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LIVE FROM RSNA 2012: Where Is Radiology Practice Headed? A Conversation with Keith Dreyer, M.D.

November 27, 2012
by Mark Hagland
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A frank discussion with one of the foremost thought-leaders in the radiology informatics world

If one could name a radiologist who one might describe as being seemingly virtually everywhere at once, one would have to put Keith J. Dreyer, M.D. at the top of any list for consideration. Dr. Dreyer’s core appointments are as the vice chairman of radiology informatics at Massachusetts General Hospital in Boston, and an assistant professor of radiology at Harvard Medical School. Not only does Dreyer hold those faculty and organizational positions; he has also served as co-chair of the informatics committee at the Reston, Va.-based American College of Radiology (ACR), and as chairman of that association’s government relations informatics committee.

 In fact, it was through his involvement with informatics issues at the ACR that Dreyer became more and more aware of the need to create a nationwide set of services to provide better clinical decision support at the point of care for practicing radiologists.
The efforts of Dreyer and a number of other colleagues led to a pilot project sponsored by the ACR that ultimately led to the commercialization of a solution through ACRselect/the National Decision Support Company, led by Michael Mardini, founder and CEO, and which has signed contracts with a number of major integrated health systems in the U.S., several of which are going live with that decision support solution in early 2013.

Dreyer sat down with HCI Editor-in-Chief Mark Hagland during RSNA 2012, the Radiological Society of North America’s annual conference, being held at the McCormick Place Convention Center in Chicago Nov. 25-29, to talk about clinical decision support for radiologists, and to discuss more broadly the challenges and opportunities facing radiology in the emerging healthcare environment. Below are excerpts from that interview.

Tell me about your involvement in what has become ACR Select/the National Decision Support Company.

One of my main motivations for becoming involved in the ACR was getting involved in what has become that entity. We had demonstrated the value of doing this—providing clinical decision support at the point of care—at Mass General, but its value was restricted to our organization. What’s more, it was difficult to prove the value of clinical decision support with such a limited scope. A key moment for me in all this was a meeting that I had in 2009 with Keith Faulkner, who was the healthcare oversight for the OMB [the White House’s Office of Management and Budget] at the time. He asked me pointedly what the difference was between decision support and radiology benefit management (RBM); he couldn’t discern the practical difference between the two concepts. And I came away from that meeting, and stepped back and said he was right. And it was important to create a nationwide entity that could provide robust clinical decision support that would provide radiologists with a better solution than what they got out of RBM, which many radiologists find oppressive.

So I got involved in taking this concept national. Henry Ford Hospital and the University of Wisconsin’s 16 hospitals became beta testers beginning in July 2011, and the commercialization came out in July, with Mike Mardini. The official first release of the solution came on Nov. 1, and the implementations of the product will begin after the first of the year.

Keith J. Dreyer, M.D.

Where are radiologists in terms of understanding how automation-facilitated they will be, and how much they will be a part of the new accountability and transparency in healthcare?

The first step of accountable care, in terms of demonstrating your metrics, is meaningful use. And radiologists are really trying to comply with meaningful use. In a lot of cases, most of the meaningful use requirements—and I think they were written very elegantly—were designed for office-based physicians in private practice, for primary care physicians. They were really not designed for specialists. But radiologists were there in the imaging center setting—they can control their space and decided whether they want to buy certified products like PACS, RIS, and EHRs. But in the scenario where the radiology group is affiliated with a hospital or multiple hospitals, it’s up to the hospital to decide what technology to buy. So CMS came back and said, we’ll provide an exception to radiologists, anesthesiologists, and pathologists, that for those essentially hospital-based specialists, we’ll create a hardship exemption to not participate but also not receive benefits, or penalties, for five years.

And they still want to participate. So back to your original question: I think like everybody else, they’re mindful of what’s happening at the federal level; and they want to participate in meaningful use, not only because of the incentives, but also to participate in quality. And what is it that they should be doing to participate, as the fee-for-service model gets shifted? So they’re keen to be a part of meaningful use. And that exposes them to all these clinical quality measures (CQMs). So it’s like a chicken-or-egg situation. CMS [the federal Centers for Medicare & Medicaid Services] creates these programs for physicians generally, and then the specialists say, we want to participate. So then CMS modifies those programs. And that’s a step-wise progression towards accountable care.

Is the culture of specialists now changing? Are radiologists coming to accept the new parameters around medical practice?