to service lines, such as radiology. We have to monitor and report quality, safety and access,” Dreyer said. The goal of MU is to improve the quality, safety and cost of healthcare. The shift in focus brings new opportunities for innovation.

He predicted that RIS functionality will converge into the EMR. However, the approach does not solve the image sharing issue, said Dreyer, before offering his next prediction. “PACS will evolve into the imaging health record.”

Dreyer also foresees hefty changes in reporting. Current systems are unstructured, unmanaged and unidirectional. Quality and safety issues can be optimized through structured reporting and multimedia interactive communications, he said.

Another informatics boost may come from more widespread deployment of decision support, as it can provide tools to assist radiologists in utilization management.

As Dreyer considered how current metrics will change in the future, he explained that most existing imaging informatics tools have increased productivity and profitability, but have had a negative effect on radiologists’ relevance or presence. Future systems will drive increases in performance and relevance, while productivity may take a slight hit.

For more from Dreyer on the future of imaging informatics, please read: “PACS: Dead, Dying or Re-born,” in Health Imaging.