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One-on-One with Healthia Consulting's Jim B-Reay, Part II

July 31, 2008
by root
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Jim B-Reay tells CIOs that when it comes to imaging requests, be nice, but not too nice.

A recent survey found data storage to be one of the more pressing issues weighing on the CIO mind. And when one tries to pinpoint the culprit for most of that data, it’s inevitably imaging. Just think of your inboxes, how easy is it to just delete the photo attachments from messages and shrink your footprint in seconds. For CIOs, multiple PACS and image redundancy are sure ways to exponentially increase storage costs. Recently, HCI Editor-in-Chief Anthony Guerra chatted with Jim B-Reay, vice president, business development at Healthia Consulting (acquired last year by Ingenix), about how CIOs can work to get their imaging houses in order.

Part I

AG: Do you think that it’s the CIO’s role to make sure this gets done properly? Do they have to be the gatekeepers who say to cardiology, ‘No, you can't have that system you want because it’s redundant or it’s just not necessary’? How should that dialogue go?

JB: We’ve always fought that fight, and when you get to the custom functionality piece, you’re going to get into the same level of argument, as they’re going to present why they need to have a new cardiac CT or why they need to have a PET CT. They’re going to say that having this level of diagnostic toolset is a value-add to the patient and leads to better patient care. They’re going to come at you more at a patient-care direction. If you’re trying to come at it saying we’re trying to consolidate toolsets and we’re trying to gather economies of scale, if you come at it too hard that way, they’re going to push back the same way that they would push back if you tried to deny or cut back on the number of modalities that they have in their department. I’ve just seen that more than once.

Radiologists, as a specific group, tend to be a little bit more flexible, simply because a lot of them work at multiple facilities or share services. They’re very used to seeing multiple toolsets and are less emotionally invested, usually, in exactly what they use for reading. Whereas, when you get more into specialties, they’re going to start to say that this is less about a report that I’m writing and it’s more about a diagnosis that’s going to change this person’s life, even though that’s exactly what radiologists do as well.

AG: You say that working with an outside organization that can play bad cop is sometimes easier?

JB: I think that’s a fair assessment.

AG: Other than that, other than possibly bringing in that outside entity that can speak impartially, as it were, what are some other tactics that CIOs can employ to navigate these waters? Are there key people they have to get on board and make sure they have their support?

JB: Yes. On an inside of the IT level, it’s extremely important, I think, to align imaging into its own group. What that means is that you need to have the people who are responsible for cardiac, for mammo and for traditional radiology all within the same organization. They can’t be departmentally owned. So what happens then is the people who are responsible for supporting it wind up with a better enterprise view of exactly what’s happening. They will then become better able to offer frank and real recommendations upward to the CIO level. Then, usually, you’ll have a director-level person who is over Enterprise Medical Imaging, or something like that. So that is a level which makes a lot of sense to cultivate.

To that end, then you also need to pull almost all PACS administration out of the departments because when responsibility for training and for infrastructure and all that remains inside of radiology — and then there is a parallel organization like that inside of cardiology and there’s a parallel organization inside of the mammo groups and oncology — then what winds up happening is that they’re fighting for resources and not necessarily fighting for what’s best for the enterprise. So, if you can pull them all up and put them into an integrated group, then the CIO will have a team that he or she can be working with who truly has the enterprise view in mind.

Then that strategy needs to be bought into by the directors of all imaging areas — your director of radiology, your director of cardiology and those groups — have to buy into that. The way that you can sell that to them is that they’ll actually get better service. Instead of having three, two person or three person groups, by having one eight person group it’s much easier and better to have 24 hour on call support or 24 hour or extended hours for on-site support and training. You could say that this group will then offer you better support. That actually does work as long as you’re willing to follow that up and not say that these eight people now can become six people. You don’t want to look at it as a cost savings. You want to look at it as a benefit.

AG: Let’s say a CIO likes what you’re saying and puts a plan down on paper. Where do they take it for support? The CEO? The board?

JB: It needs to come to the executive steering, however that works. If the CIO is at the table of the executive steering committee, or if they need to have the CEO speak for them. They should have at least on ally at the table before they pitch it.