RSNA: Can imaging informatics resurrect the doctor’s doctor?

CHICAGO—When his father retired from radiology, the senior Chang told his son he was glad to be retiring because Chang and the rest of the “PACS people” had destroyed radiology, Paul J. Chang, MD, professor and vice chairman, radiology informatics, at The University of Chicago Medicine, told the audience during the Eugene P. Pendergrass New Horizons Lecture Nov. 26 at the Radiological Society of North America (RSNA) meeting.

Legend has it, prior to PACS, radiologists were the doctor’s doctor. Medicine and surgery rounds started in radiology every morning. There was no need for computerized physician order entry (CPOE) or clinical history because clinical collaboration was built into the progress.

Chang delivered the bad news: We aren’t going back to film. The good news is that imaging informatics can be harnessed to rebuild this model for the 21st century.

However, he acknowledged the role of PACS in the demise of the doctor’s doctor. The first two generations of PACS focused on images and workflow rather than value and discouraged collaboration. Radiologists became insulated. Their role as the doctor’s doctor evaporated.

The current challenges in radiology—decreased reimbursement, increased consolidation and competition and alignment—present an opportunity, according to Chang. Radiologists can add value in the changing healthcare delivery system by managing imaging in a capitated, aligned model.

“We have to be viewed as irreplaceable and prove we add value,” insisted Chang insisted, offering a simple formula for value.

Value = Quality, efficiency + safety

One challenge, said Chang, is that all three inputs must be leveraged simultaneously. “This can only be accomplished by leveraging IT.” Current imaging informatics systems remain immature and limit radiologists to commoditization rather than meaningful service.

“We need more agile IT solutions,” he said. Chang concluded by listing four areas where IT is underleveraged and offering examples of how it can be leveraged to improve radiology’s value proposition.

  1. Advanced workflow can be developed not only to improve radiologists’ efficiency but also to enhance efficiency of upstream and downstream colleagues. “Radiologists need to move away from the reading room-centric bias and realize that the efficiency clock starts ticking when the patient presents to the referring clinician and ends ticking when the patient receives imaging results. For example, by applying IT to CT scanners, The University of Chicago Medicine has produced dramatic improvements in scanner efficiency. Similarly, a works-in-progress lesion tracker tool uses integration to identify prior lesions and automatically make the data available to downstream systems.
  2. Comprehensive collaboration must become the new normal. “We have to go beyond web 1.0, passive consumption of information, to web 2.0, an active model emphasizes collaboration and active participation.” A multimedia report, for example, not only adds value to referring physicians, but also improves efficiency because it can be created faster than a static report.
  3. Radiology needs to catch up to other business verticals and truly embrace business intelligence and analytics. “We need to go beyond dashboards and widgets and focus on intelligence.” This should entail extracting information from the EHR and developing tools to correlate imaging indications with findings with outcomes.
  4. Radiology has to connect with health consumer and engage the patient in the imaging process.

Although the list may seem overwhelming, the IT tools to drive these changes exists or can be developed, said Chang. “The real challenge is changing us. We have to get beyond optimizing the reading room.”  

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