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One Radiology Chair’s Perspectives on the Use of Teleradiology Firms to Extend Radiologist Capabilities

March 8, 2017
by Mark Hagland
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Phillip Kohanski, M.D., shares his perspectives on the use of teleradiology services by hospital radiologists

The current moment represents a time of rapid change in many medical specialties, including radiology. Changes in regulations, payment, business arrangements, clinical practice, and information and medical technology are all contributing to this being a particularly unsettled period for practicing radiologists in the United States.

With the volume of diagnostic imaging procedures increasing at the same time as shortages of radiologist availability afflict many hospitals and multispecialty medical groups, a confluence of policy, business, and technological forces is continuing to build the teleradiology market. Just a decade-and-a-half ago, teleradiology was still viewed in many quarters in U.S. healthcare as a somewhat marginal phenomenon, one involving gaps in radiologist coverage during late-night and weekend periods, and initially filled by small groups of radiologists working mostly in India—where the time difference, and a surfeit of U.S.-trained radiologists who had returned to India to live, helped boost the initial teleradiology phenomenon.

Much has happened since then. Among other things, younger radiologists working in hospitals and medical groups are, like their counterparts in other medical specialties, demanding a better work-life balance. Meanwhile, technology has made teleradiology far easier to implement and optimize, and the engagement of teleradiology firms, staffed by radiologists from all over the world, has boomed.

One of the organizations that has made use of external teleradiology services is William W. Backus Hospital, a 213-bed community hospital in Norwich, Connecticut. Phillip Kohanski, M.D., chief of radiology at the hospital, has been practicing there for 17 years, the past five of them as head of radiology. The use of teleradiology at Backus has evolved over time. Three years ago, Kohanski led his colleagues to select the New Haven, Conn.-based Teleradiology Solutions, as their teleradiology services partner.

Recently, Dr. Kohanski spoke with Healthcare Informatics Editor-in-Chief Mark Hagland about the organization’s journey around the use of teleradiology services. Below are excerpts from that interview.

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Can you share with us the background story leading up to your hospital’s use of teleradiology services?

When I first started here 17 years ago, we did our own overnight call. We did what was in effect teleradiology, ourselves; we simply read cases at home. Over time, the ER sort of exploded, and there were just more and more cases. About ten years ago or so, it just became too much, and we made the shift to using external services. Once, the volume of radiological cases [that we manage through external teleradiology] was five or six cases a night, but now it’s all night. It supports us [as attending radiologists]. We use the reads overnight and then do an over-read in the morning.


Phillip Kohanski, M.D.

We started with a small company that was OK, though their interpretations were somewhat spotty. Then, over time, we moved to a bigger company that was physician-owned, and the quality and turnaround time were somewhat better. But after that company was sold to non-physicians, our experience of their work was that the level of service had gone down, while the price had gone up. So we came across Teleradiology Solutions about three years ago now, and have been pleased with them.

In selecting a teleradiology firm, you were looking for good service, accurate reads, and reasonable pricing, correct?

Yes, that’s right. The first two things go hand in hand. Any external company really does have to provide both a quick turnaround time and accurate reads. The teleradiology service represents us during night hours when we’re not taking call. And if they take too long, the ER doctors are eager to tell me about it. And there have been some hiccups along the way. But the Teleradiology Solutions people are very responsive, and take care of everything right away. When I meet someone who represents the company, I deal with that person; he’s the point person, and he takes cares of things.

There used to be some hesitation among referring physicians, and among radiologists, about using external services, correct? But that hesitation has dissipated now?

Not entirely, actually. As soon as ordering physicians see a new name on a report, they’re skeptical, and it takes a while, maybe four or five or six months, for people to get comfortable [with the use of teleradiology-based colleagues’ services]. We’ve had three external services now, and yes, that happens. Also, we were slow to go onto teleradiology external services, for fear of losing our work; but over time, we’ve learned to rely on it.

Do you ever get to try anybody out, in the sense of a trial run, with teleradiology companies?

Well, vetting a company is not easy. The first time, the physician who connected with that first external company, met them at RSNA. And they started out OK. It was a small company, and there were only four or five guys, and over time, their turnaround time got worse; and they hired a new guy, and his interpretations weren’t so good. So then we switched to a new physician-owned company, and that worked out well until they were sold to investors. And now we’re on our third; and most of the Teleradiology Solutions guys trained at Yale, and that helped a lot. And of course, we have our own informal network, and we ask them.

What would your advice be, around vetting teleradiology firms?

Talk to their other customers. It’s better if you can find people on your own, so you get a less biased view; but if you have to resort to people recommended by the company, that can be OK, too. And the first year with Teleradiology Solutions, it was a month-by-month contract, and so yes, don’t sign a long-term contract.

Do you have any thoughts about the information technology or imaging informatics involved in making these processes run well?

