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Is the Whole Worth More than the Sum of the Parts?

January 14, 2009
by Joe Marion
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In a recent conversation with the CIO at a prominent Midwest academic medical center, he asked what I think is a very astute question! To paraphrase, “If heart problems and cancer are two of the leading killers in the US, how come there isn’t more integration of cardiology and oncology information systems?”

I think this raises a very good question in terms of vendor development and focus: what forms the basis of product development priorities? And why is there more apparent emphasis in other areas?

I am reminded of my own experience as the product planning manager for CT at GE years ago. We were contemplating the next generation of CT, and the question arose as to what should be the priorities in terms of development. Was it image quality? Scan speed? Ease of Use? Something else?

I challenged the physicists to assess this in terms of disease-specific requirements. That is, what specific ailments could occur for each organ-specific system, and what would be the imaging characteristics necessary to image them? For example, to adequately diagnose small lesions in the lung, what would be the spatial, contrast, and temporal requirements necessary to diagnose the lesions? Apparently the world wasn’t ready for such thinking, as I was told “I could write a book that would fill the room to describe these.”

Perhaps this type of thinking still prevails. All I wanted to do was to hit the high points and see if we could triangulate on a set of requirements that would achieve the best results for diseases with the most significance. If our scanner could achieve a mix of spatial, contrast, and temporal resolution that better met disease-specific requirements, we could achieve a better market position.

That brings me back to today. With all the changes occurring in healthcare, it seems that perhaps the time may be right to address technology development priorities on what may have the largest clinical impact. This may be counter to the way companies are organized, and perhaps it is time to change. We use to refer to “modality mentality” as a factor impacting the development of PACS. If the MR staff was larger and better funded, they always made a stronger case for development of what was important to promoting MR as opposed to other modalities or systems. What if companies were organized around diseases or some other medical basis such that the priority cut across multiple modalities to achieve the best outcome? Would this radically change the way products are developed and lead to greater integration?

I am also reminded of the Chief of Radiology at the Bowman Gray School of Medicine, C Douglas Maynard, MD. Unlike many departments that structured their radiologist sub-specialty around a modality, Dr. Maynard believed in structuring on the basis of organ specificity. So a Neuroradiologist read all modalities associated with the nervous system, including CT, MR, angiography, etc. This made a lot of sense to me, as the anatomy was a higher priority than the imaging device.

What impact might this have on the question of cardiology or oncology? If the industry focused more on the overall needs of information a cardiologist needs to make his diagnosis, would there be better integration between cardiology systems? Would the ability to access the echocardiography images and measurements be prioritized over some new bell or whistle on the echo cart? Would this be the impetus in cardiology (or oncology) to foster more data standards and sharing of information?

I’d like to hear from others in the industry in terms of their perspective. Is it an industry practice today at the vendors to prioritize based on healthcare priorities? Will this be a consequence of the changes taking place in government and the industry? Are there other factors to consider? I look forward to your comments and a healthy exchange of ideas!

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Joe Marion

Founder and Principal, Healthcare Integration Strategies

Joe Marion

www.hisconsultant.com

Joe Marion is founder and Principal of Healthcare Integration Strategies, specializing in the...