Patient Pathways and Better Outcomes: The Future of Radiology

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 - Sectra-waiting room
Source: Sectra

In ancient Roman times, all roads led to Rome. From one monument in central Rome, all roads began and distances were measured. Today, the patient is at the center of care—with success measured in wellness, improved outcomes, reduced variability, increased quality and higher patient engagement and patient satisfaction scores. Monumental for sure. But how do we make the patient journey better and how do radiology departments engage to help the process? Global radiology leaders weigh in.

The roads of healthcare are busy with healthcare professionals, physicians, physician assistants, nurse practitioners, nurses and technologists carefully and diligently driving patient care. But across the globe, roadblocks abound, along with potholes, poor signage, information barriers and a lot of breakdowns in care. Healthcare suffers from being disjointed, riddled with inconsistencies, harboring misaligned incentives, disabling care decisions due to siloed data and holding onto old, inefficient structures and outdated thinking. Patients and clinicians alike know we need change.

To repave the road, and re-route the right caregivers to the right patients with the right care at the right time, we need to conceive and drive widespread change. Where to begin? And what is radiology’s role? Our experts tell us to support patient pathways, we must equip multidisciplinary teams with anywhere access to patient data and images via a PACS linked to an EMR or health information exchange. We also must encourage radiologists to become essential members of multidisciplinary care teams such as tumor boards in oncology and care committees in orthopedics. Some ideas are provocative: Radiologists should offer more direct guidance to patients, even bypassing referring physicians. And the day may come when subspecialized radiologists are part of the department they serve, such as neurology or orthopedics. See what the experts recommend.

Pathways prove themselves

To gain efficiency, hospitals need to operate more like factories with patients on a line, to be cared for carefully and well. That is the view of competitive strategist Michael E. Porter, PhD. In healthcare, Porter advocates that “accountability for value should be shared among the providers involved. Thus, rather than ‘focused factories’ concentrating on narrow groups of interventions, we need integrated practice units that are accountable for the total care for a medical condition and its complications.” (What is Value in Healthcare? N Engl J Med 2010; 363:2477-2481; December 8, 2010, at

Clinical studies have long proven that patient pathways that place the patient at the center of care reduce variability in clinical practice, improve outcomes and reduce cost. (Int J Qual Health Care. 2003 Dec;15(6):509-21; Am Fam Physician. 2010 Dec 1;82(11):1338-1339) The idea is to focus on the patient’s overall journey rather than the contribution of each specialty or caring function independently. Multispecialty physicians and caregivers must work together in teams.

But what are the consequences of this change for radiology and the demands patients and healthcare organizations place on expert image interpretation and disease management advice? From an organizational perspective, how should radiology change? And how can radiology drive this change and position itself in the emerging environment? Thought-leaders we spoke to from across the globe have some solid strategies for radiology, patients and healthcare delivery.

The metamorphosis of radiology

Radiology plays the key role of jumping in to investigate disease—diagnosing, staging, monitoring and following it over time and offering expertise and consultation on disease states. This discipline is now in a stage of profound metamorphosis. “The picture of the doctor’s doctor, the radiologist, is changing. We serve that role as well as being the patient’s doctor,” says Neuroradiologist Jeffrey Sunshine, MD, PhD, vice chairman of the department of radiology at University Hospitals Case Medical Center and CMIO of University Hospitals in Cleveland.

Building the value of radiology and the radiologist, in particular, sits at the root of efforts by professional associations such as ACR and RSNA to empower radiologists to be larger contributors to care teams. ACR proposes that success hinges on answering one question: How can we deliver more value to patients? ACR’s Imaging 3.0 initiative is a call to action to all radiologists to assume leadership roles