I’m not a technological guy. But if you go with a company that’s providing teleradiology, you need redundancy. If their system were to go down, you’d need an alternate path to get there. We do have offsite redundancies with our hospital. And our lines are pretty fast. I know when they try to send stuff to my house over cable lines, it’s slower and choppier. So you should definitely investigate the IT capabilities of any firm you’re thinking of working with.

How do you see some of the business, clinical, and technological shifts involved in the current landscape, in the context of what may happen in the next couple of years, especially around ongoing consolidation among teleradiology firms on the one hand, and the availability of radiological specialists, on the other?

I can’t say that I’ve worked it all out for myself, but I have two answers for you. It’s good to have greater specialization available, but there should also be competition. And partnering with smaller teleradiology groups works well for us; we’ve consistently found that they provide better service.

It’s a little bit like the cable companies, right? When they get too big, service quality deteriorates?

Yes, that’s right! It is like that.

How are practicing radiologists’ attitudes changing? Practicing radiologists, more and more, are accepting the need to partner with external firms, correct?

Yes, exactly. We got involved in it the way everybody else did. The workload is just too much. And if you’re a small group, as we are, you can’t afford to have someone up all night and then resting the next day. And I’m not a proponent of anyone working more than 12 hours. You lose your sharpness.

How big is your hospital’s cadre of radiologists?

We have 10 radiologists here.

And is there some level of specialization on your team at the hospital?

Yes, everyone has a fellowship in some specialized area. At the same time, everyone still has to practice general radiology as well. We have teleradiology coverage only from 10 at night to 7 in the morning. So after 5 PM, you have to be able to do everything.

Is that good or bad, overall…?

Well, it’s good; it’s the reality of the situation; it helps keep us, the radiologists, sharp. A read I do on a spine MRI may not be as good as one by a neuroradiologist’s, but it’s important to have that flexibility.

What should CIOs and CMIOs be thinking about, in all of this?

What I would be careful of is that there’s a place for teleradiology; but there’s also a place for boots on the ground, and you can’t just eliminate that. And in the last 17 years since I’ve been here—it’s a very tight-knit group of people. Everybody knows what everybody’s strengths and weaknesses are. The orthopedic guy isn’t going to ask me to read a hand MRI, or ask a musculoskeletal guy to read a study of breast tissue. And there’s the possibility of final reads overnight, but we don’t do that, we want to do the final reads. So that’s our value, is that accountability.

How do you see radiology practice evolving in the next few years?

In the short term, I don’t think much is going to change; I think what we’re doing is going to be the norm for a while. Here in the Northeast, as more and more hospitals join together to become systems, and you have more and more hospitals in a system, you’ll find that teleradiology may actually become less global and more local, that there will be more local teleradiology; I think that’s probably going to happen.


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Why A.I. Will Never Replace Recruiters

September 12, 2018
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AI can be a great tool, but recruiters aren’t going away

I remember fear settling in like a big dark cloud when I opened my search practice in 2005 with all the dire predictions of how the Internet and all the online hiring websites were going to put recruiters out of business. Many articles were written on the demise of the recruiter as Monster.com would literally scare us out of business.

Then came other job opening aggregators like Indeed.com, ZipRecruiter and a whole host of other websites chasing HR gold as if there was a switch they could simply flip to eliminate the human touch that recruiters bring to the table with engaging candidates, only to be replaced by a text message alert or an email notification of all the new jobs that were now open. The only thing they were missing were qualified applicants.

These predictions never came true and all the prognosticators simply forgot what recruiters actually do every day that their technologies will never replace. CIOs need to remember the critical nature of hiring leaders and team members for key roles in their organization. Candidates need to be vetted and coached to listen to an opportunity to join your team when we call the candidates. You have to remember:

  • We talk with people. Yes, we use a cell phone, or now a VOIP phone, and actually engage in a dialogue with candidates about opportunities. It’s a novel approach—I get it.
  • We engage with people that will never look on those job posting sites because they are not looking for a new job. Period.
  • We contact passive candidates that up until our call were never going to leave their job because they are so focused on the now that they don’t even think about looking on a website for a job they are not even interested in.
  • We help clients and candidates come together on the right offer and provide two-way communication during the hiring process, so each party has a deep understanding of the other party’s point of view. Online sites—well you get the picture…
  • We hammer out the details of relocation packages with our clients and the candidates and their families to make sure the move is done smoothly to allow the family to begin their transition to a new city. It’s the personal touch that matters here because we are dealing with people’s lives.

Fast forward: The next wave of artificial intelligence (AI) products for hiring are cropping up everywhere and we are hearing similar calls for recruiters to give up and retreat as the latest algorithm and data analytics tools are able to speed up the hiring process supplanting recruiters. Within seconds, these tools are touting they can determine who the perfect candidates are based on the analytics and machine learning tools designed for hiring. Guess what? It won’t happen.

