With the U.S. healthcare system undergoing rapid and transformational change on all levels and across countless dimensions, it would be unrealistic to expect that any medical specialties would somehow remain “exempt” from said change. Indeed, even the most cursory scan of the full spectrum of medical specialties, from primary care specialties like family medicine and internal medicine, to the most procedurally focused ones like orthopedics and oncology, reveals not a single exception to the broad generalization of massive change across specialties.
That said, the various medical specialties are also all changing in their own ways, as federal and state policy and payment changes, broad industry and business trends, clinical practice shifts, and medical-technology and information-technology changes of different types affect them individually and with different emphases and particularity.
Radiology, always one of the most technologically oriented specialties, is caught in a particularly complex and interesting swirl of diverse trends of all sorts—policy/payment, business, clinical-practice, and medical-tech and information-tech trends. And radiologists are caught up in that swirl. On the one hand, they are facing tremendous reimbursement pressure, as the federal, state and private purchasers and payers of healthcare are balking at the high costs of diagnostic imaging procedures and equipment, and are putting the brakes on unrestrained, fee-for-service-based reimbursement for diagnostic imaging procedures.
At the same time, the economics of radiological practice are changing quickly. While the demand for diagnostic imaging services and diagnostic imaging reports continues, that demand remains uneven across different healthcare regions, local markets, and even micro-areas. That fact, and the expense of maintaining radiological practices, have combined with rapidly improving imaging informatics technology and communications technology, to spur the rapid advance of remote radiological practice, literally spanning the globe—with a huge cohort of remote radiologists in India, among clinicians who were trained in the United States and retain state-based medical licenses, while remote-reading from India—but also across the U.S.
And that in turn has led to the rapid consolidation of radiological practices, under a variety of auspices, many of them taking on remote-reading volume from across the U.S., as well as locally to themselves.
Then of course, there are the changes sweeping imaging informatics itself—with advances in technology and with the consolidation of the healthcare provider space leading to new realities for radiologists. PACS (picture archiving and communications systems) systems are becoming more closely interfaced with electronic health record (EHR) systems, which in turn are erasing the need for standalone RIS (radiology information system) solutions. What’s more, the shift towards vendor-neutral archive (VNA) strategies that unify the storage and sharing of images from across “-ologies” (radiology, cardiology, dermatology, gastroenterology, pathology, and beyond), is pushing PACS into the middle of the enterprise-wide mix. In other words, PACS is no longer an island unto itself. And that, too, is a factor changing radiological practice.
Can I.T. Help Radiologists Become “True Consultants”?
So where does all this leave practicing radiologists? Some, frankly, are finding themselves at least a little bit bewildered, as the volume-based system they’ve been trained to practice in and have been practicing in, shifts noticeably. Others are finding themselves comfortable with change, and moving to adapt to it. Among those is Christopher Deible, M.D., who has been practicing as a clinical radiologist for 12 years, all of those years at the vast, 20-plus-hospital UPMC health system in Pittsburgh. “I actually started in radiology at a unique time,” Deible says. “When we started residency, we were actively converting our imaging from film-based to PACS-based. I still ran up to some of the ICUs to read films. Today, we might go to a unit, or something, but we would look at things on a PACS system. So we’ve definitely accomplished the goal of making images digital, enterprise-wide. The role of the radiologist has definitely diminished to some extent, with a focus on volume—even to the point where clinicians used to come look at images with radiologists, and that kind of disappeared. So the ability to consult now virtually, that’s where we need to go,” he says. “And we still have a lot of challenges in distributing images from one hospital or medical group to another. With regard to reports, there still remains an element of delay in distributing reports with images. And with regard to radiologists becoming consultants, we’re still working on that.”
So how can radiologists become true consultants to referring physicians? And how does IT figure into that frame? “I think it comes in, in two areas,” Deible says. “One is the pre-imaging consult. To some extent, we leave that now to some standard appropriateness software, but a direct personal, telephone or in-person consult might be helpful. A second example—perhaps the ordering physician may need a clarification or an amplification, or even, they’re not sure what to do with a finding—so, pre-exam and post-exam,” he says, there is the opportunity for a more granular type of consultation.
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