Seeking radiology in the value aisle: Concede nothing on quality, do more with less

As a broad concept, good consumer value isn’t hard to get a handle on. Varying definitions abound, to be sure, but the phrase is widely understood as shorthand for the best you can get for the least you have to spend without sacrificing too much on quality within a given product or service category.

Would that the formula were so easy to apply in healthcare.

Fortunately, providers, payors and patient advocates are all thinking hard about how to prioritize value over volume right now. This makes the current moment in healthcare history a time of ripe opportunity for radiology.

So said Rasu Shrestha, MD, a radiologist who serves as chief innovation officer at the University of Pittsburgh Medical Center, in a presentation at the annual meeting of the Society of Imaging Informatics in Medicine the last week of May in National Harbor, Md.

“We couldn’t have been talking about value-based healthcare, value-based imaging, 10 or 20 years ago,” he said. “The opportunity is now, primarily because we have troves of digital assets that we can [draw from] to get to the next level of a more patient-centric view.” This will allow radiology to guide U.S. healthcare, he said, as it makes the transition from volume- to value-based models of care delivery.

Alas, there’s a rub. Radiology is conspicuously data-rich yet information-poor. The specialty has been out front in the drive to capture data, said Shrestha, but at the cost of creating “lots and lots” of isolated data silos.

“How do we go from the silos that exist out there and move from data to information and then, perhaps, from information to knowledge?” Simple: Marry the data with evidence-based guidelines, clinical best practices and fine-tuned protocols. Bring in full patient context. Observe the patient’s presenting symptoms in total for as holistic a view as is possible.

Maybe that’s not so simple—but it’s definitely doable, Shrestha suggested. “Then maybe we can reach the pinnacle,” he said, referring to the endgame of always and everywhere helping to provide consumers with high-value healthcare.

King Context

Providing value begins with a laser-like focus on serving the patient, Shrestha stressed.

“Today, 2015, we have our fancy diagnostic workstations. We have our RIS, our PACS, our 3-D workstations, our voice recognition, our fancy tables that move up and down. But have we really changed? We are still very image-centric, not patient-centric,” he said. “There’s this question of whether we’re working with a PACS-driven workflow or a RIS-driven workflow. It should really be a patient-driven workflow. There’s lack of full patient context.”

Taking the professional introspection a step further, Shrestha said radiologists are more detectives than clinicians. “This is a sorry state to be in here in 2015,” he said. “Context is king. And that’s one of the things that is missing in radiology today.”

Shrestha reviewed the technology adoptions that have placed radiology at the forefront of medicine, then noted that consolidation driven by healthcare reform demands much higher levels of interoperability.

“We need to be making sure that we are able to connect the dots across all of these information systems” and silos, he said. “Consolidation brings challenges of interoperability and efficiency and the need for us to do more with less. Healthcare reform begs the question of how we will move from a volume-based practice of radiology to one of value. We need to focus on quality in this envelope of accountable care that we now have.”

Toward a more intelligent workflow

Shrestha fleshed out the notion of data liquidity, which he defined as “freeing up data from these silos of information and really moving to liquidate those assets.”

“I think we can leverage innovation and technology to really push data liquidity forward, such that we spend less time with IT systems and more time with the patient, more time with our peers, more time collaborating and communicating,” he explained.

With all of that will naturally come more time for getting to a diagnosis in the full context of the patient’s health status.

Shrestha made the case that, when PACS, RIS, voice recognition and other advances first came into radiology, the profession embraced an “analog form factor.” Today it still works with film hanging protocols, wet reads and other time-tested techniques. “There’s nothing wrong with those things, by and large,” he said. “But we have a different opportunity today. Now that we have all of these data assets at our disposal, all these technologies—and the challenges of healthcare reform, the need to do more with less—we need to think differently.”

Shrestha insisted that radiology must work more diligently with the next generation of IT solutions, folding in predictive protocols that can automate many and varied processes.

“We’re able to leverage more new technologies with the cloud and with enterprise content management and intelligence at the back end that is able to connect the dots across the silos” with analytics that drive intelligent workflow, he said. “Where we need to be is on an imaging workspace that sits on top of what I call the image-related clinical context, pulling all of the relevant data from the silos of information systems that exist outside of the radiology department.”

This is a must, he said, because today there is just “so much content. In fact, the crux of the information around the patient isn’t in the silos that we're used to today. It's everywhere else.”

No time like the present

Getting to the point of demonstrating value daily is not easy, Shrestha conceded, especially for a profession that has long been satisfied to chip away at work lists, decrease turnaround times on reads and call it all “progress.”

“It’s a shame that, in 2015, we’re still treating just a series of images at a time. That is not what we need to be doing over the next five to 10 years,” he said.

The time to get to more of a patient-centric practice of medicine—one that delivers real value to individuals, communities, populations and the U.S. healthcare system as a whole—is now, urged Shrestha.

“It’s not about the images. It’s about the patients we treat,” he concluded. “The imperative is for us to get to this patient-centric, collaborative, intelligent, value-based platform. It’s time for us to rise to the occasion.”