AI can be a great tool, but it falls dreadfully short of meeting hiring managers' expectations. It won’t wave a magic wand suddenly making hiring enjoyable and much quicker with the same quality as the work performed by most search firms. I’ve been in technology in some form or fashion for a very long time. I love technology and what technology can do to speed up productivity and actionable data I can use every day in the work we do. It’s awesome!

But to be clear, I’m not going away. I have seen this movie before and I am fairly certain I can tell you how it ends. The work recruiters do to find and recruit great talent is something humans must do.

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Cerner President Zane Burke to Step Down This Fall

September 10, 2018
by Heather Landi, Associate Editor
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Cerner president Zane Burke, who first joined the company in 1996, will step down November2, the Kansas City, Mo-based electronic health record (EHR) company announced today.

“Cerner has been a disruptive force of positive change across health care throughout its history, and I’m pleased with the accomplishments we’ve achieved together with our clients and the broader industry community,” Burke said in a statement. “Complex and evolving challenges remain, and Cerner is uniquely positioned to continue innovating for the good of consumers and health care providers.”

 “We thank Zane for his contributions to Cerner across more than two decades,” Cerner Chairman and CEO Brent Shafer said in a statement. “Zane leaves the company with a strong client focus and commitment to continued innovation, partnership and sustainable growth deeply engrained in our culture and leadership philosophy. I am very confident in the capabilities of Cerner’s strong and experienced leadership team.”

John Peterzalek, executive vice president of worldwide client relationships, will assume Burke’s responsibilities and the title of Chief Client Officer.

Since joining Cerner in 1996, Burke had a range of executive positions across sales, implementation, support and finance. He was named President in 2013 after leading Cerner’s client organization. Burke came to Cerner in 1996 from the consultant KPMG, and has held a number of positions in the company, including president of Cerner west from 2003 to 2011, and, more recently, executive vice president of Cerner's client organization.

During his five years as president, Burke has been involved in a number of significant deals, including playing an instrumental role in Cerner winning two massive EHR modernization contracts, first with the U.S. Department of Defense (DoD) in 2015, a $4.3 billion contract, and then just this past May, with the U.S. Department of Veterans Affairs (VA) in a $10 billion contract.

During Burke’s tenure, Cerner also completed one of the biggest deals in healthcare IT history with the acquisition of Siemens healthcare IT business for $1.3 billion in 2014.

The Kansas City Business Journal reported on September 4 that Burke had exercised option to sell nearly $10 million in stock.

 

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Leadership Changes at HHS as CIO Transferred to New Role

August 21, 2018
by Heather Landi, Associate Editor
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Beth Killoran is stepping out of the role of CIO at the U.S. Department of Health and Human Services (HHS) and is moving over to a new role at the Office of the Surgeon General, within HHS.

The news was first reported by Federal News Radio. In an email, a HHS official confirmed that Killoran, who stepped up to the HHS CIO role in July 2016, has joined the Office of the Surgeon General at HHS to develop a "comprehensive information systems strategic plan for the U.S. Public Health Service Commissioned Corps.”

The HHS official also confirmed that Ed Simcox, the HHS Chief Technology Officer, will take on the added role of serving as the HHS Acting CIO, until a permanent selection is made. “Simcox has led multiple, large IT transformation efforts, both as an industry executive and consultant. As HHS’s CTO, he leads HHS’s efforts on enterprise data management, data sharing, technology-related healthcare innovation, and public-private partnerships,” the official said via email.

Simcox started as the HHS CTO in July after serving as acting CTO starting in May and deputy CTO since July 2017, according to Federal News Radio.

Killoran began working at HHS in October 2014, moving over from the Department of Homeland Security. At HHS, she has served as the acting Deputy Chief Information Officer and as the Executive Director for the Office of IT Strategy, Policy and Governance. The HHS official stated that Killoran has served in a number of high-level information technology positions at HHS, “providing leadership on a number of high priority projects.” Killoran also worked for the Department of the Treasury, where she provided IT infrastructure support and operations for over 20,000 employees across 1,500 locations.  During her tenure, she provided IT operational support in response to the 9/11 and Oklahoma City bombing events, the HHS official said.

Federal News Radio reporter Jason Miller reported that, during her time as HHS CIO, Killoran tried to move the agency forward in a number of areas through an updated strategic plan and a more aggressive approach to cloud adoption. “Recently, Killoran led a reorganization of the CIO’s office, naming Todd Simpson as the first chief product officer and promoting innovation,” Miller wrote.

Killoran becomes the fourth major agency CIO to be reassigned during the Trump administration, joining former Treasury Department CIO Sonny Bhagowalia, former Agriculture Department CIO Jonathan Alboum and FEMA CIO Adrian Gardner, according to Federal News Radio’s reporting.

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