If it seemed clear last year at RSNA 2014, the clarity this year at the annual RSNA Conference, held every year at Chicago’s vast McCormick Place Convention Center, was unmistakable: change is here.
In conversations with industry leaders like Rasu Shrestha, M.D. and Joe Marion; in interviews with innovative leaders in patient care organizations, like Tarik Alkasab, M.D., of Massachusetts General Hospital; in the press briefings and presentations of all the major vendors in the imaging informatics space, including Agfa, McKesson, Siemens, and GE Healthcare, it seemed very clear: everyone with whom I spoke recognizes that we are at an inflection point in radiology and imaging informatics, and we’re passing into a new phase in U.S. healthcare.
It’s obvious where this is all coming from: the push from the purchasers and payers of healthcare towards value-based care delivery and purchasing and away from the old fee-for-service, purely volume-driven system, is being triggered by massive changes in demographics, with the rapid aging of the U.S. population (and especially the Baby Boomers), and a frightening explosion in chronic illness. As the Medicare program’s actuaries noted last fall, we are projected to go from spending a total of $3.1 trillion a year on healthcare in the United States, to $5.5 trillion, within a decade. That is astonishing—and alarming. And finally now, the specialty of radiology is being affected, as healthcare’s purchasers and payers lower the boom on repetitive and/or potentially unnecessary imaging procedures, procedures that are helping to drive up overall U.S. healthcare costs.
And even though the Center for Medicare & Medicaid Services (CMS) mandate that was supposed to begin January 1, 2017, has been pushed off for a time (perhaps six months?), the reality that ordering physicians will be required to make use of clinical decision support and appropriateness criteria when ordering diagnostic imaging procedures only makes sense, cost-wise, patient safety-wise, and in every other way. Meanwhile, increasingly, radiologists themselves are being brought into peer review regimens that are based on medical evidence and specialist consensus, and that, too, is a good thing.
In short, the old days of largely unaccountable, purely volume-driven healthcare production and reimbursement are over. And that fact is reflected in the cast of the RSNA Conference shifting inexorably more towards an emphasis on informatics, as the easy annual purchasing of MRs, CTs, and PETs simply is no longer sustainable for hospitals and medical groups. Indeed, as one healthcare journalist colleague told me this past week, “This really is becoming more and more of an imaging informatics show every year.”
Even the top keynote addresses at the conference reflected the changes sweeping the U.S. healthcare industry these days. For example, there was the RSNA Daily Bulletin’s Monday headline, “Radiology Must Embrace Innovation.” The Daily Bulletin quoted Ronald L. Arenson, M.D., RSNA’s president, as having said on Nov. 29 that, “While some of you may feel like we are already living in a ‘strange new world,’ the point is that change is upon us. Like Earth in the 23rd century, our profession has reached a time of great challenge. It’s a time that requires us to be bold explorers and to seek our own version of ‘new life and new civilizations,’” Dr. Arenson said, referencing Star Trek language, under the heading of his keynote address Sunday, “Going Boldly Into Radiology’s Technological Future: Why Our Profession Must Embrace Innovation.”
For healthcare IT leaders, there is both wonderful promise, and some measure of peril, in that observation. On the one hand, the time is now, as never before, to create enterprise-wide, and indeed, beyond-enterprise-wide, systems for storing, sharing, and analyzing the vast numbers of diagnostic images being created by modality machines in diagnostic imaging procedures, to support rapidly evolving population health and accountable care delivery and payment systems. And there is great, great clarity in that. The days of radiology department-centric PACS systems are clearly over. Indeed, PACS (picture archiving and communications systems) technology has become almost fully commoditized at this point, particularly, as the PACS market matures. More broadly, pioneering patient care organization leaders are finally building vendor-neutral archive systems that are encompassing all of the “-ologies,” as they say—not just radiology and cardiology, but also pathology, dermatology, How information exchange for the 21st century.
There is also great promise in clinical decision support systems for ordering physicians and in peer review systems for radiologists, as healthcare IT will be essential to the success of creating, maintaining and supporting not only those systems themselves, but all the clinical and people processes around them.