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As the Diagnostic Imaging World Shifts, Time for Radiologists to “Get Out of the Dark Corners of the Reading Room”

November 25, 2015
by Mark Hagland
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UPMC’s Rasu Shrestha, M.D. shares his perspectives on the vast changes roiling the world of imaging, and imaging informatics
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The world is changing very, very rapidly these days for anyone whose work encompasses or touches on radiology or imaging informatics, and that includes radiologists, administrators in radiology groups and hospitals, referring physicians, and all the healthcare professionals whose work connects to or directly involves imaging informatics.

In his November/December cover story on imaging informatics, HCI Editor-in-Chief Mark Hagland interviewed a number of healthcare leaders and industry experts on all the policy, operational, clinical, and information technology changes sweeping the industry these days. Among those he interviewed was Rasu Shrestha, M.D., chief innovation officer at the 20-plus-hospital, 3,600-plus-physician UPMC (University of Pittsburgh Medical Center) health system in Pittsburgh. This autumn, Hagland discussed with Shrestha—who not only oversees imaging informatics at UPMC, but also continues to practice part-time as a radiologist, and further, is the current chair of the Scientific Programming Committee for Informatics within the Radiological Society of North America (RSNA). Below are excerpts from that interview, published here just days before the start of the annual RSNA Conference, to be held Nov. 29-Dec. 4 at Chicago’s vast McCormick Place Convention Center.

Rasu Shrestha, M.D.

How do you view the current landscape around imaging and imaging informatics right now, as all the “tectonic plates” seem to be shifting at once?

From my perspective, there are at least two massive dynamics in the healthcare industry right now that aren’t just altering the landscape; in fact, our tomorrow in terms of how we practice medicine and operate, will be different from our yesterday. Healthcare reform and consolidation are those two dynamics,” he says. “So there’s a massive amount of consolidation going on among  providers, practices, payers, and vendors—Merge bought by IBM for over a billion dollars, for example. And this consolidation brings challenges of interoperability, efficiency, the need for us to do more with less. Then with healthcare reform, the train’s left the station. And it’s critically important to us: it brings challenges of volume to value. It particularly challenges to us practicing radiologists, because we’ve been so volume-focused.

How are you and your colleagues approaching all of this at UMPC in particular?

With regard to how we’re meeting change here at UPMC, we look at consolidation and healthcare reform as offering us opportunities, first, to engage in patient-centered care; and second, to focus on newer care models. And as a payer and provider organization, we’re not just talking about it; we’re living and breathing it today. So these newer care models we’re developing and incentivizing our physicians, that’s real for us. And third, embracing new technologies—we’ve been doing that for three decades now. And it’s time for us to double down and really leverage technologies, and eliminate the silos.

So what does all this mean for imaging informatics in particular?

Imaging data is different from wave-form data, which is different from other forms of data. And working with all of those image and data forms at once requires that everyone, including radiologists, participate in re-visioning how to store and share data, including images, of all kinds, across and beyond the enterprise.

How will radiology practice change in the next five years?

With regard to some of the challenges I referenced around consolidation and healthcare reform, those are all very, very, real. What’s interesting about radiology is that we’re no strangers to pushing the needle, to pioneering change. DICOM first came about in 1983—it was the ACR NEMA (National Electric Manufacturers Association) 1.0 standard. So it’s been around for a while. And when we came up with the 2.0 standard some years later, it became DICOM. So DICOM has been around for a while. And well before people started embracing meaningful use and going live with EMR and CPOE [computerized physician order entry], we had PACS [picture archiving and communications systems], we had RIS [radiology information systems], we had 3D imaging and post-processing. We’re no strangers to change in radiology; the problem that we have is that we’ve been stagnant. Complacency is one of the biggest impediments to innovation and change. Now is the time for us to wake up and lead change and continue to push the needle.

Radiology continues to be important in the healthcare paradigm. And we’ve moved from being a departmental system to an enterprise asset. The opportunity for us to take the new dynamics and leverage our advantage by really pushing patient-centric care and informatics across the enterprise and position radiologists not just as a bunch of clinicians reading images in a dark room and pushing out reports; but rather, being consultants to our colleagues. It’s not just about us performing a study and producing a report, but being a part of the value chain. If we only focus on the read-flow process, then it’s unfortunate, because it’s well after the “scene of the crime,” as I put it. The potentially bad study that shouldn’t have been done in the first place, doesn’t really look at our value.

What can radiologists do, per the mandate set for January 2017 around referring physicians being required to use clinical decision support and appropriateness criteria tools?


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