Some reputations are hard to shake. Medical imaging has for years been thought of as one of the biggest cost centers in the healthcare system, and it’s a perception that affects how radiology services are regulated. Change is in the air, however, and radiologists themselves are leading the charge. The American College of Radiology’s Imaging 3.0 campaign, for instance, champions the power of imaging to deliver value over volume, and radiologists across the country are taking notice.
Now it’s time to get the C-suite on board.
“Early diagnostics can improve quality and decrease costs in a value-based world. That’s not an easy message for the C-suite to swallow because they often think of imaging as just a cost,” says Ohad Arazi, vice president of product management, diagnostic imaging, at McKesson Imaging and Workflow Solutions. Arazi says the conversation must shift to challenge some of the preconceived notions held by some healthcare executives.
This can be a tall task, especially considering the response of politicians and regulators to the growth of imaging in the 2000s. Fee-for-service reimbursements faced cut after cut over the last eight years, and with the target still on imaging, pressure remains to cut costs. Providers and payers forced to do more with less—the insured population is increasing while available dollars fall—are turning to rigorous prior authorization in an attempt to decrease volume and save money.
“The issue is [this strategy] undervalues the contribution that imaging has to the whole diagnostic workflow,” says Arazi.
He offers the example of diagnosing appendicitis. Providers hoping to constrain costs might try to direct patients to low-cost procedures first, so someone presenting with lower quadrant pain, possibly indicating appendicitis, may initially be given abdominal ultrasound. If appendicitis is not ruled out on ultrasound, an x-ray may be ordered followed by an abdominal CT, as the provider follows the payer’s protocol and gradually steps up the tools being used.
This strategy, however, can be short-sighted. Longer waits increase the chance of needing surgery, which is the most expensive and invasive option in appendicitis treatment. The use of outcomes-based data that confirms a strong correlation between abdominal CT and positive outcomes for patients with appendicitis may lead a patient to undergo CT sooner, which might allow for the issue to be resolved with a non-surgical treatment.
“Investing in analytics and workflow to drive diagnosis is more efficient than always performing the lowest cost procedure first,” sums Arazi.
This doesn’t mean going to the C-suite and telling executives that everyone with a stomach ache should be put in front of a CT scanner. Rather, Arazi says, value-generating imaging should be designed around the following four main focus areas:
1. Workflow orchestration
The right image should be read at the right time by the right person. Investment in rules-based logic to assign studies to the most qualified reader and self-learning technology that looks at a physician’s behavior to anticipate next steps can greatly increase the value generated by a diagnostic workflow.
Better workflows can also foster more robust collaboration between imaging specialists and ordering physicians. Now, images can be pulled up anywhere there’s a tablet or smartphone, creating many more opportunities for radiologists to be seen as trusted advisors.
2. Integration of clinical data with imaging
One of the challenges faced by radiologists is looking beyond the image to a patient’s broader history. The problem can be seen whenever a radiologist has to access information like lab results in the EMR. “It’s painful,” says Arazi. “They are switching gears, moving from a study-centric context to a patient-centric context. Yet if they don’t do that, if they don’t access the EMR, then they’re only seeing a small part of the picture.”
More value can be generated if clinical information can be integrated directly into the imaging cockpit, so that lab reports, ER notes or any other data is automatically presented to radiologists when and where they need it. This goes both ways, as relevant images should then become part of the longitudinal record because they contain information beyond the written report that can be mined later.
3. Measuring quality and safety
It’s important to follow up on past reports in order to constantly improve quality and safety, but first data must be mined over a period of time. This is easily done with structured content that is machine readable, making it easier to correlate a report with what happens downstream. Not all inputs necessarily need to be structured, either, as natural language processing technologies on the back end can help make sense of a dictated report and pull out discrete data.
4. Leveraging analytics to choose the appropriate procedure
All the data that is collected from past reports becomes an important tool that can then be fed into clinical decision support systems. Investment in analytics can drive appropriateness, and tools that can create a dialogue between imaging specialists and referring physicians using evidence-based analytics can drive up value.
Investments in these four areas, even at a time when budgets are constrained, can eventually push down costs to the system as a whole. But it will take continued effort on the part of providers to maximize workflows and the vendor community must also see its role as being about more than simply making analog pictures digital.
“We can promote the idea that imaging is essential to medical practice, and we have to make sure that in the race to decrease costs, we’re not throwing out the baby with the bath water,” says Arazi.