James Whitfill, M.D., chief medical informatics officer at Scottsdale Medical Imaging, a 65-radiologist, 19-site specialist group in the Phoenix metropolitan area, sees successful radiologist practices as being driven first by business strategy, with information technology facilitating a shift towards value-based payment systems. Whitfill sat down with HCI Editor-in-Chief Mark Hagland to share his perspectives on the future of radiology practice, on the Tuesday of RSNA 2012, being held at the McCormick Place Convention Center in Chicago. Below are excerpts from that interview.

What have your impressions been of the RSNA Conference so far this year? Did you know that attendance is apparently down from last year? As of yesterday, according to numbers provided by RSNA [the Radiological Society of North America], total attendance was 51,781, compared to 57,668 on the same day of the conference last year (with the final total for 2011 being 59,097. In any case, what have your impressions been of the exhibit hall, and of the conference more generally?

I think there continues to be an element of fear that is running through the imaging community. The last several years have been challenging ones, both from a macroeconomic standpoint, and from a reimbursement perspective; and the transition to a value-based environment is beginning to invade people’s consciousness. So perhaps “fear” is too strong a word; but there is anxiety. For instance, it seems to mean something that attendance appears to be down this year; I think the fact that attendance is down is catching people’s attention. So I think that’s a major theme.

James Whitfill, M.D.

More positively,  I think that there’s still a growing discussion—and this is actually exciting to me—of radiology being involved with some major trends going on, including meaningful use—and it’s not just about railing about how good or bad meaningful use is; and there’s also a growing discussion about participation in accountable care. And I think there’s a serious discussion of how radiology demonstrates its value in a value-based environment; and that to me is encouraging, because people are beginning to become focused on answering the important questions, rather than challenging the need to answer them to begin with.

Won’t there be more opportunities for radiologists going forward, given that federal healthcare reform will be bringing tens of millions of newly insured patients into the care delivery system? What’s more, we’ve got the fundamental demographic shift taking place right now towards an aging population, with far higher percentages of Americans having chronic illnesses.

A lot of people will enter the health insurance system, it’s true, though many won’t be high utilizers of radiology. But as far as imaging goes, absolutely, the core demographics of the United States point to an increase in utilization of imaging, even with [reimbursement-based] curbs on utilization. So those are some definite opportunities. And we’re not hearing about it much, but I think there are some definite opportunities going on with the Watson-type technologies coming out of IBM and Nuance; I’ve been very encouraged by those possibilities. Those information technologies will be disruptive in the sense of being able to provide an output that until now could only be provided by humans—the ability to synthesize seemingly disparate, complex data, and to synthesize a new approach.

Will clinical decision support be helpful to radiologists in the emerging environment?

There are two paths forward for imaging and how you control it. When imaging is in a fee-for-service environment, you need things like RBM [radiology benefit management]. And certainly, clinical decision support can help in that area. And we’ve seen a lot of people partnering with payers, and there’s momentum building in that area, but it doesn’t feel to me yet like we’re at a tipping point with regard to that. But when you go to a risk-based or value-based environment, so much changes in terms of the incentives for imaging; and RBMs probably won’t be needed, because assuming physicians are at risk themselves, they will become highly incentivized to order appropriately, and radiologists become incentivized to become something like gatekeepers. And I see CDS potentially being a tool in that environment, but all the drivers will also be altered. And I would hope that you would bake into the culture the need to order appropriately.

Will radiologists get used to that new environment?

I think they’ll have to; they won’t have any option.

Are you optimistic for your organization and in your local market environment?

It’s been an incredibly challenging last few years, but we’ve got a strategic plan, and we’re executing on it. It’s not a fairly-tale world, with a happy, fairy-tale ending, but I believe strongly in our methodology and staying true to our values, so that makes me optimistic about our future. It’s been a rocky ride, but imaging is not going away; it’s just going to be different.

Do your colleagues better understand the value of informatics now than in the past?

Our colleagues have seen that value for a long time. But we’ve been defining core business concepts and doing strategic planning, and IT fits within that. As Paul Chang [Paul Chang, M.D., who told his audience on Monday, Nov. 26 that “We’re no longer going to be valued as radiologists just interpreting images; we’re going to be valued for managing the role of imaging in a capitated, aligned system”] talks about how you really had to work hard to fail in radiology ten years ago; in contrast, in today’s environment, many places, including smaller practices and imaging centers in the Phoenix metropolitan area, are going bankrupt and closing. So being able to survive in that market will not only require informatics, but sound corporate strategy and business infrastructure. And I think when you put that together with highly quality people and sound informatics, that’s an important triad.