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Shifting Landscape: In the Imaging Informatics World, Everything Is Changing

November 16, 2015
by Mark Hagland
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Healthcare system reform, consolidation on all fronts, and changing technologies, are combining to create an unprecedented landscape of questions and instability in imaging informatics

It has become a truism that the U.S. healthcare system is going through a time of rapid, jarring change. With healthcare costs continuing to rise at unacceptably high rates of inflation, and with demographic changes including the aging of American society and a massive explosion in the incidence of chronic illness threatening a tsunami of cost and care burdens, the public and private purchasers of healthcare are pushing providers hard to shift to new payment models focused on value rather than volume. As a result, consolidation is everywhere: hospitals and health systems are busy merging with and acquiring each other and physician practices; physicians, too, are consolidating into larger multispecialty groups, while even specialist groups like radiology groups are becoming larger and more consolidated. And in the radiology area, even the remote-read companies and contracted groups are consolidating.

Then there is the phenomenon of vendor consolidation, which has been accelerating of late. Just consider the following examples from this year:

  • In May of this year, the Stamford, Conn.-based Fuji Medical Systems USA announced that it was acquiring the Wauwatosa, Wis.-based VNA software firm TeraMedica.
  • Also in May, the Minneapolis-based vRad (Virtual Radiologic), one of the largest remote-read radiology physician services companies, announced that it was being acquired by MEDNAX, a provider of maternal health, newborn, pediatric, and anesthesia services, for $500 million in cash.
  • In August, the Armonk, N.Y.-based IBM announced it was acquiring the Chicago-based Merge Healthcare for $1 billion, in one of the biggest deals of its kind to date. IBM senior executives cited the potential to leverage analytics that would encompass imaging procedure patterns among patients as one of the benefits of the acquisition for IBM customer organizations.
  • Dwarfing the IBM-Merge deal was the announcement in early October that the Round Rock, Tex.-based Dell Inc. was acquiring the Hopkinton, Mass.-based EMC Corporation for a whopping $67 billion in cash and stock. Of course, both Dell and EMC are companies whose enterprises span many industries. But healthcare industry observers agreed that that deal would have ripple effects across healthcare.
  • Many smaller deals have taken place as well, including the acquisition of the Garner, N.C.-based Viztek in early October by the Japan-based Konica Minolta.

At the same time, imaging informatics vendors are responding—albeit primarily in reactive mode—to the shift in care delivery and payment systems towards payment for value, including to the development of accountable care organizations (ACOs), population health management initiatives, and the forward evolution of health information exchange (HIE). The concept of the vendor-neutral archive, which just two or three years ago was considered leading-edge, is coming close to becoming a standard architecture, at least in the ideal, for those now crafting enterprise-wide storage and sharing strategies for imaging.

What’s more, expanding policy mandates are set to strongly affect diagnostic imaging ordering patterns, and therefore radiologist practice patterns, and the use of information and modality technologies. One of the biggest mandates involves the ordering of diagnostic imaging procedures: one mandate that had been set for January 2017 was the requirement that referring physicians use appropriateness criteria when ordering advanced imaging for Medicare patients (at press time, the Centers for Medicare & Medicaid Services had just announced a delay in the effective date of that requirement, with a new effective date to come in the near future). While championed by the American College of Radiology, that mandate is proving worrisome for many practicing radiologists.

So what does this pace of change mean for imaging informatics? Above all, say healthcare IT leaders and industry experts, it means that CIOs, CMIOs, imaging informatics directors, and radiology and other medical specialty leaders, must think more broadly and strategically than ever before about the next few years in healthcare. Simply replacing an aging legacy PACS (picture archiving and communications system) or RIS (radiology information system) solution no longer makes sense. Instead, all of those interviewed for this article agree, healthcare IT and imaging informatics leaders must skate to where the proverbial puck is headed, and lay plans for an integrated, interoperable, specialty-agnostic, enterprise-wide-plus, imaging informatics future, one in which diagnostic images (from all specialties) will be shared in the same the way that all forms of healthcare data are shared across enterprises and beyond. And they must look to a time when images really are shared across the breadth of the U.S. healthcare system.